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PMMH > UPPER LIMB > Flashcards

UPPER LIMB Flashcards

1
Q

WHAT ARE SOFT TISSUE INJURIES

A
  1. TENDONS- CONNECT MUSCLE TO BONE
  2. MUSCLE- CONTRACT TO PRODUCE MOVEMENT (THINGS THAT GIVE YOU POWER)
  3. LIGAMENTS- FIBROUS BAND OF TISSUE THAT CONNECTS BONE TO BONE.
  4. MENISCUS- A FIBROCARTILAGINOUS STRUCTURE THAT REDUCES FRICTIONS BETWEEN JOINTS.
  5. BURSA- FLUID FILLED SAC THAT REDUCES FRICTION BETWEEN MUSCLES AND BONES. (MAY BECOME INFLAMED AND CAUSE PAIN)
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2
Q

WHAT ARE THE DIFFERENT TYPES OF JOINTS?

A
  1. BALL AND SOCKET (SHOULDER)
    2.PIVOT (ULNA/RADIAL, TIBIA/FIBIA)
  2. PLANE (WRIST, ANKLE AND VERTEBRAE)
    4.SADDLE (THUMB)
    5.HINGE(ELBOW,KNEE, DIGITS)
    6.ELLIPSOID (WRIST, BASE OF SKULL AND ANKLE)
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3
Q

TYPES OF MINOR INJURIES:

A
  1. SPRAIN- TENDON OR LIGAMNET DAMAGE
  2. STRAIN- ISSUE UE WITH MUSCLE
    3.RUPTURE OF A LIGAMNET/TENDON- IT’S TORN (LONG HEALING PROCESS)
    4.FRACTURE- BREAK OF A BONE
    5.SUBLUXATION- PARTIAL DISLOCATION
    6.DISLOCATION- COMMON IN SHOULDER & KNEE
    7.WOUNDS
    8.ULCERS
    9.BURNS
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4
Q

SOFT TISSUE INJURY CLASSIFICATION:

A
  • GRADE 1: THERE IS DAMAGE TO A SMALL AMOUNT OF FIBRES, VISIBLE LOCALISED SWELLING. GOOD RANGE OF MOVEMENT, RELIEVED WITH SELF CARE
    -GRADE 2: DUE TO MORE OF A SEVERE MECHANISM, LARGER NUMBER OF FIBRES ARE DAMAGED,OFTEN BLEEDING/HEMATOMA, LAXITY- EXCESS MOVEMENT IN THE LIGAMENT.
  • GRADE 3: A BIG DEFORMITY, COMPLETE LOSS OF FUNCTION AND YOU MAY SEE PALPABLE GAPS, REFFER TO ORTHOPAEDICS
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5
Q

TYPES OF FRACTURES

A
  • GREENSTICK- COMMON IN PAEDS
  • AVULSION
  • NORMAL
  • GREENSTICK
  • TRANSVERSE
  • OBLIQUE
  • SPIRAL
    -COMMINUTED
  • IMPACTED
  • FISSURE
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6
Q

TENDON PAIN

A
  • NO CLEAR HISTORY
  • NOT ONE MECHHANISM OF HX THAT OFTEN SUGGESTS INJURY
  • LOCALISED TO THE. JOINT AS THAT’S WHERE THE TENDON IS.
  • TENDONITIS - INFLAMMATION OF THE TENDON, OCCURS QUITE QUICKLY (E.G. KICKING FOOTBALL FOR A PROLONGED TIME WHEN YOU DO NOT USUALLY, AND ANKLE GETS SWOLLEN)
    *TENDINOSIS- SLOWER PROCESS, TISSUES CHANGE, MINOR TEARS IN TISSUE, HEALING PROCESS CAUSES SCARS AND COLLAGEN TISSUES TO BUILD UP. OFTEN DUE TO REPETITIVE STRAIN INJURIES (TENNSI ELBOW).
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7
Q

CARTILAGE PROBLEMS

A
  • PAINLESS
  • LOCKING AFFECT IN KNEE DUE TO MENISCUS
    -OFTEN DUE TO INJURY OR WEAR AND TEAR
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8
Q

LIGAMENT PROBLEMS

A
  • DIRECT OR INDIRECT FORCE
  • SIGN OF INJURY (GOING OVER ANKLE)
  • MAY BE JOINT INSTABILITY
  • MAY HAVE LAXITY
  • PT MAY BE SYMPTOMATIC FOR 6-8WKS
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9
Q

STEPS FOR PHYSICAL EXAMINATION

A
  • INTRODUCTION
  • ASK FOR CONSENT!
  • INSPECTION/LOOK
    -PALPATION/FEEL
    -MOVEMENT/MOVE
    -JOINT ABOVE, JOINT BELOW
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10
Q

INSPECTION

A

LOOK FOR SWEADES
Swelling
Wounds
Exudate- liquid pus
Atrophy- muscle wastage
Deformities
Erythema- redness
Scars

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11
Q

PALPATION

A
  • Palpate the hurry bit last!!!
  • Look for signs of discomfort
  • Assess for neurovascular compromise- radial pulses, distal sensation, temperature
  • feel underlying structures
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12
Q

MOVEMENT

A
  • Feel for crepitus- don’t illicit it
  • ACTIVE
  • PASSIVE
  • RESISTED MOVEMENT
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13
Q

PLAN:

A

-If we are concerned and the pt is presenting with red flags, neurovascular compromise or deformities, take them to ED!
-minor injury unit
- Self care worsening care advice e.g. If they’ve hit their head and mechanism is not that serious, give them warning signs; if you experience any nausea or vomiting, dizziness, experience loss of consciousness, go to ED or call back 999.

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14
Q

Assessment:

A
  • assessment needs to be thorough
  • injury could affect daily living
  • ask about hand dominancy in hx
    -look, feel, move-active, passive, resisted
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15
Q

How to assess for vascular compromise:

A
  • check pulse
  • cap refill
  • temperature
  • colour
  • sensation (touch all 3 nerves)
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16
Q

Kumars test

A
  • assesses for motor compromise
  • Dorsal flexion of the wrist tests the radial nerve
  • thumb to ulna tests the medial nerve
  • ulnar nerve, medial nerve, radial nerve
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17
Q

Joint above-neck

A
  • look: any deformities like kyphosis, scoliosis
    -feel the c spine for any pain, tenderness, atrophy
  • movement: flexion, extension, rotation
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18
Q

Shoulder anatomy:

A
  • start from the sternum, then across the clavicle which joins the sternum via the sternoclavicular joint.
  • the acromion process joins the clavicle via the acromioclavicular, then the glenohumeral joint
  • coracoid process is the bony bit that sticks out that’s not attached to anything.
    *4 joints: sternoclavicular, acromioclavicular, glenohumeral, scapulothoracic
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19
Q

Shoulder landmarks:

A
  • ANTERIOR:
    . Sternoclavicular joint
    . Clavicle
    . Acromioclavicular (AC) joint
    . Coracoid Process
  • POSTERIOR:
    . Spine and boarders of the scapula

-HUMERAL:
.Head of humerus
.Greater and lesser tubercule
. Biceptial groove
. Deltoid muscle

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20
Q

What are the 4 rotator cuff muscles?

A

Rotator cuff helps the muscle with joint stability. Easily injured through tendon, muscle or bone injuries.
1.Supraspinatus- abduction
* usually occurs due to painting their ceiling
2. Infraspinatus- external rotation
3. Teres Minor- external rotation
4. Subscapularis- internal rotation

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21
Q

What are the movements of the shoulder?

A
  • extension
  • flexion
  • internal & external rotation
  • abduction & aduction
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22
Q

Painful arc test

A
  • You can assess what tendons/muscles are damaged by how far the pt can go abduct their arm.
  • If pt experiences severe pain when abducting their arm from:
    1. 0-20 degrees, it’s likely a full thickness tear of the supraspinatus
    2. 20-40 degrees axillary nerve damage (deltoid is not working)
    3. 40-60 degrees adhesive capsuilitus (frozen shoulder)
    4. 60-120- impingement of the supraspinatus/ sabacromial pain
    5. 120-180 degrees, they have acromioclavicular pain
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23
Q

How can you assess for neurovascular compromise in shoulder injury/pain?

A
  • perform regimental badge sign on both arms and if there is pain, pt has axillary nerve damage which is a red flag and needs to go ED.
  • This assesses motor and sensation
24
Q

What are common shoulder injuries?

A

TRAUMA
- Fractures
- Dislocation

NON TRAUMA:
- rotator cuff tear
- impingement
-Adhesive capsulitis (frozen shoulder)

25
Q

What’s osteomyelitis?

A

Infection of the bone, be cautious with open wounds

26
Q

What are the 4 tests for rotator cuff tear?

A
  1. Drop arm/painful arc
  2. Jobes/ empty can test
  3. Teres minor and infraspinatus test
    4.lift arm test
27
Q

What is adhesive capsulitis?

A
  • AKA Frozen shoulder
  • Unknown cause
  • Pts with diabetes have a higher incidence
  • Comes on progressively with pain, stiffness, reduced ROM, pt is unable to sleep on that side
  • Quite rare
28
Q

What 3 bones does the elbow consist of?

A
  • Distal humerus
  • Proximal radius
  • Proximal ulna
29
Q

What are 3 joints of the elbow?

A
  • Ulnotrochlear
  • Radiocapitellar
  • Radioulnar
30
Q

What would you palpate in an elbow assessment?

A
  • Lateral epicondyle
  • Medial epicondylitis
  • Radius
  • Ulna
  • Humerus & shoulder (joint above)
31
Q

What ligament allows for movement of the radius?

A
  • angular ligament
32
Q

What are common elbow injuries?

A
  • Pulled elbow
  • Lateral epicondyle (tennis elbow)
  • Medial epicondyle (Golfer’s elbow)
  • Olecranon bursitis
  • Fracture
  • Dislocation
33
Q

Pulled elbow

A
  • Common in kids when their swung from both arms.
  • This occurs as the angular ligament is not fully developed and it slips out of the radius.
  • Pain on supination’
  • May be caused by a fall
  • In over 5’s, the annular LIGAMNET is thicker and stronger and prevents subluxation (partial dislocation).
34
Q

Lateral epicondylitis

A
  • Result of repetitive strain injury (form of tendinitis)
  • AKA tennis elbow
  • Common injury with hx preceding it
  • Overuse strain on insertion of muscles at the lateral epicondyle
  • Perform the mills test to investigate for this.
35
Q

Medial epicondylitis

A
  • AKA golfer’s elbow
  • repetitive strain injury due to pressure from playing golf for a long time.
  • Overuse strain on insertion of muscles at the medial epicondyle
  • Tear in the tendon
36
Q

Olecranon Bursitis

A
  • Repeated minor trauma from leaning on the elbow
  • Single blow to the elbow= bleeding into bursa
  • If the limb becomes hot to touch and red, think SEPSIS, check pts NEWS2– RED FLAG!
  • Pt may require antibiotics and might need it drained if it’s large.
  • Corticoid steroids may be used on recurrent cases
37
Q

Radial head fracture

A
  • May be the result of a FOOSH due to the force exerted onto the outstretched limb.
  • Often tenderness, decreased ROM and pain
  • Perform a shoulder and elbow exam too
38
Q

Supracondylar Fracture

A
  • Common in paeds
  • Distal head of the ulnar
  • If its s shaped there’s a deformity and the fracture has moved.
  • If you’re querying a fracture, get pt to perform active movement. If that’s fine get them to do passive and if it’s still painful, it’s likely a fracture, do not perform resisted if suspecting a fracture!!
39
Q

What are the 8 carpal bones?

A
  1. Scaphoid
  2. Trapezium
  3. Trapezoid
  4. Capitate
  5. Hamate
  6. Lunate
  7. Triquetrum
  8. Pisiform
    * So Long To Pinky Here Comes The Thumb
40
Q

Anatomy of the hand:

A
  • Distal head of the radius (thumb side)
  • 8 carpal bones
  • Metacarpals
  • Metacarpal phalangeal joint (knuckles)
  • 3 parts to the phalanges: Proximal, Middle and distal phalange
41
Q

Common injuries of the hand:

A
  • Fractures
  • Laceration
  • Carpal tunnel

Assessment:
- HX
- look
- Feel
- Move
-Colour
- Perfusion
- Sensation & Motor
- Neurovascular compromise-kumar

42
Q

Radial head fracture

A
  • Flexion fracture of radius (smiths fracture)
  • Extension fracture (colles fracture)- most common FOOSH injury
  • GREENSTICK fractures- common in paeds
43
Q

Scaphoid fracture

A
  • Really debilitating, can cause disability in the thumb if it’s missed.
  • FOOSH mechanism
    -May not heal properly if left to heal on its own, could develop avascular necrosis due to retrograde blood supply from radial artery.
  • Anatomical snuffbox- if it hurts on PALPATION, pt may have a scaphoid fracture
  • Telescoping of the thumb- pressing the metacarpal into the thumb
44
Q

Carpal tunnel syndrome

A
  • Where the medial nerve becomes trapped- tendons and nerves become inflamed causing compression of the median nerve.
  • May be the result of trauma, arthritis, swelling, fracture, pregnancy diabetes
  • Pt experiences pain & numbness
  • Chronic condition
    *Phalens test- upside down prayer sign (hold it there for a min) and see if pt feels pins n needles.
  • Tinnel tap test should illicit pins and needles and sensation if the medial nerve is trapped.
45
Q

Finger Joints

A
  • Flexor tendons bend the fingers (palmar aspect of hand) pronate hand
  • Extensor tendons - straighten the fingers (dorsal aspect)
  • In an extensor tendon injury, the affected inter is unable to extend and stays flexed.
  • Distal interphalangael joints (DIP)
  • Proximal interphalangeal joints (PIP)
46
Q

Flexor tendons

A
  • Flexor digitorium profundus
  • Profundus goes from the finger to the tip, it’s profund
  • Flexor digitorium superficialis
  • Joins to the middle phalange
47
Q

Flexor tendons examination

A
  • Flexor Digitorium Profundus
  • To assess, isolate the DIP by stabilising the middle phalanx and get pt to bend their finger.
  • Flexor Digitorium Superficialis
  • Isolate other fingers and ask the pt to flex the PIP
48
Q

Jersey finger

A
  • Common rugby injury when someone grabs another players jersey forcing the finger backwards.
  • Causes an avulsion fracture of the flexor Digitorium fundus
  • Avulsion fracture is where piece of the bone off is ripped from the joint.
  • surgery is needed asap
49
Q

Extensor injuries

A
  • More common
  • Mallet finger
    -Boutonnière
  • Swan neck deformity
50
Q

Mallet finger

A
  • Extensor injury
  • Forced hyperflexion
  • May occur when trying to catch a baseball and the ball forces the finger forwards, causing an injury to the flexor.
  • May occur when changing bed sheets.
  • If there’s blood under the nail, it may be an open fracture, usually immobilised in a splint and heels itself.
51
Q

Boutonnière deformity

A
  • Disruption of the PIP central slip
  • There has been volar slip of the lateral bands
  • Can be caused by a laceration or an inflammatory weakening.
  • PIP has been flexed whilst the DIP has been hyperextended.
52
Q

Swan neck deformity

A
  • Opposite of boutinneres
  • May be caused by rheumatoid arthritis or untreated mallet finger
  • Hyperextension of the PIP and flexion of the DIP
  • There is damage to the tendon or weakening at the DIP.
53
Q

Finger Fractures

A
  • Punch injuries- pts who have been in fights who have been bitten need to go UCC as they need tetanus and antibiotics, they may need surgery to irrigate it.
  • Boxers fracture- 5th metacarpal, very common from punching someone or something
54
Q

Digital nerves

A
  • Branches of the radial, medial and ulna all go to digital nerves.
  • To test digital nerves, other than assessing sensation , use a bic pen
  • Digital nerves stimulate sweat production, if there is no sweat and the pen glides, potentially the digital nerves have become damaged.
  • Good for avocado injuries.
55
Q

What do flexor tendons do?

A
  • Bend the fingers
56
Q

What do extensor tendons do?

A
  • Straighten the fingers

PMMH (12 decks)

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