Common Pathologies Of UL 2 Flashcards
Adhesive capsulitis
Formation of excessive scar tissue or adhesions across GHJ
Leads to pain, stiffness and dysfunction
Primary (idiopathic)- spontaneous
Secondary - post trauma
Risk factors for adhesive capsulitis
Females>males >40 Trauma Diabetes Hyperthyroidism Cerebrovascular disease Coronary artery disease HLA P-B27 positive
Stages of adhesive capulitis
1) shoulder pain mainly at night
Arthroscopically- synovitis no adhesions
Inflammatory cell infiltration of synovium
2) stiffness development
Arthroscopically- synovitis, loss of axillary fold
Synovial proliferation
3) loss of ROM, pain at EOM
Arthroscopically- resolved synovitis, adhesions, axillary fold obliterated.
Dense collagenous tissue within capsule
4) chronic stage- persistent stiffness, minimal pain.
Resolved synovitis, advanced adhesions
Clinical presentation of adhesive capsulitis
Pain
Gradual loss of ROM
Management of adhesive capsulitis
Physio- early mobilisation Education Corticosteroid injections Hydrodilation NSAIDS Surgery-MUA and Capsular release
Types of fractures
Transverse Linear Oblique non-displaced Oblique displaced Spiral Greenstick Communited
Clavicle fractures
Result from fall
Neuro/vascular structures nearby
Mid-shaft>lateral>medial
Clavicle fracture management
Conservative- physio and sling
Surgical
Proximal humeral fractures and management
Classified on number of fragments displaced
Collar and cuff 2-3/52
Progressive active management
Surgery
Distal radius fracture
Colles fracture- extra articular, dorsally displaced
Smiths fracture- anteriorly displaced
Bartons fracture- intra articular, associated dislocation of RCJ
Distal radius fracture management
Physio- immobilisation
Splints, cast, k wires, MUA
Scaphoid fracture
FOOSH
waist>proximal pole>medial pole
Risk of AVN and non union
Pain over anatomical snuff box
Scaphoid fracture management
Cast, surgery, physio after immobilisation
Osteoarthritis
Can develop in any synovial joint
Common in knees, hips and small joints of the hand
Osteoarthritis management
Physio
Corticosteroid injection
Surgery (joint replacement, debridement)
Rheumatoid arthritis
Systematic autoimmune disease- inflammatory with extra articular involvement
Synovium infiltrated by immune cells
Fibroblasts and inflammatory cells lead to osteoblast generation resulting in bone and loss of joint integrity
Epidemiology of osteoarthritis
F>M
Increases with age
Paediatric- juvenile idiopathic arthritis
Risk factors of rheumatoid arthritis
Genetics Smoking Air pollution Obesity Low vitamin D
Rheumatoid arthritis clinical presentation
Polyarthritis small joint in hand- PIP, MCP, RCJ
Insidious onset
Joint stiffness in morning, fatigue, deformity, pain, weakness, restricted mobility
Cervical spine- instability between C1-2
Management of rheumatoid arthritis
Symptom management
Pharmacological- DMARDS
nutrition
Physio
Shoulder dislocation
Anterior- arm in apprehension position (abd and ext)
Humeral head displaces antero- inferiorly
Can result in Hills Sachs lesions or Bankart lesion
Concurrent RC injuries can occur
Posterior- blow to ant shoulder, can occur in seizure
Concurrent injuries to RC (subscap) and post labrum
Shoulder instability
Disruption of static and dynamic GHJ stabilisers
Static- articular conformity, negative intra art pressure, labrum, GH ligs
Dynamic- RC and scapula stabilisers
Traumatic or atraumatic
Ant,post, inf, multidirectional
Shoulder instability clinical presentation
Clicking/pain Sub acromial signs RC signs Positive apprehension tests/Relocation test Increased accessory motion at GHJ postive sulcus signs
Shoulder instability management
Physio- education Motor control Strength training Proprioceptive training Surgery- depends of structural impairments
Dupuytrens disease
Nodular hypertrophy and contracture of superficial palmer fascia
Flexion contracture of MCP and PIP joints
Slowly, progressive
Thickening of skin, bands of fibrotic tissue form in palmer area
Occurs bilaterally
Aetiology of dupuytrens disease
M>F
Genetics
Environmental factors: smoking, alcohol, manual labour, low bmi, anticoagulants
Associated with diabetes, epilepsy, HIV, adhesive capsulitis, cancer
Surgical management of dupuytrens disease
Simple fasciotomy- contract cord cut
Fasciotomy- partial/complete removal of diseased palmer fascis and cord
Dermofasciotomy- removes underlying skin and fat, full thickness skin graft to cover surgical site
Amputation of digits
dupuytrens disease physio treatment
Post operative Splinting Exercise- passive stretching, active exercises, function Education and advice Oedema and scar tissue management
