Upper Limb - Arm + forearm Flashcards
Biceps Tendinopathy, Proximal Humerus Fracture, Humeral Shaft Fracture
What is biceps tendinopathy?
Inflammation of the long head of the biceps tendon
What symptoms suggest biceps tendinopathy?
- Anterior shoulder pain radiating to the elbow
- Worsened by shoulder flexion, forearm pronation, and elbow flexion
What might a snapping sensation indicate?
Subluxation of the tendon
What is a key sign of a bicep tendon tear?
‘Pop-eye’ sign and extensive bruising
A pop-eye sign is seen where?
- Proximal long head of the biceps tendon (more common)
- Distal biceps tendon (less common but dramatic)
What investigation is used for bicep tendinopathy?
Ultrasound scan (USS)
‘There’s significant weakness + pain at the elbow, especially after lifting’
This suggest what?
Distal rupture
‘there’s a bulge but minimal weakness’
proximal long head
A 19-year-old is brought into the emergency department by ambulance from the gym. He reports attempting to ‘curl’ over 20kg of weight with his right arm when he felt intense pain at his right elbow with almost immediate weakness in his right arm. On examination of the arm, there is marked swelling at the elbow joint, there is also a prominent bulge in the anterior upper arm and the patient is extremely weak in flexion although supination is preserved
What is the most likely injury?
Long head of biceps rupture
A 45-year-old male presents to the GP after noticing a prominent bulge over his right biceps which appeared suddenly 1 day ago. There is no pain and there is no limitation to his movements. He is a frequent weight-lifter and has a history of injury to his shoulder 5 years ago
What is the most possible diagnosis?
Proximal bicep tendon rupture
What is the most common type of proximal humerus fracture?
Surgical neck fracture
What is the typical cause of proximal humerus fracture?
Low-energy falls, especially in osteoporotic bone
What are the key symptoms of a proximal humerus fracture?
Pain, swelling, and decreased motion
What is a significant concern in the clinical exam for those with a proximal humerus fracture?
Axillary nerve injury—check neurovascular status
How are simple proximal humerus fractures managed?
Conservatively with a collar and cuff
= ORIF or joint replacement in severe cases
What causes a humeral Shaft Fracture?
- Direct trauma to the arm (eg, RTC) results in transverse or comminuted fractures
- Fall resulting in oblique, or spiral fractures if rotational
What are the symptoms and signs of a humeral Shaft Fracture?
Symptoms
1. Pain
2. Extremity weakness
Signs
1. Preoperative/pre-reduction neurovascular exam is critical
- Examine and document the status of radial nerve pre and post-reduction
- Radial nerve injury - neurovascular examination!!
What commonly causes fractures of the radius and ulna shafts?
Direct or indirect trauma to the forearm
What are the 4 types of fracture patterns seen in radius and ulna shaft fractures (forearm fractures) ?
- Monteggia
- Galeazzi
- Nightstick fracture
- Greenstick fracture
What is a Monteggia fracture?
A fracture of the proximal third of the ulna with dislocation of the proximal head of the radius
= (1) Fall on an outstretched hand with forced pronation
(2) Needs prompt diagnosis to avoid disability
What is a Galeazzi fracture?
A fracture of the distal third of the radius with dislocation of the distal radioulnar joint
= Direct blow
What is a nightstick fracture?
An isolated fracture of the ulnar shaft, usually from a direct blow
What is a greenstick fracture and who typically gets it?
An incomplete fracture of a long bone that bends and cracks instead of breaking completely
= common in children due to flexible bones
What causes radial nerve palsy?
- Wrist drop ( the inability to extend the wrist, stays flexed and downwards) = classic sign of radial nerve palsy
- Inability to extend elbow and fingers
- Sensory loss over the posterior arm, forearm, and dorsum of lateral 3½ fingers
= matches radial nerve distribution
Therefore a humeral shaft fracture
