Upper limb conditons Flashcards
In what directions can shoulders dislocate?
anteriorly (goes forward and down) or posteriorly
What can cause a posterior shoulder dislocation?
usually rotator cuff contracting with massive force in electic sock or seizure
Where do clavicular fractures most commonly occur?
the lateral 1/3rd portion
In a clavicular fracture which segment goes up and which goes down and why?
lateral segment does down due to deltoid attachment
medial segment goes up due to sternocleidomastoid
How do humeral neck fractures occur?
- FOOSH
- Direct blow
- Electric shock, seizures - posteriodislocation with it
Are humeral neck fractures usually displaced or non displaced?
nondisplaced
What must you worry about with humeral shaft fractures?
damage to radial nerve
What would indicate damage to radial nerve in mid shaft of humerous fractures?
loss of wrist and finger extension, loss of sensation to back of arm possible
What is impingement of the shoulder joint?
inflammation of the tendons of the rotator cuff or the bursa over the shoulder causing pain on abduction.
what nerves are most at risk with humerous neck fractures? What is another complication?
axillary, raidal, suprascapular and musculocutaneous
Avasuclar necrosis due to blood vessel severed
What is a similar but more severe differential diagnosis to impingement?
rotator cuff tears
What muscles make up the rotator cuff?
Supraspinatus, infraspinatus, subscapularis, teres minor
What is the main causes of rotator cuff tears in young and old ppl?
young- traumatic
old- atraumatic- calcific attrition, intrinsic degradation ect
What will be experienced by someone with acriomioclavicular osteoarthiritis?
usually asymptomatic, high painful arc, tenderness
What will be experienced by someone with glenohumeral osteoarthiritis?
progressive pain and stiffness
What is experienced by someone with adhesive capsulitis (frozen shoulder)?
Often starts with progressive stiffness. Pain on jerk movements and mostly at night. The pain is severe and progressive. It can be triggered by trauma but goes away after 2-3 yrs
What is happening in a frozen shoulder?
the capsule and extracapsular ligaments become inflamed and stiff
What is calcific surpaspinatus tendinitis?
Build up of calcium (and so bone) in rotator cuff. The pressure can lead to impingement and there is also pain from possible subsequent rotator cuff tears, it leading to frozen shoulder and from the calcium.
how can calcific tendinitis be diagnosed?
x ray
What should be stated when describing a fracture
- side of body
- name of bone
- part of bone
- fracture pattern (oblique, transverse, spiral, saggital)
- joints involved? (articular or extraatricular)
- if fragments are displaced
- is simple compound or complex
What is most common mechanism for elbow dislocation?
FOOSH
In which direction do elbow dislocations usually occur?
posteriorly and usually have fractures also
Where does a supracondylar fracture of the humerus occur and in what age group?
the distal end of the humerus, across the humurs above both medial and lateral epicondyls. 5-7y/os
What is most common mechanism for supracondylar fractures?
FOOSH
What are complications of supracondylar fracture?
radial nerve and artery and medial nerve damage, compartment syndrome
Fractures of the radial head and neck can be hard to see on xray, what other sign on xray indicates fracture here?
fat pads becoming visible as darker patches around the joints
What is a colles fracture?
a fracture at the distal end of the radius due to FOOSH with hand palm down
What is a smiths fracture?
a fracture at the distal end of the radius due to FOOSH onto the dorsal surface (back) of the hand
When does sublaxation of the radial head (pulled elbow) most commonly occur? What is it?
In kids- when parents yank/ swing them around.
Radial head comes out of annular ligament a bit.
Is tennis elbow inflammation of the medial or lateral collateral ligaments?
lateral
In what group of ppl is olecranon bursitis common?
students
What is the deformity often seen with colles or smith fractures called?
Dinner folk defomity
In which joints in the hands do rheumatoid arthiritis occur and in which does osteoarthritis occur?
rheumatoid: Carpal- metacarpal and distal interphalageal
Osteo: metacarpal- phalangeal and proximal interphalangeal
What are herbedens nodes?
Hard Nodules on the interphalangeal joints from where articular cartilage is worn and moves and then calcifys in osteoarthritis
What signs suggest a scaphoid fracture?
Poor pinch and grasp
Pain in anatomical snuffbox
What is common mechanism for scaphoid fractures?
FOOSH
Why do scaphoid fractures take a long time to heal?
Poor blood supply
Why are two X-rays a few days apart often needed to diagnose a scaphoid fracture?
Because there are lots of lines in that region due to overlapping bones so it can be hard to see. When you look later when the bone is healing it will be easier to see as healing bone appears whiter.
What is a boxers fracture?
Fracture to the distal end of the 5th metacarpal at its distal end
What is de quervains tenosynovitis?
Inflammation to the sheath that encloses the thumb extensor tendons (at the top of the snuff box)
What action is painful with de quervains tendosynovitis ?
Usually scissors (thumb extension)
What is carpal tunnel syndrome?
Compression of the contents of the carpal tunnel- especially the median nerve- due to inflammation.
What is often experienced in carpal tunnel syndrome?
Pins, needles, pain and numbness over the 1st, 2nd and 1/2 of 3rd digit due to compression of the median nerve.
Wasting and weakness of thenar eminence.
Pain on flexion of the wrist.
Who is carpal tunnel common in and what can cause it?
- women in later 50s and men or women in late 70s
- genetic, arthritis, fractures, obesity, pregnancy, menopause, repetative flexion of wrist (eg in typing, or using power tools)
Where can ulnar nerve be compressed and what symptoms does its compression cause?
Guyons canal in wrist and medial epicondyl
Pain and numbness in 5th and 1/2 of 4th digit.
What can cause compression of the ulnar nerve?
Pressure, overuse, cysts, fractures, arthiritis but usually unknown
What is dupuytrens contracture/ Viking disease?
Skin/ fascia in palm of hand thickening and causing fingers to be permanently bent
What is reflex sympathetic dystrophy?
Pain response to surgery/ injury is exaggerated and prolonged. can lead to significant loss of function if not spotted and treated quickly.
what would be the result of a median nerve legion?
Loss of thumb flexion and sensation of thumb side of hand
Describe a distal ulnar Claw
4th and 5th Metacarpal- phalangeal joint hyperextended
4th and 5th proximal interphalangeal joint flexed
What causes a distal ulnar claw and how?
Ulnar nerve legions at wrist level
- lateral 2 lumbricals loose motor innervation so they can no longer flex the MCPJ leading to the MCPJ hyperextending
- Lumbricals normally also extend the PIPJ so they flex
What is the result of ulnar nerve legion at elbow level? What is the name of this
Flexor carpi ulnaris and 1/2 of flexor digitorum profundus loose motor innervation as well as lateral 2 lumbricals.
FDP normally flexes the DIPJ so they extend slightly. This leads a less severe ulnar claw.
Ulnar paradox
What is a hand of benediction?
The index and middle fingers cannot flex due to a median nerve legion at the elbow level
How does an upper median nerve injury lead to a hand of benediction?
loss of innervation to lateral half of flexor digitorum profundus and lateral two lumbricals leading to a loss of IPJ and MPJ flexion
What will be the result of a traumatic force from behind the ulna?
monteggia fracture: proximal shaft of ulna fractures + anterior dislocation of head of radius (force transmitted through interosseous membrane)
What is a galeazzi’s fracture?
A fracture to the distal radius, with the ulna head dislocating at the distal radio-ulnar joint.
What ligament is sprained in inversion injuries?
Anterior talofibular and calcaneofibular
What ligament is commonly injured in ankle eversion injuries?
Medial (deltoid) ligament
