Upper Limb Injuries

Question 1

Skier’s thumb

Answer 1

Sprain > rupture > fracture

Common injury due to falling with outstretched hand while holding a ski pole

Sx:
Pain at base of thumb & along UCL course, swelling, bruising, loss of pincer grip strength, thumb pain with all movement, referred wrist pain

Laxity

• stretch/place stress on UCL by extending thumb and adducting
• if pain inc or laxity felt, positive test

Tx

1) Ice, pain control
2) Assess for laxity
3) Thumb spica
4) X ray if suspect #

Partial tear - immobilisation
Complete tear - surgery

Complications: chronic pain, instability, weakness, arthritis

Question 2

Bones in hand mnemonic

Answer 2

Some - scaphoid
Lovers - lunate
Try - triquetrum
Positions - pisiform
That - trapezium
They - trapezoid
Can’t - capitate
Handle - hamate

Question 3

Wrist sprain vs fracture

Answer 3

Sprain:

• popping sound
• normal ROM
• throbbing pain

Fracture

• crack
• numbness & tingling
• limited ROM
• obvious deformity
• sharp pain on movement, dull when stable

Question 4

Shoulder dislocation

Answer 4

Square shoulder
Massage muscles
Sling after relocation