Common Pathologies Of UL 2

Question 1

Adhesive capsulitis

Answer 1

Formation of excessive scar tissue or adhesions across GHJ
Leads to pain, stiffness and dysfunction
Primary (idiopathic)- spontaneous
Secondary - post trauma

Question 2

Risk factors for adhesive capsulitis

Answer 2

Females>males
>40 
Trauma 
Diabetes
Hyperthyroidism 
Cerebrovascular disease
Coronary artery disease 
HLA P-B27 positive

Question 3

Stages of adhesive capulitis

Answer 3

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

Question 4

Clinical presentation of adhesive capsulitis

Answer 4

Pain

Gradual loss of ROM

Question 5

Management of adhesive capsulitis

Answer 5

Physio- early mobilisation
Education
Corticosteroid injections
Hydrodilation
NSAIDS
Surgery-MUA and Capsular release

Question 6

Types of fractures

Answer 6

Transverse
Linear
Oblique non-displaced
Oblique displaced
Spiral
Greenstick
Communited

Question 7

Clavicle fractures

Answer 7

Result from fall
Neuro/vascular structures nearby
Mid-shaft>lateral>medial

Question 8

Clavicle fracture management

Answer 8

Conservative- physio and sling

Surgical

Question 9

Proximal humeral fractures and management

Answer 9

Classified on number of fragments displaced

Collar and cuff 2-3/52
Progressive active management
Surgery

Question 10

Distal radius fracture

Answer 10

Colles fracture- extra articular, dorsally displaced
Smiths fracture- anteriorly displaced
Bartons fracture- intra articular, associated dislocation of RCJ

Question 11

Distal radius fracture management

Answer 11

Physio- immobilisation

Splints, cast, k wires, MUA

Question 12

Scaphoid fracture

Answer 12

FOOSH
waist>proximal pole>medial pole
Risk of AVN and non union
Pain over anatomical snuff box

Question 13

Scaphoid fracture management

Answer 13

Cast, surgery, physio after immobilisation

Question 14

Osteoarthritis

Answer 14

Can develop in any synovial joint

Common in knees, hips and small joints of the hand

Question 15

Osteoarthritis management

Answer 15

Physio
Corticosteroid injection
Surgery (joint replacement, debridement)

Question 16

Rheumatoid arthritis

Answer 16

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

Question 17

Epidemiology of osteoarthritis

Answer 17

F>M
Increases with age
Paediatric- juvenile idiopathic arthritis

Question 18

Risk factors of rheumatoid arthritis

Answer 18

Genetics
Smoking
Air pollution
Obesity
Low vitamin D

Question 19

Rheumatoid arthritis clinical presentation

Answer 19

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

Question 20

Management of rheumatoid arthritis

Answer 20

Symptom management
Pharmacological- DMARDS
nutrition
Physio

Question 21

Shoulder dislocation

Answer 21

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

Question 22

Shoulder instability

Answer 22

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

Question 23

Shoulder instability clinical presentation

Answer 23

Clicking/pain
Sub acromial signs
RC signs
Positive apprehension tests/Relocation test
Increased accessory motion at GHJ
postive sulcus signs

Question 24

Shoulder instability management

Answer 24

Physio- education 
Motor control
Strength training
Proprioceptive training
Surgery- depends of structural impairments

Question 25

Dupuytrens disease

Answer 25

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

Question 26

Aetiology of dupuytrens disease

Answer 26

M>F
Genetics
Environmental factors: smoking, alcohol, manual labour, low bmi, anticoagulants
Associated with diabetes, epilepsy, HIV, adhesive capsulitis, cancer

Question 27

Surgical management of dupuytrens disease

Answer 27

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

Question 28

dupuytrens disease physio treatment

Answer 28

Post operative
Splinting
Exercise- passive stretching, active exercises, function
Education and advice
Oedema and scar tissue management