Upper Limb Flashcards
What causes forearm fractures?
Direct or indirect trauma
What are the 3 main fracture patterns of a forearm fracture?
Galeazzi, Monteggia, Nightstick
What is a Galeazzi fracture?
Fracture over distal 3rd of radius
Dislocation of distal radioulnar joint
What is a Monteggia fracture?
Fracture of proximal third of ulna with dislocation of proximal head of radius
What is a Nightstick fracture?
Isolated ulna shaft fracture?
How do forearm fractures present?
Pain and swelling, loss of arm and hand function
Gross deformity
How are forearm fractures investigated and how are they managed?
X-ray- AP and lateral
Assessment of pulses and nerve fractures
Managed with casting or ORIF depending on severity
What causes elbow dislocation
FOOSH
What are the types of elbow fractures
Dependent on direction:
Posterior, anterior, lateral, medial, divergent
How do elbow fractures present
How are they managed and treated?
Pain and swelling over elbow
X-ray AP lat
Needs reduction, closed under sensation usually works (traction and pressure over olecranon)
2 weeks in sling with some rehab
What is an olecranon fracture and what causes it
olecranon= site of insertion of triceps tendon, responsible for elbow extension
Common when falling onto elbow
How does an olecranon fracture present and how is it investigated and managed?
Pain- well localised to posterior elbow
Displacement indicated by palpable defect
Inability to extend elbow (discontinuity of triceps mechanism)
X-ray- AP lat
Can be casted, or tension band wiring/ORIF plating if severe
What causes a supracondylar humeral fracture
FOOSH
Very common in children
How do supracondylar humeral fractures present?
Pain and refusal to move elbow
Gross deformity, swelling, Ecchymosis
Limited elbow motion
How are supracondylar humeral fractures investigated and how are they treated
What are the potential complications?
X-ray AP Lat-
Assess humerocapitellar alignment
Posterior fat pad sign- lucency on lateral view along posterior distal humerus and olecranon fossa suggests hidden fracture of elbow
Managed with casting or ORIF (pins) if needed
Can damage brachial artery and median nerve, causing long term damage if missed
What is lateral epicondylitis and what causes it?
Tennis elbow- repeat supination and pronation eg tennis players
Overuse injury of extensor carpi radialis brevis which originate in the lateral humeral epidcondyle
How does tennis elbow present?
Pain and tenderness over lateral epicondyle
Exacerbated with stretching muscles eg opening a jar
Only 10-20% are bilateral
How is tennis elbow investigated and managed?
Mainly clinical, can do USS and MRI if needed Nerve conduction studies if there are any nerve symptoms
Self limiting- treat conservatively. Can use steroid injections
Surgical release in recurring cases
What is medial epicondylitis?
Golfers elbow- repeat strain of flexor origin
Overuse of flexor tendons that originate in medial humeral epicondyle
How does golfers elbow present?
Medial elbow pain
Tender point over origin of flexors at medial epicondyle
Exacerbated by wrist flexion and pronation, and grasping
How is golfers elbow investigated and managed?
Mainly clinical, can do USS and MRI if needed Nerve conduction studies if there are any nerve symptoms
Self limiting- treat conservatively. Can use steroid injections
Surgical release in recurring cases
What is cubital tunnel syndrome?
Ulnar nerve compression at elbow- behind medial epicondyle
Who gets cubital tunnel syndrome, and what causes it?
More common in men
Over 30
Can be caused post trauma, by direct pressure, or arthritis
How does cubital tunnel syndrome present?
Parasthesia in ulnar two fingers
Pain, clumsiness
Numbness and weakness is late sign
Tinels test over cubital tunnel positive
Ulnar clawing of ring and small fingers
How is cubital tunnel syndrome managed?
Elbow splintage
Physiotherapy
Nerve gliding
NSAIDs
Severe cases- ulnar nerve decompression
What is bicep tendinopathy and what causes it?
Inflammation of the long head
How does biceps tendinopathy present?
Localised pain, aggravated by shoulder flexion
Forearm pronation and elbow flexion
Bicep tendon will be tender to palpate, if torn there will be pop eye sign and bruising
How is a bicep tendinopathy investigated and treated?
USS
Managed conservatively and possible steroid injections, with surgical repair if necessary
What causes a proximal humerus fracture and what are the 2 main types
Usually osteoporotic
Surgical neck- lower down the ball and socket
Anatomical neck- higher up the joint
How do proximal humerus fractures present?
Pain and swelling, decreased motion
Ecchymosis of chest, arms, forearms
May cause axillary nerve injury -> deltoid weakness
Investigations and management for proximal humerus fractures
X-ray AP lat, CT for pre op
Can give collar and cuff sling
Operative- ORIF, replacement
What causes a humeral shaft fracture?
Fall -> oblique or spiral if rotational
Direct trauma
How do humeral shaft fractures present?
How are they investigated and treated?
Severe pain
Weakness in extremities
X-ray AP lat
Managed with braces all a full cast, or with IM nailing/ORIF plating
Radial nerve status needs checking as RN palsy can occur
Travels in spiral groove along profunda brachii artery, which is at level of humeral diaphysis
