lecture 11- upper extremity injuries Flashcards
elbow area contusions
laterally= radial nerve at risk
extensor muscle weakness
posterolateral numbness
medially= ulnar nerve at risk
“funny bone” injuries
numbness in medial forearm and digits IV +V
flexor muscle weakness
posteriorly:
olecranon bursitis
Strains and tendinopathy
Hx: resisting a force, fall, overuse
SSx: pain worse with movement against resistance, tenderness, swelling, crepitus
–> using equipment that is too big? Often happens with kids
Tx: rest, POLICE, ROM, physio, tape, shin splints, rehab
most dislocated carpal bone
lunate
most fractured carpal bone
scaphoid
2 nail injuries
- Avulsion (nail ripped off, high chance of infection)
- Subungual haematoma (contusion, crush, bleeding under nail)
Superficial hand injuries:
Hand abrasions, lacerations
- always looking for infections with these!!!!!
Laceration= a cut (ex. tip of finger cut off)
biceps tendinopathy
tendinosis in biceeps, male athletes 45-60 years old
SSx: pain anterior shoulder, pain w 900 to 120 degrees shoulder flexion
Tx: rest, ice, modified activities, ROM, strengthening
can lead to biceps rupture
biceps rupture
SSx: snap, weakness, bruising, popeye’s sign (sticking up lump in biceps)
MRI or diagnostic ultrasound
Tx: surgery, rehab
Medial/lateral epicondylalgia
golfers/tennis elbow
SSx: aching pain, worse w movement
TX: rest, splints, ice, physio (eccentric loading), NSAIDs, rehab, surgery
tendinopathy in forearm and wrist areas may result in
may result in ganglion
–> cyst in tenosynovium or swelling in joint capsule
-mobile, swollen, painful, crepitus
-may lead to carpal tunnel syndrome if on palmar side (by putting pressure on the carpal tunnel)
Tx: surgery
carpal tunnel syndrome
swelling in tunnel causes compression of median nerve
Hx: repeated wrist flexion (tendinopathy), trauma (sprain, fracture, dislocation), ganglion, tumour, pregnancy
SSx:
pain, worse at night and at rest
numbness/weakness of thumb
atrophy of thenar eminence
carpal tunnel brace?
only at nigh bc it actually increases muscle activity and causes more harm than good w active movement bc have to overcome resistance!!
carpal tunnel syndrome Tx
POLIE, tear underlying cause
splint
send to MD
NSAIDs
may need surgical decompression
De quervain’s tenosynovitis
Hx
cause: repetitive use of wrist/thumb, w wrist in ulnar deviation
—> inflammation of abductor pollicis longus and extensor pollicis brevis tendon sheaths
(much more common w phone!!! having to reach w thumb)
De quervain’s tenosynovitis
SSx, Tx
SSx: pain/swelling at base of thumb/radial side of wrist.
pain and stiffness w radial deviation of wrist and thumb flexion
Tx: POLIE, rest, brace, physio, corticosteroid injection, surgery
Hand strains and tendinopathy
-beware of possible
avulsion fracture
(bone comes off with the tendon)
upper extremity sprains and dislocations Hx
torsion
resisting a force
FOOSH
upper extremity sprains and dislocations SSx
pain, tenderness
swelling
deformity if dislocated
bruising
reduced ROM
upper extremity sprains and dislocations Tx
check neovascular status
POLICE, splint, hospital
Xray, splint or cast
Tape, physio, NSAIDs, rehab
UCL sprain of the elbow
UCL is resistant to valgus stress to elbow.
UCL sprain makes elbow less stable.
SSx: pain medial elbow, laxity w valgus stress test
Tx: POLICE, NSAIDs, GH joint and elbow mechanics, pitching motion, surgery?
Elbow sprain/dislocation
commonly dislocated by parents pulling child by arm
radius and ulna go back, humerus displaces forwards
dislocation of elbow= EMERGENCY!!
wrist sprains and dislocations
check neovascular status
complications: lunate, other dislocations, carpal tunnel syndrome, scaphoid fracture
annular ligament
circular
holds radial head in place at the elbow
finger ligament sprains
collateral ligament sprains
perform valgus or varus stress tests on IP joints
