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common conditions > upper limb pain > Flashcards

upper limb pain Flashcards

1
Q

serious cardiovascular conditions that should not be missed with upper limb pain include

A

angina, myocardial infarction, pericarditis
DVT (axillary, subclavian)

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2
Q

serious neoplastic, infection and respiratory conditions that should not be missed with upper limb pain include

A

primary/ secondary bone tumours, lymphoma

osteomyelitis
pneumonia

pneumothorax

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3
Q

what conditions are often missed when diagnosing upper limb pain

A

cervical myelopathy
thoracic outlet syndrome
rheumatological - OA, RA, gout, polymyalgia rheumatica
visceral referral from the GI, diaphragm

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4
Q

how can subacromial pain syndrome be classified

A

primary impingement - structural abnormalities

secondary impingement - functional deficits

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5
Q

what can contribute to the development of subacromial pain syndrome

A

roattaor cuff or biceps pathology
scap dyskinesia
shoulder instability
slap lesions
capsular restriction
thoracic posture and hypermobility

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6
Q

what is the onset of subacromial pain syndrome

A

can be be eitehr acute following trauma or insidious

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7
Q

what quality and site of pain associated with subacromial pain syndrome

A

diffuse pain in the ant, sup, lat aspect of shoulder

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8
Q

what are the aggrivating factors and radiations of subacromial pain syndrome

can there be parasthesia

A

worse with overhead movements, and sleeping on affected shoulder

pain will radiate to the elbow or neck

yes, possibly in the arm/ hand (neurogenic TOS??)

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9
Q

can you expect to find limited ROM with subacromial pain syndrome

A

yes, due to pain and or capsular restriction

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10
Q

what test is used for SAPS

A

NEERS TEST - To perform this test have your patient in sitting position. With one hand depress the scapula, internally rotate your patient’s shoulder with your other hand and bring it into maximal flexion passively. This test is positive if your patient’s pain is reproduced.

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11
Q

WHAT Muscles make up the rotator cuff

A

supraspinatus
infraspinatus
teres minor
subscapularis

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12
Q

what is the nerve supply to the rotator cuff

A

subscapular nerve, suprascapular nerve, axillary nerve

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13
Q

what action is supraspinatus responsible for

A

abduction

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14
Q

what action is infraspinatus responsible for

A

external rotation

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15
Q

subscapularis action

A

stabilization

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16
Q

teres minor action

A

external rotation

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17
Q

what are the two types of injury mechanisms for a rotator cuff tendinopathy

A

extrinsic or intrinsic

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18
Q

what is an intrinsic mechanism of rotator cuff tendinopathy

A

originated within the tendon, degenerative process

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19
Q

what is an extrinsic mechanism of rotator cuff tendinopathy

A

originates external to the tendon, compression on shear (torsion)

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20
Q

what are the clinical features of a rotator cuff tendinopathy

A

insidious onset
(tendinopathy can predispose tears which can present with acute pain)
pain with overhead activity
pain with sleeping on effected side
referred pain into the arm, chest wall or neck
reduced rom
evidence of mm weakness, scap dyskinesis, tx spine dysfunction
tenderness over tendons and insertions

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21
Q

what test is used for subscapularis

A

lift off test

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22
Q

what test is used for supraspinatus

A

empty can test

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23
Q

what test is used for infraspinatus

A

hornblowers sign

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24
Q

what are the 4 classifications of biceps disorders

A

inflammatory/ degenerative disorders (long head and tendon)
instability of tendon in bicipital groove
partial or complete tears
SLAP lesion

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25
Q

what are the clinical features of a biceps tendon disorder

A

anterior shoulder pain
deep throbbing ache
sharp pain on movements of gh flexion and elbow supination
radiation down towards elbow
agg by over head activities, reaching pulling lifting, sleeping on affected side
mm weakness and easy fatigue
+/- localized swelling morning stiffness and palpable crepitation

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26
Q

what is a slap lesion

A

a lesion to the superior labrum that extends from the anterior to posterior aspects of the biceps tendon

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27
Q

type 1 slap classification

A

the attachment of the labrum to the glenoid in intact but there is evidence of fraying and degeneration

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28
Q

type 2 slap classification

A

detachment of the superior labrum and tendon of the LH of biceps from the glenoid rim

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29
Q

type 3 slap classification

A

teh superior labrum is torn away and displaced into the joint, but the tendon and labral rim attachment are intact

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30
Q

type 4 slap classification

A

the tear of the superior labrum extends into the tendon, part of which is displaced into the joint

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31
Q

what are the common injury mechanisms for a slap lesion

A

repetitive overhead movements (especially with load)
sudden, excessive traction on labrum through LH of biceps (FOOSH, lifting/catching heavy)

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32
Q

what are three of the non slap lesions

A

a degenrative lesion

GLAD (glenoid labral articular disruption

bankart lesion

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33
Q

what is a bankart lesion

A

damage to the anterior/inferior labrum with a glenoid rim fracture

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34
Q

what is a GLAD injuy

A

tear of the anterior inferior labrum and adjacent articular cartilage

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35
Q

what injury mechanism is usually associated with a bankart lesion

A

anterior GH dislocation

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36
Q

what injury mechanism is usually associated with a GLAD lesion

A

forced adduction injury when the arm is in abd and er

37
Q

what are the clinical features of a SLAP lesion

A

pain localised to the posterior superior joint line
pain worse with abduction and overhead movements +behind the back arm motions
+/- popping, catching, grinding
palpable tenderness over anterior shoulder
pain on activated resisted testing

38
Q

what type of joint is the AC joint

A

plane type synovial

39
Q

the most common ac pathology is

A

trauma - usually a fall onto teh shoulder

40
Q

a recent ac injury can predispose

A

osteoarthritis

41
Q

type 1 ac joint pathology classification

A

sprain of the joint capsule

42
Q

type 2 ac joint pathology classification

A

complete tear of the coaracoacromial ligament with sprain of the coracoclavicular ligaments

43
Q

type 3-4 ac joint pathology classification

A

complete tears of the coracoacromial and coracoclavicular ligaments (with varying levels of displacement and ST inury)

44
Q

what are the clinical features of an ac joint pathology

A

recent hx of trauma
localose dpain over the ac joint
movement worse with horizontal flexion
palpable tenderness of the AC joint +/- step deformity

45
Q

what is adhesive capsulitis

A

formation fo excessive scar tissue or adhesions across the GH joint

46
Q

adhesive capsulitis is more common in

A

women
older
diabetics

47
Q

primary adhesive capsulitis onset is

A

idiopathic, spontaneous

48
Q

secondary adhesive capsulitis occurs

A

following severe articular trauma
or surgery

49
Q

stage 1 adhesive capsulitis

A

shoulder pain is the primary complaint, worse at night, motion preserved

50
Q

stage 2 adhesive capsulitis

A

pts begin to develop stiffness (early adhesion formation and capsular contraction)

51
Q

stage 3 adhesive capsulitis

A

profound global loss of ROM and pain at extremes of motion

52
Q

stage 4 adhesive capsulitis

A

chronic stage - presistent stiffness but minimal pain

53
Q

ashesive capsulitis typically resolves in

A

1-3 years but 20-50% of pts have enduring symptoms

54
Q

what is the pathomechanism of elbow tendinopathy

A

overuse and excessive load

55
Q

what are the clinical features of elbow tendinopathies

A

a history of overuse (gripping, wrist stabilisation, wrist flexion/ extension)
localised pain over epicondyle
palpable tenderness and tightness of effected muscles
reproduction of pain through resisted mm testing

56
Q

what are the common associated findings of elbow tendinopathy

A

decreased joint play in elbow joint
dysfunction of lower cx and tx spine (tenderness and decreased rom)
active triggerpoints in periscapular soft tissues

57
Q

what tendon is most commonly effected in a lateral (extensor) elbow tendinopathy

A

extensor carpi radialis brevis
ECRB

58
Q

asside from ECRB, what are the other common tendons also associated with a lateral (extensor tendinopathy)

A

extensor digitorum and extensor carpi ulnaris
ED AND ECU

59
Q

what is the most common tendon effected in a medial (felxor) elbow tendinopathy

A

pronator teres

60
Q

what is de quervains tenosynovitis

A

inflammation of the synovium surrounding APL and EPB

61
Q

what is the common cause of de quervains tenosynovitis

A

repetitive load and continued strain of the APL and EPB tendons

62
Q

what are the clinical features of dequervains tenosynovitis

A

localised wrist pain that can radiate along the course of the tendons
palpable tenderness
+/- swelling, crepitis

63
Q

CARPAL TUNNEL SYNDROME IS

A

compression of the median nerve as it passes through the carpal tunnel

64
Q

what can contribute to nerve compression at the carpal tunnel

A

oedema, tendon inflammation, hormonal changes and manual activity can contribute to nerve compression

65
Q

what are the risk factors of carpal tunnel

A

diabetes, obesity, menopause, pregnancy, hypothyroidism, wrist arthritis

66
Q

what are the clinical features of carpal tunnel syndrome

A

parasthesia - begins as intermittent and nocturnal but becomes more frequent
burning pain - not always present, but can radiate to the forearm, elbow or shoulder

67
Q

chronicity of carpal tunnel syndrome is associated with

A

axonal degeneration - weakness and thenar mm, atrophy

68
Q

what ligament makes the roof of the carpal tunnel

A

transverse carpal ligament

69
Q

what are the clinical features of osteoarthritis in the wrist and hand

A

pain stiffness, reduced ROM
pain releived by rest
decreased grip and pinch strength
+/- visible deformity and crepitus

70
Q

what joints are first, and most commonly affected by hand osteoarthritis

A

IP joints and CMC of the thumb

71
Q

what are the radiographic features of hand OA

A

joint space narrowing, osteophyte formation, subchondral sclerosis, subchondral cyst formation

72
Q

what are the possible complications of a scaphoid fracture

A

avascular necrosis
delayed union, or non union

73
Q

what are the clinical features of a scaphoid fracture

A

tenderness in teh anatomical snuffbox
pain with axial compression of the thumb
pain with radial deviation
+/- swelling or loss of grip strength

74
Q

what are the 4 structures found in the subacromial space

A

rotator cuff tendons, subacromial bursa, coracoacromial ligamts, long head of biceps tendon

75
Q

with an axillary nerve injury where would you perform sensory testing

A

skin of superolateral arm

76
Q

with an axillary nerve injury which muscles would you test for weakness

A

teres minor - ER
deltoid - abd

77
Q

with an axillary nerve injury would you expect a reflex change

A

no - not if it is a true axillary nerve injury

78
Q

when might the radial nerve be damaged in the axilla

A

disloaction of shoulder joint or fracture of proximal humerus

79
Q

the radial nerve gives motor supply to which muscles

A

posterior compartments of the arm and forearm

80
Q

explain why a patient with a radial nerve injury may present with wrist drop

A

the radial nerve gives motor supply to teh muscles in the posterior compartment (extensors), without propper motor supple, the flexor muscles on the opposite side have no opposing force, causing the wrist to drop

81
Q

radial nerve spinal levels

A

c5-t1

82
Q

axillary nerve spinal levels

A

c5 and a little c6

83
Q

musculocutaneous spinal nerve supply

A

c5-7

84
Q

where is the median nerve typically compressed in the elbow

A

pronator teres

85
Q

what is the ortho test for carpal tunnel syndrome

A

phalens test

86
Q

which branch of the medial nerve does not get entrapped in the tunnel

A

palmar branch

87
Q

what muscles does the median nerve supply

A

forearm flexors - except FCU AND half of flexor digitorum
thenar muscles

88
Q

why does an ulnar nerve injury cause claw hand

A

the ulnar nerve innervated fcu and half of flexor digitorum, if these are not contracting there os unopposed contraction of the extensor mm, causing teh claw hand shape

common conditions (3 decks)

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