Shoulder and Arm 2 Flashcards
what nerve runs in the spiral groove of the humerus and is at high risk of damage in an humeral shaft fracture
radial nerve
risk factors for humeral shaft fractures
increasing age
osteoporosis
previous fractures
pathological fracture risk
if the radial nerve is damaged, what sensory and motor deficit would they complain of
reduced sensation over the dorsal 1st webspace and back of the forearm
weakness in wrist extension (wrist drop deformity) - supplies the extensor muscles of the wrist and fingers
what is a Holstein-Lewis Fracture
distal third of humerus fracture resulting in entrapment of the radial nerve
resulting in loss of sensation in the radial distribution and a wrist drop deformity
management of humeral shaft fractures
conservative - humeral brace and re-alignment of the limb
surgical - open reduction and internal fixation, intramedullary nailing indicated in the presence of pathological fractures and severely osteoporotic bones
what does tendinopathy mean
broad term used to encompass a variety of pathological changes that occur in tendons, typically due to overuse
the result is a painful, swollen and structurally weaker tendon that is at risk of rupture
what special tests can be used to examine biceps tendinopathy
Speeds Test - elbow extended and forearm supinated, then flex their shoulder against examiners resistance
Yergason’s Test - elbow flexed at 90 degrees and forearm pronated, then actively supinate against examiner resistance
management of biceps tendinopathy
analgesia and ice therapy
physiotherapy
US guided steroid injections can be useful in cases unresponsive to initial conservative management
what is the common mechanism of action for a biceps tendon rupture
sudden forced extension of a flexed elbow
what does a ‘reverse popeye sign’ indicate
its a bulge of the biceps on the upper arm post biceps tendon rupture
what is the Hook test in terms of biceps tendon rupture
elbow flexed at 90 degrees, then examiner tries to hook finger underneath the distal biceps tendon
this is not possible in distal biceps tendon rupture
investigation into ruptured biceps tendon
clinical diagnosis but confirmed via US, if inconclusive then an MRI scan
in a ruptured biceps tendon, does flexion of the elbow still remain
yes
brachialis muscle and supinator muscles still allow for flexion at the elbow and supination
what is adhesive capsulitis commonly known as to the lay person
frozen shoulder
what is the pathophysiology behind adhesive capsulitis
glenohumeral joint capsule becomes contracted and adherent to the humeral head
often associated with inflammatory diseases aswell
what endocrine disorder is most associated with adhesive capsulitis
diabetes
clinical features of adhesive capsulitis
generalised deep and constant pain of the shoulder
joint stiffness and limited ROM
atrophy of the deltoid muscle
what is the characteristic feature of adhesive capsulitis on MRI?
thickening of the glenohumeral joint capsule
what other tests (and why) should you order in a patient presenting with adhesive capsulitis without any risk factors or precipitating events
HbA1c and blood glucose
more common condition in diabetic patient
management of adhesive capsulitis
self-limiting
conservative = physio, assurance, analgesia and corticosteroid injections for those failing to improve
surgical = when symptoms significantly affect quality of life, joint manipulation under anaesthetic
what is subacromial impingement syndrome
refers to inflammation and irritation of the rotator cuff tendons as they pass through the subacromial space
results in pain, weakness and reduced ROM within the shoulder
what anatomical structures run through the subacromial space
rotator cuff tendons
long head of the biceps tendon
coraco-acromial ligament
subacromial bursa
what is the most common symptom of subacromial impingement syndrome
progressive pain in the anterior shoulder classically exacerbated by abduction
investigations into subacromial space impingement
diagnosis is a clinical one but MRI can confirm it
will show narrowing of the subacromial space
