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
What is Speed’s test
Shoulder flexed to 90deg, palm upwards
Provide downward resistance
If pain present = +ve
indicates biceps tendon or labral tear
What is Obrein’s test
Shoulder elevated to 90deg, thumb down
Adduct arm across midline
Provide resistance against further shoulder elevation
Repeat with thumb up
Pain with thumb down, relieved by thumb up = positive
What is Crank’s test
Fully abduct arm and provide axial lode on humerus then internally and externally rotate the arm
Pain, catching or painful clicking = +ve
most common types of shoulder dislocation
Anterior most common (95%)
Posterior (2-4%)
Inferior (0.5%)
Mechanism of injury of shoulder dislocation
Anterior: blow to abducted, Externally rotated and extended arm (e.g. blocking a bball shot)
Posterior: Violent muscle contractions following a seizure or electrocution, blow to anterior portion of shoulder
Clinical presentation of anterior shoulder dislocation
Held in abduction and external rotation
Resists in all movement
Acromion is prominent (in thin patients)
Loss of normal rounded appearance of shoulder
Check axillary n function (deltoid patch)
X-ray findings of posterior shoudler dislocation
Light bulb on AP x-ray (internal rotation - rounded appearance of humeral head)
Management of shoulder dislocation
closed reduction with short term pain relief (e.g green whistle)
Immobilisation with collar and cuff/sling and swathe
- 3w under 30y
- 1w over 30y (lower rate of redislocation, need early mobilisation)
Indications for surgery in shoulder dislocation
Irreducible
Displaced greater tuberosity fractures
Bankart fractures causing glenohumeral instability
Significant Hill-Sachs lesions
recurrent instability or activity limitations
Complications of shoulder dislocation
Recurrent dislocation (50-90% under 20y)
Hill-sachs deformities
Bankart lesions
Greater tuberosity fracture (10%)
What is a hill-sachs deformity
Cortical depression of humeral head created by glenoid rim during dislocation
What is a bankart lesion
Disruption of labrum during dislocation +/- avulsion of bone fragment (=bony bankart)
Golf elbow
Medial epicondylitis
Tennis elbow
Lateral epicondylitis
Management of epicondylitis
NSAIDs
Observation
Modification of activities
Bracing (counter force brace beneficial during first 6 weeks following injury)
Tendons attaching to LATERAL epicondyle
Wrist extensors
tendons attaching to MEDIAL epicondyle
Wrist flexors
