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CS6 > Upper limb and chest > Flashcards

Upper limb and chest Flashcards

1
Q
A
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2
Q

What is the dermatomal distribution to the upper limb?

A

C4 - shoulder and clavicle

C5 - lateral arm

C6 - posterolateral to thumb

C7- posterior elbow to digits 2-3 and middle palm

C8 - armpit to digits 4-5

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3
Q

What is the nerve supply to the upper limb

A
  1. Axillary nerve -
  2. intercostobrachial - lateral trunk medial arm
  3. Radial nerve - posterolateral arm, posterior forearm, dorsum of hand 2 -3 digint and thumb
  4. medial antebrachial cutaneous nerve
  5. lateral antebrachial cutaneus nerve
  6. Median nerve - palm between thumb and 3 digit
  7. Ulnar nerve -
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4
Q

Brachial plexus

A
  1. Dorsal scapular - C5 - Root
  2. Long thoracic - C4,5,6,7 - Roots
  3. Suprascapular - C5-6 - Superior division
  4. Subclavius - C5-6 - Superior division
  5. Axillary - C5-6 - Posterior cord
  6. Lateral Pectoral - C5,6,7 - Lateral cord
  7. Musculocutaneus - C4-5,6,7 - Lateral cord
  8. Radial - C5,6,7,8,T1 - Posterior Cord
  9. Median - C5,6,7,8,T1 - Lat - medial cord
  10. Ulnar - C7,8, T1 - Medial Cord
  11. Subscapular - C5,6 - Posterior cord
  12. Thoracodorsal - C5,6,7 - Posterior cord
  13. Medial Pectoral - C8, T1 - Medial cord
  14. Medial AnteBrachial - C8, T1 - medial cord
  15. Medial brachial - C8 - medial cord
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5
Q

What is the light touch pathway?

A

3 Neuron pathway

  • 1st order neuron stimulates the copurscle mechanorecepter travel through the nerve
  • Enters via the dorsal root ganglion
  • Enters the cuneate nucleus - synopsis with second order neuron
  • Thalamus via DCML to synopsis with 3th order neuron
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6
Q

What are the cutaneous supply to the thorax?

A

Poterior thorax dorsal rami spinal nerve

Anterior thorax, anterior rami spinal nerve - give anterior medial cutaneus branch

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7
Q

What is the sensory supply to the viscera

A

visceral afferent fibres give sensory supply.

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8
Q

What are the red flags for chest pain?

A
  • •Dizziness/syncope
  • Pain in arms L>R, jaw
  • Thoracic pain
  • Sweating
  • Palpitations
  • Dyspnoea
  • Pain on inspiration
  • Pallor
  • Past history: ischaemia, diabetes, hypertension
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9
Q

Always assume a person is having a heart attack

A

True

False

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10
Q

What are the most likely causes of chest pain?

A
  1. Musculoskeletal
    • intercostals, pecs, mm. strain (coughing - overuse)
    • Costochondritis (inflammation)
    • rib fracture
    • rib sprain
    • Facet sprain referral
    • TOS
  2. Psychogenic - (localized pain over heart)
    • Stress
    • anxiety
  3. Angina - (referred locations)
    • Stable
    • unstable
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11
Q

What are the chest pain serious disorders?

A
  • Cardiovascular
    • unstable angina
    • aortic dysection
    • pulmonary embolism
  • Neoplasia - tumour
  • Infection
    • pneumonia
    • pleurisy
    • pericardis
  • Pneumothorax
    • traumatic
    • closed
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12
Q

What are other chest conditions often missed

A
  1. TOS
  2. Gastrointestinal
    • gord
    • gastritis
    • ulcera
    • reflux
  3. Herpes zoster
  4. esophageal pain
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13
Q

What are the most common conditions for shoulder pain?

A
  1. Cervical spine dysfunction
    • Somatic referred
    • Radiculopathy
  2. subacromial impingement syndrome
  3. Tendinopathy
    • Rotator cuff
    • Bicipital
  4. Adhesive capsulitis
  5. GH labral tear
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14
Q

Serious disorders affecting shoulder?

A
  1. Cardiovascular
    • •Angina, myocardial infarction, pericarditis
    • •Deep vein thrombosis (axillary, subclavian)
  2. Neoplasia
    • •Primary or secondary bone tumours
    • •Pancoast syndrome
    • •Lymphoma
  3. Severe infections
    • •Osteomyelitis
    • •Pneumonia, pleurisy
  4. Pneumothorax
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15
Q
  1. Cervical Myelopathy
  2. Thoracic Outlet Syndrome
  3. Rheumatological
    • •Osteoarthritis: glenohumeral joint, acromioclavicular joint
    • •Rheumatoid arthritis
    • •Gout
    • •Polymyalgia rheumatica
  4. Visceral referral
    • •Gastrointestinal
    • •Other causes of diaphragmattic irritation?
A
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16
Q

What structures cause subacromial impingement?

A

Intrinsic factors

  • Biceps tendonitis
  • Supraspinatus tendonitis
  • irritation of a subacromial bursa
  • Rotator cuff pathology

Extrinsic factor

  • scapular dyskinesis
  • Abnormalities on AC joint
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17
Q

What are the Hx, S&S for subacromial impingement?

A

Hx

  • Pain overhead
  • repetitive movements (throwing)
  • P sleeping on the shoulder
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18
Q

What test can be done for subacromial impingement

A
  • Empty can
  • Hackings - kenedy
  • Neer’s
  • Painful arch
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19
Q

What causes and Hx for adhesive capsulitis?

A

Idiopathic

spontaneus onset

women 3;1 40-60yr

metabolic condition

Loss of ROM GH

pain with movement

20
Q

What is the hx and what test is done for a labral tear?

A
  • Aprehension test
  • o’brian
  • catching grabbing
  • trauma
21
Q

What are the causes of arm pain?

A
  • Referral from shoulder
  • Referral from Cx
  • Bone disease (osteomyelitis)
  • lateral/ medial epicondylitis
  • tenosynovitis (inflammation of fluid around tendon)
  • carpal tunnel syndrome
  • tendonitis
  • ulnar nerve neuropathy
  • OA
  • Trauma #
22
Q

What are the most common conditions of the arm?

A
  1. Cervical spine dysfunction
    • •Radiculopathy
    • •Somatic referral?
  2. Shoulder disorders
  3. Medial or lateral epicondylitis
  4. Wrist tendonitis
    • •De Quervains
  5. Carpal tunnel syndrome
  6. OA of the thumb and DIP joints
23
Q

What are the conditions most often missed?

A
  1. Cervical myelopathy
  2. Thoracic outlet syndrome
  3. Entrapment neuropathies
    • •Ulnar nerve
    • •Median nerve
    • •Radial nerve
  4. Elbow inflammation
    • •Osteoarthritis
    • •Rheumatoid arthritis
    • •Olecranon bursitis
  5. Ischaemic necrosis
    • •Scaphoid #
24
Q

Serious conditions of the arm

A
  1. Cardiovascular
    • •Angina, myocardial infarction
    • •Deep vein thrombosis (axillary, subclavian)
  2. Neoplasia
    • •Primary or secondary bone tumours
    • •Pancoast syndrome
    • •Lymphoma
  3. Severe infections
    • •Osteomyelitis
    • •Septic arthritis
25
Q

What are the S&S of tennis elbow (lateral epicondylitis)?

A

wrist extension

P with stretching of the wrist

weakness

26
Q

What are the tests for tennis elbow (lateral epicondylitis)?

A

Cozens test - resisted ext. wrist

Mills - arm pronated at 90’, flex the wrist and extend arm. pain reproduced at lateral epicondyle

27
Q

What are the tests for carpal tunnel?

A

Phalens - reverse prayer

Tinels - tap on wrist

upper limb neuro

carpal compression test

28
Q

What test are done to differentiate the upper limb entrapment neuropathies?

A
  1. Ulnar nerve
    • Tinnels at gyon or olecranon
    • Ulnar tension test
  2. Median nerve
    • Median Nerve tension test
    • tinnels at carpal tunnel
  3. Radial Nerve
    • Radial tension test
29
Q

What are the rotator cuff provocation tests, to test for a rotator cuff pathology

A
  1. Speeds - biceps brachii - resist shoulder flexion with extended supinated arm.
  2. Empty can - supraspinatus
  3. Lift off - Subscapularis
  4. Infraspinatus provocation test (resist ext. rot gh)
30
Q

What are the tests for subacromial impingement?

A
  1. Neers - Passive flexion arm
  2. Hawkins Kenedy - PROM internal rotation at 90’ in a transverse plane
  3. painfull arch
  4. Rotator cuff pathology tests
31
Q

What tests are done for labral tear

A
  1. Obrian test
  2. Crank test - apprehension dislocation
32
Q

What test is done for tenosynovitis?

A

finkelstein

33
Q

What test are done for GH instability

A

sulcus

load and shift

apprehension

34
Q

What is the mechanism of action for Neural Tension test

A

•Assess sensitivity of nerve roots and peripheral nerves to movement and tension caused by movement (neurological mechanosensitivity)

35
Q

What are the tests done for TOS?

A

Clinical Features

  • Rarely purely arterial, venous or neurological
  • Pain and heaviness in neck, shoulder, arm, hand.
  • Adsons test for pure arterial
  • Roos test – most sensitive
  • • Combine with ULNTT
36
Q

What is the clinical presentation for TOS?

A
  • Compression of neurovascular structures from the neck into the axilla.
  • 3 common compression points

Hx

  • Common in overhead athletes, extended posture with protracted anterior GH.
  • Congenital abnormalities
  • Cervical rib, clavicle abnormalities,
  • large C& TP’s
37
Q

What is the recommended treatment for TOS?

A
  1. Patient education: improve posture
  2. Exercise: increase ROM, strengthen back mm.
  3. OMT: ST pecs, MET 1st rib, treat neck mm.
  4. Pharmacological: NSAIDS
  5. Venous TOS: avoid thrombus - blood thinners
  6. Arterial: surgery
38
Q

What are the grades of an acromioclavicular injury

A
  1. Sprain on the capsule
    • Localised tenderness and pain on
    • movement especially horizontal flexion
  2. II:
    • Tearing of AC ligs and sprain of CC ligs
    • Localised pain, possible small step deformity
  3. III & IV:
    • Complete Tearing of AC ligs and of
    • CC lligs
    • Marked step deformity
  4. V:
    • High levels of displacement
    • Radiograph and surgical intervention
39
Q

What is the treatment for an acromioclavicular injury?

A
  1. I & II: RICE, NSAID, reduce swelling
  2. Reduce pain and inflammation.
  • Normalise joint range of motion.
  • Strengthen your shoulder.
  • Improve your shoulder blade and shoulder alignment.
  • Normalise your muscle lengths.
  • Improve your upper limb proprioception.
  • Improve your technique and function eg lifting, overhead activities.
  • Minimise your chance of re-injury as you return to sport or work
  1. Grade 5: surgery
40
Q

What is the clinical presentation of adhesive capsulitis?

A
  • Occurring following trauma (fracture or surgery), injury to neural structures in the neck or spontaneously (idiopathic).
  • Most common between ages 40-60, F>M.
  • Increase risk with diabetes and thyroid disorders.
  • Self limiting condition that lasts over 1.5 years on average.
  • No one treatment modality has shown better outcomes.
  • Focus on keeping ROM, addressing biomech compensations, advice, reassurance.
41
Q

What is the treatment for adhesive capsulitis?

A
  • Non-steroidal anti-inflammatory medicines. Drugs like aspirin and ibuprofen reduce pain and swelling.
  • Steroid injections. Cortisone is a powerful anti-inflammatory medicine that is injected directly into your shoulder joint.
  • Physical therapy. Specific exercises will help restore motion
42
Q

What is the management for subacromial impingement?

A

Long term management

• NSAID

  • US
  • Cortisone

• Scapular retraining

43
Q

When should I use the different imaging for the shoulder?

A
  1. xray : usually first in acute pain
  2. Ultrasound usually first line of evaluation in rotator cuff pathology
  3. MRI for adequate evaluation of extra-articular soft tissue trauma, Capsular and ligament tear
44
Q

What are the vies for x-ray of the shoulder ?

A
  • Views
  • AP - humeral head on glenoid fossa
  • AP internal rot - lesser tubercle
  • AP external rot - greater tubercle
  • Lateral - dislocation gh
  • Axial -
  • Scapular Y Should
45
Q

What are the x-ray views of the elbow?

A
  • AP
  • Lateral flexion
  • Medial Oblique - What are the x-ray views of the elbow?
46
Q

WHat are the vies for x-ray of the wrist and hand?

A
  • PA: Carpals, distal radio ulnar joint, radiocarpal and ulnar carpal
  • Lateral: Carpal alignment (especially lunate) with radius
  • Oblique: Scaphoid: Ulna deviation and flexion
47
Q

For what conditions do you use ultrasound of the wrist?

A
  • Tunnel Syndrome and
  • Dequervains
  • Tenosynovitis

CS6 (10 decks)

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