Upper limb conditions (not fractures) Flashcards
Origin, attachment, function and innervation of supraspinatus muscle
O: supraspinous fossa
A: superior and middle facet of greater tuberosity
F: abduction of arm (empty can/Jobe’s test)
I: Suprascapular n (C5)
Origin, attachment, function and innervation of infraspinatus muscle
O: Infraspinous fossa
A: posterior facet of greater tuberosity
F: externally rotates arm
I: Suprascapular n (C5-6)
Origin, attachment, function and innervation of teres minor
O: middle half of lateral border of scapula
A: inferior facet of greater tuberosity
F: externally rotates arm
I: Axillary n (C5)
Origin, attachment, function and innervation of subscapularis
O: Subscapular fossa
A: Lesser tuberosity
F: internally rotates arm (Push-off test)
I: upper and lower subscapular n (C5-6)
Muscles of rotator cuff
SITS Supraspinatus Infraspinatus Teres minor Subscapularis
Clinical features of rotator cuff injury
Pain over lateral deltoid on overhead activities
Active painful arc test (beyond abduction of 90deg)
Drop arm test (failure to smoothly control shoulder adduction)
Weakness in external rotation
Investigations in rotator cuff injury
x-ray usually normal
U/S - superficial tendon and muscle lesions
MRI; full thickness or partial tears
Management of rotator cuff injuries
Physical therapy (mobility, strength, function) \+/- corticosteroid injection
Indications for surgical management:
- failure of conservative 6-12m
- tear over 3cm
- acute full thickness tear in otherwise normal rotator cuff
definition of adhesive capsulitis AKA frozen shoulder
A condition of varying severity characterised by the gradual development of global limitation of active and passive shoulder motion where radiographic findings other than osteopaenia are absent
Presentation of adhesive capsulitis
Phase 1: painful - diffuse, disabling shoulder pain - worse at night - increasing stiffness - lasts 2-9m Phase 2: stiffness - stiffness and severe loss of ROM - Pain less pronounced - lasts 4-12m Phase 3: recovery - gradual return of ROM - 5-24m
Physical findings in adhesive capsulitis
Reduce active and passive ROM in at least 2 planes - esp. external rotation and abduction
Firm, painful, premature end to passive ROM
Confirm diagnosis with injection of local anaesthetic (rule out red. ROM due to pain)
Causes of adhesive capsulitis
Diabetes Thryoid disease Prolonged immobilisation Stroke Autoimmune disease Shoulder injuries (RC tears, proximal humerus fractures etc.)
SLAP lesion
Superior laburm, anterior to posterior
Injury to the superior labrum (upper cartilage rim that lines the glenoid
Mechanism of SLAP lesions
Repetitive throwing motions
Falling onto outstretched arm
Pulling of the arm
Sudden force applied to the biceps when muscle in contracted
Direct blow to the shoulder with the arm in throwing position
Physical findings and examination in SLAP lesion
+ve Speed’s test
+ve Obrein’s test
+ve Crank test
MRI arthrogram
