Upper Limb Conditions Flashcards
Erbs palsy
Excessive increase in angle between the neck and shoulder
Trauma or baby birth (dystocia)
C5 and C6
Present with: Adduction Medially rotated Elbow extension Wrist flexion Pronation
Erbs palsy affected muscles
Biceps brachii - MN - C5 -C7 Corocobrachialis - MN Brachialis- MN Deltoid - AN - C5 - C6 Teres minor - AN Brachioradialis- RN - C5-T1
Klumpke’s palsy
Forced hyperextension or hyperabduction
C8-T1
Claw hand Hyperextension of MCPJ Flexion of IPJ Abduction of thumb Wasting of interossei
Claw hand
Seen in klumpke’s palsy
Hyperextension of MCPJ
Flexion of IPJ
Abduction of thumb
Wasting of interossei
Axillary lymphadenopathy
Enlargement of axillary lymph nodes due to: Infection Metastases of breast cancer Leukaemia or lymphoma Malignant melanoma metastases
Axillary lymph node dissection - danger of damage to long thoracic nerve or thoracodorsal nerve
Fracture of the scapula
Uncommon
Very chest trauma - RTA
Does not require fixation - muscle tone
Fractures of the surgical neck of the humerus
Frequent
Blunt trauma
FOOSH
Circumflex arteries at risk
Axillary nerve damage
Cannot abduct
Regimental badge area parasaethesia
Rupture of the biceps tendon
50+ yrs old minimal trauma
Something snap in shoulder whilst lifting
Flexion at alelbow produces firm lump - Popeye sign
Triceps tendon reflex test
C7
Elbow extension
Dislocated shoulder
Common
Visible swelling, deformity and bruising around shoulder
Restricted movement
95% are anterior
Hand behind head - hyperabduction and external rotation
Bankart lesion
Labral tear of glenoid labrum
Sometimes bone fragments torn off
In anterior dislocation
Hill-Sachs lesion
Dent in the posterolateral numeral head
Posterior dislocation
Less common
Violent muscle contraction:
Epileptic seizure
Electrocution
Arm internally rotated
Adducted
Squaring of shoulder
Prominent corocoid process
Inferior dislocation
Forceful traction of arm when fully extended over the head - hyperabduction
Damage to
nerves
Blood vessels
Rotator cuffs
Clavicle fractures
Common in mid clavicular area - middle third
FOOSH or on shoulder
Indication for surgical fixation in clavicle dislocations
Complete displacement Severe displacement Open fractures Neurovascular compromise Floating shoulder
Position of arm and clavicular fragments in displaced midclavicular fracture
Sternocleiodmastoid - elevates medial segment
Shoulder drops - unable to hold lateral aspect up by trapezius
Pectoralis major - Adducted
Suprascapular nerve may be damaged
Supraclavicular nerve damage (C3 - C4) - upper chest paraesthesia
Rotator cuff tear
Common
Tendons commonly affected
Supraspinatous tendon most common - tear at greater tubercle
Age related degeneration - degenerative microtrauma
Anterolateral shoulder pain
Radiating down arm
Pain on flexion and leaning on elbows
Weakness of shoulder abduction
Tenocyte
Tendon cell apoptosis due to oxidative stress
Impingement syndrome
Supraspinatus tendon impinges on the coroco-acromial arch
Irritation
Inflammation
Causes: Dull Pain (60 - 120 degrees abduction ) Weakness Limited range of movement Grinding and popping sensation
During abduction and flexion of shoulder
Causes of impingement syndrome
Narrowing of space between the corocoacromial arch and humerus
E.g
Thickening of corocoacromial ligament
Inflammation of supraspinatus tendon
Subacromial osteophytes
Calcific supraspinatus tendinopathy
Deposits of hydroxyapatite in supraspinatus tendon
Acute chronic pain Aggravated by abduction and flexion of arm above shoulder Stiffness Catching Reduced range of movement
Regional hypoxia - tenocytes - differentiate into Chondrocytes - cartilage
Adhesive capsulitis
Frozen shoulder
Capsule of glenohumeral joint becomes inflamed and stiff
Restricted movement
Chronic constant pain
Worse at night
Exacerbated by movement and cold weather
Idiopathic
Risks: Female Epilepsy Diabetes Trauma CT disease
Long periods of inactivity
Treatment of adhesive capsulitis
Analgesia
Physiotherapy
Anti - inflammatory
Manipulation under anaesthesia
