Diagnosis and management of upper limb Flashcards
Name the muscles of the rotator cuff group
supraspinatous
infraspiatous
subscapularis
teres minor
how does a person usually develop a rotator cuff injury
repeated performing of overhead movements
what is the difference between impingment and tendinitis at the shoulder
impingement is caused by the subarcomial bursa becoming inflammed
tendinitis is caused by the tendon becoming inflammed
which of the rotator cuff muscles is most commonly damged in an overuse tear
supraspinatous
describe the process of the Apley scratch test
what movements does this test
what is seen if there is pathology
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
describe Hawkins test for shoulder impingement
what would be seen if there is impingement
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
describe Neer’s test for shoulder impingement
what would be seen if there is impingement
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
describe the cross arm test
what pathology is this looking for
what would be seen if pathology were present
flex arm to 90
adduct the arm across the chest
looks for acromioclavicular joint dysfunction
pain is suggestive of this
describe the empty can test
what pathology is this looking for
what would be seen if there was pathology
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
describe the infraspinatous/teres minor test
what pathology is this looking for
what would be seen if there was pathology
arms by side, elbows flexed to 90
externally rotate against resistance
looking for rotator cuff tear which would cause pain
describe the conservative method of treatment for impingement syndrome
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
describe how surgery can be used to treat impingement syndrome
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
describe the conservative treatment for rotator cuff tears
avoid aggrevating activity
physio to increase the range of movement
then strengthen muscles when shoulder becomes pain free
who is likely to be considered for surgery for rotator cuff tears and what does this surgery involve
patients with functional deficits
athletes who play over head throwing sports
tear in the rotator cuff is sutured together
describe the rehabilitation process following shoulder surgery
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
what are the boundries for different scores on the UCLA shoulder rating scale
34-35 = excellent
28-33 = good
below 27 = poor
which epicondyle is affected in tennis elbow and golfers elbow
tennis = lateral golfers = medial
what is the cause(s) of tennis/golfers elbow
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
what are the signs and symptoms of tennis and golfers elbow
pain which is very specifically located
pain on doing the movements caused by the affected muscles
stiffness
weakness
in tennis elbow, the tendon of which muscle is most commonly involved
extensor carpi radialis brevis
describe two tests used to detect tennis elbow and what is indicative of a positive result
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
what method of non-surgical treatment has been shown to be effective in the treatment of tennis elbow
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
how can tennis elbow be prevented
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
describe the normal extensor mechanism of the finger
dorsal extensor tendon divides into a central slip that extends to the PIP joint
two lateral bands then extend to the DIP joint
explain how a person gets a mallet finger injury
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
what are the signs and symptoms of mallet finger
pain and swelling at DIP joint
flexion deformity
inability to extend the finger
what is the treatment of mallet finger if there is no avulsion fracture
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
describe what has happened in central slip extensor tendon injury
what are the signs and symptoms of this
PIP joint is forcibly flexed whilst being actively extended
this damages the extensor tendons
pain over the dorsal middle phalanx
unable to extend
what is the treatment of central slip extensor tendon injury
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
describe what has happened to cause a jersey finger injury
damage to flexor digitorum profundus
finger gets trapped in clothing of opponent which causes forced extension at the DIP joint
what are the signs and symptoms of jersey finger
may feel or hear it happen
pain, swelling and tenderness over the volar aspect of the DIP joint
finger in extension at rest
how do you examine the flexor digitorum profundus and superficialis tendon separatly
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
what treatment is required for jersey finger and why
surgery because the tendon doesn’t heal following a complete tear
then held in a plastic splint for 6 weeks
how do you get a contralateral ligament injury of the finger
how do you test for it
how do yo treat it
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
