Diagnosis and management of upper limb

Question 1

Name the muscles of the rotator cuff group

Answer 1

supraspinatous
infraspiatous
subscapularis
teres minor

Question 2

how does a person usually develop a rotator cuff injury

Answer 2

repeated performing of overhead movements

Question 3

what is the difference between impingment and tendinitis at the shoulder

Answer 3

impingement is caused by the subarcomial bursa becoming inflammed

tendinitis is caused by the tendon becoming inflammed

Question 4

which of the rotator cuff muscles is most commonly damged in an overuse tear

Answer 4

supraspinatous

Question 5

describe the process of the Apley scratch test

what movements does this test

what is seen if there is pathology

Answer 5

patient attempts to touch the oppersite scapula from above and below

abduction and external rotation
adduction and internal rotation

pain or difficulty compared to the other side
popping sensation when performing the movement

Question 6

describe Hawkins test for shoulder impingement

what would be seen if there is impingement

Answer 6

patients arm is held at 90 at the shoulder
arm out infront with elbow bent

internally rotate the shoulder by pulling the forearm down

would see popping sensation or pain at a certain point

Question 7

describe Neer’s test for shoulder impingement

what would be seen if there is impingement

Answer 7

patient pronates the arm

then passively flex the arm at the shoulder

feel the scapula to ensure it doesn’t move because this is a compensatory mechanism to avoid pain

pain would be seen if there is impingement

Question 8

describe the cross arm test

what pathology is this looking for

what would be seen if pathology were present

Answer 8

flex arm to 90

adduct the arm across the chest

looks for acromioclavicular joint dysfunction

pain is suggestive of this

Question 9

describe the empty can test

what pathology is this looking for

what would be seen if there was pathology

Answer 9

abduct shoulder to 90 with arms out infront

thumbs pointing downwards

elevate arms against resistance

looking for a rotator cuff tear

if present this would cause pain

Question 10

describe the infraspinatous/teres minor test

what pathology is this looking for

what would be seen if there was pathology

Answer 10

arms by side, elbows flexed to 90

externally rotate against resistance

looking for rotator cuff tear which would cause pain

Question 11

describe the conservative method of treatment for impingement syndrome

Answer 11

cessation of painful activity or movement
physio to increase the range of movement
improve posture
strengthen shoulder muscles
NSAIDS and ice

corticosteroids and local anesthetic can be injected if problem is persistent

Question 12

describe how surgery can be used to treat impingement syndrome

Answer 12

removal of the impinging structure e.g inflammed bursa or bony spurs

or to widen the subacromial space by resection of the distal clavicle and removal of osteophytes from the clavicle

Question 13

describe the conservative treatment for rotator cuff tears

Answer 13

avoid aggrevating activity
physio to increase the range of movement
then strengthen muscles when shoulder becomes pain free

Question 14

who is likely to be considered for surgery for rotator cuff tears and what does this surgery involve

Answer 14

patients with functional deficits
athletes who play over head throwing sports
tear in the rotator cuff is sutured together

Question 15

describe the rehabilitation process following shoulder surgery

Answer 15

pain relief and ice needed for 2-3 weeks

arm is immobalised for 6 weeks to allow the muscle to heal
passive movement is started by a therapist to regain range of movement

then move on to active movements to regain strength

Question 16

what are the boundries for different scores on the UCLA shoulder rating scale

Answer 16

34-35 = excellent

28-33 = good

below 27 = poor

Question 17

which epicondyle is affected in tennis elbow and golfers elbow

Answer 17

tennis = lateral 
golfers = medial

Question 18

what is the cause(s) of tennis/golfers elbow

Answer 18

inflammation of the tendons of the forearm muscles

as a result of excessive use/ repetitive strain injury

direct trauma

miss hitting of the ball allowing force to travel up the arm

Question 19

what are the signs and symptoms of tennis and golfers elbow

Answer 19

pain which is very specifically located
pain on doing the movements caused by the affected muscles
stiffness
weakness

Question 20

in tennis elbow, the tendon of which muscle is most commonly involved

Answer 20

extensor carpi radialis brevis

Question 21

describe two tests used to detect tennis elbow and what is indicative of a positive result

Answer 21

Cozen’s test:
extend at elbow and try to extend at the wrist against resistance

chair lift test:
stand behind a chair and attempt to lift it with a straight arm

pain on both tests suggests pathology

Question 22

what method of non-surgical treatment has been shown to be effective in the treatment of tennis elbow

Answer 22

eccentric wrist extensor exercise with a rubber bar

hold bar in effective hand, with wrist extended
twist the bar with the good arm
bring the twisted bar out infront of the body
slowly untwist the bar by allowing bad wrist to move into flexion

Question 23

how can tennis elbow be prevented

Answer 23

reduced playing time

strengthening of forearm muscles and muscles of upper arm, shoulder and back to stabalise the joint

use lighter racket

strapping to reduce discomfort

Question 24

describe the normal extensor mechanism of the finger

Answer 24

dorsal extensor tendon divides into a central slip that extends to the PIP joint

two lateral bands then extend to the DIP joint

Question 25

explain how a person gets a mallet finger injury

Answer 25

object strikes the finger to cause sudden flexion at the DIP joint

this causes injury to the extensor tendon which stretches/tears/ causes avulsion fracture

Question 26

what are the signs and symptoms of mallet finger

Answer 26

pain and swelling at DIP joint

flexion deformity

inability to extend the finger

Question 27

what is the treatment of mallet finger if there is no avulsion fracture

Answer 27

splint in neutral or slight hyperextension for 6 weeks
PIP remains mobile

must completely avoid flexion at the DIP joint

if healing well, splint only needs to be worn when sleeping and playing sport for the following 6 weeks

Question 28

describe what has happened in central slip extensor tendon injury

what are the signs and symptoms of this

Answer 28

PIP joint is forcibly flexed whilst being actively extended

this damages the extensor tendons

pain over the dorsal middle phalanx
unable to extend

Question 29

what is the treatment of central slip extensor tendon injury

Answer 29

splint in full extension for 6 weeks if no avulsion

extension must be constantly maintained

after 6 weeks, if extension is possible then splint only needs to be worn for sleep and sport for another 6 weeks

Question 30

describe what has happened to cause a jersey finger injury

Answer 30

damage to flexor digitorum profundus

finger gets trapped in clothing of opponent which causes forced extension at the DIP joint

Question 31

what are the signs and symptoms of jersey finger

Answer 31

may feel or hear it happen

pain, swelling and tenderness over the volar aspect of the DIP joint

finger in extension at rest

Question 32

how do you examine the flexor digitorum profundus and superficialis tendon separatly

Answer 32

FDP:
hold MCP and PIP in extension and ask patient to flex at DIP. won’t move if damaged

FDS:
hold unaffected fingers in extension and ask patient to flex injured finger. won’t move if damaged

Question 33

what treatment is required for jersey finger and why

Answer 33

surgery because the tendon doesn’t heal following a complete tear

then held in a plastic splint for 6 weeks

Question 34

how do you get a contralateral ligament injury of the finger
how do you test for it
how do yo treat it

Answer 34

forced varus of valgus movement, usually at PIP

flex affected joint to 30 and MCP to 90 and apply a varus or valgus stress.
then compare laxity to the other digits

if no fracture, buddy strap the fingers