Upper limb injuries Flashcards
Posterior interosseus nerve entrapment onset/MOI
gradual
compression or trauma causes entrapment of nerve
Posterior interosseus nerve entrapment subjective/agg.ease
- local pain or numbness in wrist/forearm
- ache
- ease = avoiding positions that stretch/compress nerve
Posterior interosseus nerve entrapment 24hr pattern
PM worsened, worse at end of day
Posterior interosseus nerve entrapment physical
- AROM supination painful
- PROM pronation EOR painful
- RSC of ecrb, wrist extensors painful
- MMT weakness of thumb, wrist + fingers if severe
- MLT tight wrist ext.
Posterior interosseus nerve entrapment Mx
- neural mobilising techniques
- local treatment
- EPAs
- massage
- bracing/strapping
- eccentric exercises
Dupuytren’s contracture aetiology
- previous hand trauma
- diabetes
- alcoholism/smoking
more common in males
Dupuytren’s contracture MP
- nodules in hands form + cause problems with flexion contractures
- hard to dress, wash
- shaking of hands
Dupuytren’s contracture observation
- firm nodules on observation + palpation
- TOP
Dupuytren’s contracture AROM
- contractures of PIP or MCP
Dupuytren’s contracture Mx
- deep massage
- stretches
- splinting
- surgery
Gamekeeper’s thumb prognosis
4-6 weeks
Gamekeeper’s thumb MP, agg, ease + 24hr pattern
local pain in thumb - torn ulnar collateral lig.
- pinching/gripping
- resting, stabilisation
- depends on activity
Gamekeeper’s thumb HPC, contributing fx
falling on thumb
skiing etc
Gamekeeper’s thumb observation, AROM, palpation
- localised swelling, discolouration, weak pinch grip
- TOP
- decreased AROM
Gamekeeper’s thumb tests
+ve valgus stress test
Gamekeeper’s thumb mx
- rest
- taping/splinting
- EPAs
- ROM exercises
- strengthening
Carpal tunnel aetiology
compression of median nerve as it passes through carpal tunnel
Carpal tunnel MP, behaviour of symptoms
- pain + numbness
- difficulty manipulating small objects
- prolonged wrist F/E
- pressure over anterior wrist
- prolonged exposure to drilling etc.
Carpal tunnel contributing Fx
- decreasing size of carpal tunnel due to synovitis from RA, tumours or spurs
- increasing size of carpal tunnel content due to fluid retention, tendon sheath irritation, distal radius fracture
- lifestyle factors
Carpal tunnel observation, AROM, MMT
- atrophy of thenar muscles if advanced
- decreased AROm oppositon if advanced
- MMT weakness of thenar muscles
Carpal tunnel special tests
+ve phalens
+ve tinels
Carpal tunnel Mx
- EPAs
- rest, ice
- massage
- mobilisation
Extensor tendinopathy tendons involved
ECRL
ECRB
Ex dig
ECU
Extensor tendinopathy risk factors
- repetitive activity/movement (+2hrs daily)
- age 45-54
- poor blood supply
- faulty technique
- smoking/obesity
Extensor tendinopathy subjective
- 1-2cm below origin of ECRB + radiating down forearm
- agg = arm pronated + extended
- ease = rest/splints
- Hx = insidious
Extensor tendinopathy physical
- PROM pain w/ E pron, wrist F/UD
- +ve mill’s test
- RSC painful wrist E w/ EE
- TOP
Extensor tendinopathy Mx
- EPAs
- myofascial release
- stretches
- eccentric strenghtening
Lateral epicondylitis Mx
- anti inflams
-> ice, EPAs, NSAIDs
De Quervain’s MP
- tenosynovitis of APL + EPB (snuffbox)
- presence of inflammatory cells
De Quervain’s subjective
- localised swelling + tenderness
- agg = wide grip, watches, repeated thumb ext
- ease = rest, ice
De Quervain’s physical
- local swelling
- TOP
- RSC painful
- +ve finklestein’s
De Quervain’s Mx
- corticosteroid injection
- rest
- EPAs
- heat
- strengthening + stretching
