ULimb Flashcards
Ulnar nerve palsy
Paper between thumb + index finger -> Pull
@ulnar nerve palsy = unable to hold paper
Flex which muscle at what joint to compensate???
Froment’s Sign
FLEX flexor pollicis longus @ ITP joint to compensate
More sensitive than Tinel’s
Assess carpal tunnel – opposite prayer sign
Phalen Prayer
Tap over median wrist retinaculum =
tingling over thumb, index, middle finger
Tinel Tap
Heberden
DIP osteophytes
Bouchard
PIP osteophytes
Lateral epicondyle tender
Pain @ elbow extension +
(resisted wrist extension) + SUPination
Lateral epicondylitis - tennis
Pain @ elbow extension + PROnation
4-5cm distal to lateral epicondyle
Radial tunnel syndrome –
post interosseous
Similar to lateral epicondylitis
Medial epicondyle tender
Pain @ flexion wrist + pronation
Poss 4th 5th finger tingling - ulnar nerve dx
Medial epicondylitis - golfers
INTERMITTENT tingling @ 4th 5th finger
Pain @ elbow rest/flexed for ages
Ulnar paradox:
If ulnar damaged at wrist, what happen?
If ulnar damaged at elbow, what happens?
Cubital tunnel syndrome -
Ulnar nerve compression
Dx @ wrist = 2 medial lubicrals fucked so
can’t flex MCP and ext D/PIP so there will be lots of clawing
Dx @ elbow = medial aspect of FDProfundus only fucked so there’ll be less clawing cos it’s still got its lateral (median nerve) supply
Posterior elbow swelling
Inflamed – pain, hot, red
Middle aged men
Olecranon bursitis
pain and swelling of the shoulder joint. The clavicle is prominent and there appears to be a step deformity.
AcromioClavicular Dislocation
3 grades
Intact joint minor tear of ligaments,
<50% Clavicular subluxation +
stretched coracoclavicular ligament’s
> 50% Clavicular subluxation +
complete rupture of coracoclavicular ligament’s
Ext rotated and abducted Commonest, Axillary nerve palsy = weak delt + badge patch sensory loss Bankart lesion @ recurrent & Hill-Sach defect
Manoeuvre to reduce??
GlenoHumeral ANT dislocation
Stinson to reduce!!
Rim’s, light bulb and trough sign
Manoeuvre to reduce??
GlenoHumeral POST dislocation
Stinson to reduce!!
Rare AF and after trauma
Manoeuvre to reduce??
GlenoHumeral SUP shoulder
Stinson to reduce!!!
Luxatio erecta
GlenoHumeral INF dislocation
Stinson to reduce!!
Shoulder initially painful
Followed by joint stiffness
Restricted active and passive ROM –
ext rot most marked restriction
Assoc DM + NON-dom hand
Tx?
Frozen adhesive capsulitis -
Pain+freeze, thaw, resolve >2yr
Physio analgesia/csted brace surgery
Pop swell click grinding
Pos scarf test
Acromioclavicular degen
Shoulder arc pain + weakness Pain @ palpation Wasting+tenderness Passive movements normal Active abnormal
Rotator cuff tear
Shoulder arc pain + NO weakness
NO pain @ palpation
NO waste
Impingement
Extreme pain + reluctant 2 move
Pain @ palpation
Calcific tendonitis
pain and weakness @ shoulder.
unwell with viral illness and fully recovered
muscle wasting and winging of scapula. Power @ active movements = impaired
Parsonage – Turner syndrome
HypermoBeighton score 6=kids 5=adults /9
Elastic issue
ARegurg/MProlapse/ADom
Ret angiod streaks, SAH
Ehlers Danlos
Palate high arch, pectus excavatum, pes cavus
Arm:height>1.05, Aortic sinus dilation, ADom
Lens upward dislocation
Scoliosis/sclera blue
Marfans - fibrillin issue
Where do the rotator cuff muscles attach?
Supraspin, infraspin, teres Minor = GREATER tubercle
Supscapularis = less tubercle
Nerve supply to rotator cuff muscles.
Supraspinatus= suprascap nerve
Subscap = subscap nerve
Teres minor = axillary nerve
Degrees of abduction of shoulder - give muscles and nerves.
0-15 = supraspin - suprascap nerve
15-100 = deltoid - axillary nerve
> 90 = trapezius - accessory
> 100 = serratus anterior - long thoracic
Painful arc abduction between 60 and 120°
Tender over anterior acromion
Supraspinatous tendon -itis
