Upper limb Flashcards
Erb’s palsy
upper roots of brachial plexus
affected, C5 and C6
limbs hangs by side in medial rotation with an adducted arm and extended elbow
Waiters tip position
an excessive increase in angle between neck and shoulder
May occur in trauma or during birth of a baby if the shoulders become impacted in the pelvis (shoulder dystocia) and excessive traction is applied to baby’s neck
Klumpke’s palsy
Injury to lower roots of brachial plexus
Nerve roots C8 and T1 affected
Occur due to forced hyperextension or hyperabduction
Ie. When someone falls from a height and grabs onto a tree branch on the way down
○ If baby’s arm is delivered first and traction is applied to arm to deliver the rest of baby
Klumpke’s palsy symtpoms
The paralysis affects the intrinsic muscles of the hand and those flexors within the forearm that are supplied by the ulnar nerve (i.e. flexor carpi ulnaris and the ulnar half of flexor digitorum profundus).
affects those muscles supplied by the C8 and T1 fibers within the median and radial nerves, so is not just a straightforward high ulnar nerve injury (compare the image on the next page with the ‘high ulnar claw’ in session 9 here).
'claw hand' with hyperextension of all of the metacarpophalangeal joints (not just the ring and little finger seen in an ulnar nerve injury), flexion of the interphalangeal joints abduction of thumb wasting of the interossei
Rupture of biceps tendon
Popeye sign
Long head may rupture near to its scapular origin
Patients >50 following quite minimal trauma
‘head something snap’ in shoulder whilst lifting
Flexion of the arm at the elbow produces a firm lump in lower part of the arm - unopposed contracted muscle belly of the bicep = Popeye sign
Patient will not notice much weakness in upper limb due to action of the brachialis and supinator muscle, mamagenet is usually conservative
Weightlifters: distal tendon of the biceps sometimes snap near to its insertion instead
Dislocated shoulder
Will be visibly deformed and there may be visible swelling and/or brushing around the shoulder
Restriction of movement
90-95% are anterior dislocations
Head of humerus sits anterior to the glenoid fossa, glenoid fossa is shallow
Joint is stressed on its superior, anterior and posterior aspects, it is weak at its inferior aspect
Head of humerus usually dislocates anteroinferioyl but then often displaces in an anterior direction due to pull of muscles and disruption of the anterior capsule and ligaments
Subcoracoid locatio = 60% of cases
Head of humerus may come to lie anterior-inferior to the glenoid (subglenoid location in 30% of cases0
Both are types of anterior dislocation
anterior dislocation arm look like
held in position in a position of external rotation an slight abduction
Bankart lesion/labral tear
Force of humeral head popping out of the socket often causes part of the glenoid labrum to be torn off
Small piece of bone can be torn off with the labrum
Hill Sachs lesion
-When humeral head is dislocated anteriorly, the tone of the infraspinatus and teres minor muscles means that the posterior aspect of the humeral head becomes jammed against the anterior lip of the glenoid fossa
Causes a dent (indentation fracture) in the posterolateral humeral head = Hill-Sachs lesion
50% of people <40 with anterior shoulder dislocation, and up to 80% of those with recurrent dislocations will have this
Assocaited with Anterior dislocation
Posterior dislocation
Less common - 2-4% of cases Violent muscle contractions due to: epileptic seizure Electrocution lightning strike blow to the anterior shoulder or when arm is flexed across the body and pushed posteriorly
Pos. Dislocation arm look like
internally rotated and adducted
Flattening/saying of the shoulder with a prominent coracoid process
○ Arm cannot be externally rooted into the anatomical position
What injuries are commonly assocated with Post.Dislocations
fractures rotator cuff tears, and hill-Sachs lesions
Inferior dislocations
0.5%
Head of humerus sits inferior to the glenoid
Mechanism is forceful traction on the arm when it is fully extended over eh head, may occur when grasping an object over the head to break fall i.e. hyperabduction injury
Injuries associated with inferior dislocation include damage to nerves 60%, rotator cuff tears (80%) and injury to blood vessels (3%)
In dislocations, which is more common nerve or arterial injuries?
injuries of the axillary nerve which occur in around 10-40% of shoulder dislocations
Axillary nerve wraps around neck of femur and supplies the deltoid muscle and skin overlying the insertion of deltoid
Regents badge area as it corresponds with where a shoulder badge woul be worn on the sleeve of a jacket
Most with xaxiallry nerve damage will recover full as ymptoms resolve when the should is reduced/aka put back into place
Less commonly dislocation of shoulder may damage the cords of the brachial plexus or msuculocutanous nerve
what are the rotator cuff muscles
Supraspinatus, infraspinatus, subscapularis,
teres minor
rotator cuff muscle tears
- Association with shoulder dislocation commonly in older people
Common complication of inferior dislocation in all age groups - 80% of inferior dislocations are associated with a rotator cuff tear
Integrity of the rotator cuff should always be assessed as part of the follow up patients after reduction of dislocated shoulder
Clavicle fracture
3-5% of all fractures
peak in children and young adults
Clavicle acts as a structure to brace the shoulder from the trunk so the arm has freedom of motion and transmits force from the upper limb to the axial skeleton
Provides protection to the brachial plexus, subclavian vessels and the apex of the lung
80% of fractures occur in middle third of the clavicle - midclavicualr fracure
Most result from falls onto the affected shoulder or onto the outstretched hand
Clavicle fracture treatment
conservatively without surgery, using a sling
Surgical fixation:
Complete displacement- so bone ends are not in apposition and cannot unite
Severe displacement causing tending o the skin with risk of puncture
Open fractures - fracture associated with a break in the integrity of skin
Neurovascualr comprimse
Fractures with interposed muscle
Floating shoulder - clavicles fracture with ipsilateral fracture of glenoid neck
What will happe to the position of the arm and clavicular fragments in a displaced mid-claviclular fracture - fracture at the midpoint of the clavicle?
Sternocleiodomastoid muscle elevates the medial segment
Because the trapezius muscle is unable to hold the lateral segment up, and also because of the weight of the upper limb, the shoulder drops
Arm is pulled medially by pectoralis major - addiction
What are general complications with fracture healing?
General complications associated with fracture healing i.e. non-union (failure to unite) and malunion- uniting in a suboptimal position, there are potential local complications such as pneumotorax or injury to surrounding neurovacular structures
Suprascapular nerve may be damaged by the elevation of the medial part of the fracture
Supraclavicualr nerves c3 and 4 may also be damaged = paraesthesia over the upper chest anterioly
Cause of rotator cuff tears
age relegated degeneration
Age, blood supply to the rotator cuff tendons decreases, impairing the body’s ability to repair inor injury
Degenerative-microtauma model
Age related tendon degeneration compounded by chronic micro trauma results in partial tendon tears that develop into full rotator cuff tears
Inflammatory cells are recruited
Oxidative stress leads to tenocyte - tendon cell apoptosis, leading to further dengue ration
Recurrent lifting and repetitive overhead activity are also risk factors e..g carpenters, painters, as are support tht invovle repeated overhead motion e.g swimming volleyball, tennis, weightlifting
More common in shoulder of domianant arm for rotator cuff tears,but a tear in one shoulders shoulda an increased risk of a tear in the opposite shoulder
Rotator cuff tears symptoms
asmyptomatic
Clincial presetiaon is aterolatera shoulder pain, often radiating down the arm
May occur with activity particular shoulder activity above the horizontal position but is may also be present at rest
Patents experience pain in their shoulder hen they lean o their elbow and push downwards e..g learning on an armrest of a chair, as this pushes te head of the humerus superiority and decrease the space between the humeral head and the coracoacromial arch
pain in shoulder when reaching forward - flexing the shoulder e.g. to take a bottle of milk from the refrigerator
Pain restricted movements above the horizontal position may be present, as well as weakness of shoulder abduction but weakness only found on physical examination, as it is the pain that predominately limited the patients activities and leads them to seek medical attention
Impingement syndrome
Supraspinatus tendon impinges - rubs or catches on the coraco-acromial arch, leading to irritation and inflammation
Space between the head of the humerus and coracoacromial arch is small,
- Impingement may be caused by anything that narrows this space further e. g thickening of the coracoacromial ligament,
inflammation of supraspinatous tendon,
subacromial osteophytes in OA
Impingement syndrome symptoms
grinding or popping sensation during movement of shoulder
Calcific supraspinatus tendinopathy/ tendonitis
Macroscopic depositis of hydroxyapatite - crystalline form of calcium phosphate in the tendon of supraspinatus
Can occur in any tendon of the rotator cuff
Most common in supraspinatus
- Present with acute or chronic pain, aggregated by abducting or flexing the arm above the level of the shoulder, or by lying on the shoulder
Mechanical symptom may occur due to hyiscl presence of a large deposition = stiffness, snapping sensation, catching, or reduced range of movement of the shoulder
Cause of Calcific supraspinatus tendinopathy / tendonitis
Disease believed to be multifactoral
Regional hypoxia leads to tenocytes being transformed into chrondrocyes and laying down cartialge in tendon. Calcium depositions are then formed through a process resembling endochondral ossification
Ectopic bone theory. Formation from metaphase of mesenchymals stem cells normally present in tenons into osteogenic cells
Calcification dspesiit are visible on x rays
- explain
Crystalline in their ‘resting phase’
Eventually reaborsbed by phagocytes and it is during this reabsorption stage that they end to cause the most pain
During the reabsoprtion stage thy look microscopically like ‘toothpase’ and often appear ‘cloudy’ i.e. less well defined on x ray
Treatment of Calcific supraspinatus tendinopathy / tendonitis
conservative with rest and analgesicsa, surgical treatment is sometimes required for persistent symptoms
Adhesive capsulitis / frozen shoulder
Painful and disability disroder
Capsule of the glenohumeral joint becomes inflamed and stiff
Restricting movement and causing chronic pain
Constant pain, worse at night and exacerbated by movements and cold weather
Adhesive capsulitis / frozen shoulder - risk factors
Female,
epilepsy with tonic seizures - sudden muscle contractions,
DM - glucose bonds to capsular collagen,
trauma to shoulder,
CT disease,
thyroid disease - hypo/hyper, cardiovascular disease,
chronic lung disease,
breast cancer,
polymyaliga rheumatica - inflammatory condition using msucle pain and weakness and
Parkinson’s disease
Adhesive capsulitis / frozen shoulder - treatment
physio therapy, analgesia and antinflammatory medication
Manipulation under anaeastheisa hich breaks up the adhesions and scar tissue in the oint to help restore range of motion
Intense post op physio this then helps maintain the movement that has been gains
Typically resolves with time and Evian 90% of their shoulder motion
Once frozen shoulder has resolved, the opposite shoulder becomes affected in 6 to 17% of patients within 5 years, lending further weight to the autoimmune hypothesis
OA of shoulder
Can occur in shoulder joint and has radiological features similar to osteoarthritis occurring in other joints
People > 50 years of age
Affects acromicoclavicualr joint than the glenohumeral shoulder joint
OA of shoulder treatment
Activity modification - avoiding activities that precipitate symptoms
Analgesia
Anti-infalmmtaories - NSAIDs
Some report a benefit fro taking nutritiaonl supplements e..g glucosamine and chondrotin sulfate
Steroid injections can be performed into joint to reduce swelling and thereby alleviate shoulder stiffness and pain
Hyaluronic acid injections into joint - viscosupplementation may increase lubrication, although evidence is omitted
Arthroscopy - key whole surgery- can be performed to remove loose pieces of damaged crialge from glenohumeral joint but some patients will progress to hemiarthroplasty - replacement of humeral head or total shoulder replacement - replacement of humeral head and glenoid
Supracondylar fracture
Fracture line = extraarticualr (joint is not involved) and distal fragment is posteriorly displaced
Falling from a moderate height ont an outstreched hand with elbow hyperextened (i.e. monkey bars)
90% seen in children <10 with a peak age: 5-7 years , more in boys
Child presents with pain, deforming and loss of function
Less common mechanism (5%) - falling onto a flexed elbow
‘flexion supracondylar fractures’ occur more in elderly
Supracondylar fracture - complications
Malunion - resulting in cubitus varus / gunshock deformity
Damage to median nerve (most common), radial or ulnar nerve
Ischaemic contracture - brachial artery passes v.close to the fracture site and can occasionally by damaged or occluded by a displaced fracture
If reflex spasm of collateral circualtion around elbow occurs - ischamei of muscles in atnerior compartment of forearm. Results in oedema and a rise in compartment pressure (compartment syndrome) = further exacerbrate the ischameia as it impeded arterial inflow and if untreated the muscle bellies will undergo infarction
During repair phase: dead muscle tissue becomes replaced by scar tissue through fibrosis
Fibrotic tissue contracts by myofibroblast activity = flexion contracture known as Volkman’s ischaemic contracture
Supracondylar fracture - what does the wrist look like
flexed, fingers extened at MCPJ and flexed at the interphalangeal joints, forearm pronated and elbow flexed
Dislocated elbow
Person often child, falls on their outstretched hand with the elbow partially flexed
More likely to cocur in mid flexion
90% are posterior (named by the displacement of distal framgnet i.e. ulnar and radius and not the proximal fragment - humerus)
Distal end of humerus is driven through the joint capsule anteriorly
Ulnar collaterla ligament is torn and can be an associated fracture and/or ulnar nerve involvement
Dislocated elbow - anterior dislocations
<10%
direct blow to posterior aspect of a flexed elbow
Assocaited fractures of he olecranon are common seen due to degree of force requreid to dislocate joint
Nursemaid’s elbow/pulled
Subluxation of radial head (subluxation = partial disruption of a joint with some remaining but abnormal apposition of the articular surfaces i.e. it is an incomplete dislocation)
Occurs in chldren agen: 2-5 years
Reduced movement of elbow and pain over lateral aspect of the proximal forearm - ‘not using their arm’
50% = 50% during falls or over-reaching for an object
Injury occurs most commonly in pronation becaue the annular ligament is tauty in supination and more relaxed in pronation so it is easier for subluxation to occur
Longituadionl traciton on radial head tears the distal attachement of the annular ligament from where it is losely attached to neck of radius
Radial head is then displaced distally through the torn ligament
As children age, the annular ligament naturally strenghteshn making conition less common
Mechanism of action of pulled elbow
Mechanism: longitudinal traction is applied to arm with forearm pronated (tugging an uncooperative child or swining a child by their arms during play) = 50% iof cases
Radial Head/neck fractures
Result from a fall on an outstertched hand when radial head impacts on the capitellum of humerus
Patient presents with pain in the lateral aspect of their proximal forearm and loss of range of movement
Swelling asociated with these fraactures - modest in comparision with supracondylar fracture
Fracture by red arrow
Fat pad sign (or sail sign) is an indicator that an effusion is present
Setting of trauma, due to a haemarthrossi (blood in joint) secondary to an intra-articular fracture
Displacement of the anterior fat pad
Displaced fat pad is relatively radio-lucent and therefore appears black on the X ray
RA of elbow
Autoimmune disease in which autoantibiodes (rheumatoid factor) attack the synovial membrane
Inflamed synovial cells proliferate to form a pannus, which penetrates through the cartialge and adjacent bone = joint erosion and deformity
Affects the metacarpophalagneal joints and proximal interphalngeal joints of hands, feet and cervical spine, involve the large joints
Autoimmune process leads to damage to other organs, inclduign eyes, skin, lungs, heart and blood vessels and kidneys
Commonly have anaemia of chronic disease
Women ore affected than men (2:1 or 3:1)
X ray features of RA
Joint space narrowing
Periarticular osteopenia
Juxta-articular (called marginal) bony erosions (in non-cartilage protected bone)
Subluxation and gross deformity
RA of elbow
Managed medically rather than surgically through presciprtion of dsiease-modifying medication
Surgery in severe cases to relieve pain and improve mobility
X ray - extensive erosion of the humeroulnar joint with most of the trochlear of humerus having been destroyed and sigmoid fossa of the olecranon being sig enlarged
Tennis elbow
lateral epicondylitis
Tendinopathy - chronic overuse disorders in tendons
3% of persons aged 40-60 years
Present with pain due to tendinopathy of common extensor tendon (common extesor origin) at lateral epicondyle
Extensor carpi radilais brevis (ECRB) muscle helps stabilise wrist when eblow is traight. Occurs during ateensi groundstroke.
When ECRB is weakened from oversue, microscopic tears form in tendon where it attaches to lateral epicondyle. Leads to inflammation and pain
Pain over lateral epicondyle during extension of the wrist
Tennis players, painters, plumbers and carpenters are prone - due to repetitive nature of their activity at wrist and elbow
Patients are advides to modify activities to give tendon an opportunity to heal.
Disorder is self-limiting and 90% of patients recover within 1 years.
Physio and bracing required sometimes, and a small number of patients need injections or surgery
Golfer’s elbow/ medial epicondylitis
10x less common than tennis elbow
Affects common flexor origin at the medial epicondyle
Associated with golfing and with throwing sprots that palce valgus stress on the elbow.
Most comon site of patholgogy - inferface between the pronator teres and the flexor carpi radialis (FCR) origins
Patients present with an aching pain over the medial elbow, assocaited with accelearation phase of throwing
Pain is produced on resisted flexion or pronation of the wrists
Ulnar nerve symptoms are present in up to 20% of cases due to proximity of the ulnar nerve to the medial epicondyle
Student’s elbows/ Olecranonn bursitis
Inflammation of olecranon bursa
Situated between skin and the olecranon process of ulna
Usually due to repeated minor trauma e.g. students leaning with elbows on desk for many hours whilst studying
Contnets will be serous fluid
Swelling = soft cystic (fluid-filled) and transilluminates (light can be shined through it)
Student’s elbows/ Olecranonn bursitis - treatment
conservative with compression bandagin +- aspiration
Hydrocortiosne injection sometimes necessary in chronic cases
Sometimes, bursitis is a result of infection of the bursa (septic bursitis e.g. following a minor penetrating injury to the elbow), then aspirton, compression and antibotics are required
Occosaionally, surgical draininage and washout under anaesthetic will be needed to resolve the infection
Rheamtoid nodules
extra-articualr manifestions of RA
Firm lumps. Not usually painful
Affects 20% of patients with RA
Those who develop them, are smokers, and more aggressive joint disease, and more prone to other extra articular (outside of the joint) manifesations of rheumatoid disease including vasculitis (inflammation of blood vessels) and lung disease
Occur over exposed regions that are subject to repeated minor trauma
Affects elbow reign, fingers and forearms and occasionally over back of heel
Non-tender athlout overlying skin can occasionally ulcerate and become infected
Patients present due to cosmetuc concers
Rheumatoid nodules - treatment
improvming medicla control of underlying RA, although response of exisiting nodules to this is somewhat variable
Gouty trophi
Tophi are nodular masses of monosodium urate crystals deposited in soft tissues
Late complication of hyperuricaemia and devleop in >50% of patients with untreated gout
Usually painless, but complaications can include pain, soft tissue damage and deformity, joint destructuin and nerve comrpession
Common sites: fingers and ears, but can be found in the olecranon bursa and subcutaneous tisue of elbow where they can resemble rheatoid noduels I appearance
Contain white ‘pasty’ materal and as they enlarge, they work their way towards skin surface to drin, either foriming a sinus tract or a continusoly draininage ulcer
Cubital tunnel syndrome
Flexor carpi ulnaris muscle has 2 heads - one head orignating form common flexor origin on medial epicondyle and a seond head originating from medial margin of the olecranon
2 heads untied by a tendinous arch
Ulnar nerve passes beneath this tendinous arch to enter the cubital tunnel - this area forms a common site for ulnar nerve compression = cubital tunnel syndrome
Cubital tunnel syndrome
to ‘decompress’ nerve - surgically release it and transpose it anterior to medial epicondyle
Scaphoid fracture
70-80% of all carpal bone fractures, and 10% of hand fractures
Proximal pole = 20%
Distal pole = 10% = 10% scaphoid tubercle
Scaphoid fracture - mechanisms of actions
FOOSH - fall onto an outstretched hand
=hyperextensin and impaction of scaphoid against rim of radius or in direct axial (‘end on’) compression of scaphoid
Complain of pain in the anatomical snuffbox. Exaccerbed by moving the wrist. passive rang eof mtion is reduced but not dramatically. Can get swelling around the radial and posterior aspects
Scaphoid fracture risk
Blood supply to scaphoid is retrograde (from distal to proximal pole) = asvscaulr necrosis
Displaced fractures through the waist of the scaphoid have high risk of non-union (8-10%), malunion, avascualr necrosis and late complications of carpal instability and secondary osteoarthritis
Colle’s fracture
Extra-articular fracture of distal radial metaphysis, with dorsal angulation and impaction
An associated ulnar styloid fracture is present in 50% of cases
Common type of distal radial fracture
Common in: osteoporotic (reduced bone density) and post menopasual women
High imoact trauma e.g. skiing
FOOSH with a pronated foream and wrist in dorsiflexion
Energy transmistted from carpus to distal radius in a dorsal direction and along the long axis of the radius
Fracture: dorsally angulated and impacted
Colles fracture treatment
Reduction and immobilisation in cast
Colles fracture complications
Malunion - can cause dinner fork deformity
Median nerve palsy and Post traumatic carpal tunnel syndrome
Secondary osteoarthtris (more common with intra-aticular fractures)
Tear of extensor polllicis longus tnednon (through attrition of tendon over a sharp fragmenet of bone)
Smith Fracture
Fracture of distal radius with volvar (palmar) angulation of the distal fracture fragments
85% are extra-articular
Thought as a ‘reverse colles’ fracture
Smith fracture- mechanism
Occur in young ales and elderly femlaes
Fall onto a fleed wrist or a direct blow to back of wrist
Malunion of a smith fracutre with residual volar displacement of distal radius = cosmetic deformity = ‘garden spade defomrity’
Narrows and distorts carpal tunnel
Carpal tunnel syndrome can be a result form this
RA of MCPJ and IPJs
Inflammaed synrovial cells proflieratite to forma pannus which penetrates through the cartialge and adjacent bone, leading to joint erosion and deformity
RA described as a symmeetircal polyarthritis = affects multiple joints in a snyovial distriction e.g. L and R wrist at same time
Symmetircal inflammation can make mild swelling in hand difficult to diagnose as there is no ‘normal’ hand with which to make a comparison
RA of MCPJ and IPJs symtpoms
Pain and swelling of PIPJs and MCPJs of the fingers
Erythema (redness) overlyign joints = idnicates inflammation
Stiffness, worst in morning or after periods of inactivity = causing difficulty with tasks such as doing up buttosn)
Carpal tunnel syndorme due to synrovial swelling
Fatigue and flu-like symtpomts due to systemic nature of rheumatoid disease
2 deformities of RAof MCPJ and IPJs
Swan neck - PIPJ hyperextends and MCPJ and DIPJ are flexed
Boutonniere - MCPJ and DIPJ are hyperextened and PIPJ is flexed.
Psoriatic arthropathy
Only a minority of patients with psoriasis will develop arthritis.
Develops an asymmetrical oligoarthritis (it develops in one joint at a time, progressing in an asymmetrical manner e.g. left big toe then right index finger).
Psoriatic arthritis involves the small joints of the hands and feet most commonly.
The patients present with fusiform (sausage-shaped) swelling of the digits, known as dactylitis (=swollen digits).
The affected joints stiffen and if the disease progresses, it can progress to a widespread joint destruction called arthritis mutilans.
Psoriatic arthropathy
smyptoms
affects the DIPJs.
80% of patients also have nail lesions, such as pitting and onycholysis (separation of the nail from the nail bed). [note: onycholysis can also be caused by hyperthyroidism and fungal nail infections, but the nail pitting is very typical of psoriasis]
OA of hand
Osteoarthritis of the 1st CMC joint and DIPJs, including Heberden’s nodes.
The joint in the hand that is most commonly affected by osteoarthritis is the 1st carpometacarpal joint (between the trapezium and the first metacarpal). This is more common in women
OA of hand - symtpoms
The patients complain of pain at the base of their thumb. The pain is exacerbated by movement and relieved by rest. Stiffness increases following periods of rest (e.g. in the mornings).
There may be some swelling evident around the base of the thumb.
In the later stages, the first metacarpal subluxes in an ulnar direction, resulting in loss of the normal contour and ‘squaring of the hand’.
Herberdens nodes
classic sign of osteoarthritis and affect the DIPJ of the fingers. They typically develop in middle age, are more common in women than men and tend to run in families, suggesting a genetic predisposition.
Carpal Tunnel syndrome
compression of the median nerve as it passes through the carpal tunnel from the forearm into the hand.
common site of nerve entrapment in the body
Carpal Tunnel syndrome - risk factors
Obesity
repetitive wrist work
Pregnancy
Rheumatoid arthritis Hypothyroidism
Guyon’s canal syndome/ Handlebar palsy
The ulnar nerve can be compressed in Guyon’s canal, as it passes
radial (lateral) to the pisiform bone over the volar surface of the flexor retinaculum.
Called Ulnar tunnel syndome, Guyon’s canal syndome or Handlebarpasly (due to postioning of cylsists wrists on handlebards leading to ulnar nerve compression)
Guyon’s canal syndome/ Handlebar palsy
smyptoms
reports paraesthesia in the ring and little fingers,
progressing to weakness of the intrinsic muscles of the hand supplied by the ulnar nerve (notably adductor pollicis and the palmar and dorsal interossei; also lumbricals to ring and little fingers and deep head of flexor pollicis brevis, but these are not usually noticed by patients)
Dupuytren’s contracture
common condition in which there is localised thickening and contracture of the palmar aponeurosis leading to a flexion deformity of the adjacent fingers.
Dupuytren’s contracture -conditions that increase risk of developing this
Type 1 diabetes
Having had adhesive capsulitis of the shoulder (‘frozen shoulder’, here)
Epilepsy, taking certain medications e.g. barbiturates, phenytoin
Liver disease and/or excessive alcohol consumption (more than a bottle of wine per day)
Smoking
Hypercholesterolaemia
Heart disease
HIV
Hypo- or hyperthyroidism
Trauma to the hand or fingers
Vibration-related hand injury (e.g. working with vibrating tools regularly for > 10 years)
