Upper limb pathologies 1 Flashcards
Rotator cuff muscles function
stabilize the humeral head in the glenoid, physiological movement of shoulder
rotator cuff muscle shoulder pain
subacromial pain syndrome/ impingement, rotator cuff tendinopathy, rotator cuff tears
what causes rotator cuff tendinopathy- tendon compression
tendon compression- extrinsic factors- compression between greater tubercle of humerus and superior aspect glenoid, intrinsic- tendon pathology that occurs within the tendon
what causes rotator cuff tendinopathy- other
tendon overuse/ underuse, genetics, nutrition
risk factors for rotator cuff shoulder pain
over 50’s, people with diabetes, people who work with their shoulder above 90°- overuse
clinical presentation- rotator cuff related shoulder pain
pain and impairment of shoulder movement/ function, usually during elevation and lateral rotation
numerous factors, but excessive or mal-adaptive load seem to be a major influence
painful arc- rotator cuff related shoulder pain
flexion abduction- begins pain free, then 90° is pain, then as they reach full abduction there is no pain
management- rotator cuff related shoulder pain
surgery of phsyio- exercises to improve scapula rhythm- increase lower trap activities, strengthening
exercise, education, load magnification
lateral epicondylitis
most common overuse syndrome in the elbow. tendinopathy involving the extensor muscles of forearm
affects 1-3% of population
most common in 40/50s
prognosis, cause and risk factors- lateral epicondylitis
prognosis- most cases are self limiting
cause- excessive/ repetitive use- musicians, racquet sport
smoking and obesity are risk factors
lateral epicondylitis- clinical presentation
pain located around lateral epicondyle of elbow pain often radiates down in line with extensors
variable pain- intermittent/ continuous, varying in severity
lateral epicondylitis- clinical presentation- aggravating
aggravated by resisted wrist/ finger extension, forearm supination, extension of middle finger- provides secondary stress to ECRB, as it acts as a fixator on 3 MC
stretching the tendon can reproduce symptoms as can gripping
lateral epicondylitis and medial epicondylitis- physiotherapy
load management- stop overuse/ underuse, exercise, brace/ taping- minimise symptoms- offloading, education- explain what the problem is, what’s causing it, how to avoid it
lateral epicondylitis and medial epicondylitis - treatment other
NSAID, corticosteroid injection, shockwave therapy, surgery
medial epicondylitis
overuse tendinopathy, similar to tennis elbow but affecting the CF origin of the flexors and pronators, less common than LE, involves PT and FCR
medial epicondylitis- who is affected
age 40-60, female>male, associated with manual work,
medial epicondylitis- clinical presentations
pain on medial aspect of the elbow- tender on palpation, aggravated by resisted/ repetitive wrist flexion or pronation, valgus stress, stretching
also aggravated by throwing/ gripping
medial epicondylitis- affect
reduced grip strength, can involve ulna nerve (20%)- may have P and N of 5th and half of 4th MC
De quervains tenosynovitis
reactive thickening/ inflammation of the tendon sheath around EPB and APL, may occur spontaneously (idiopathic) or can be initiated by overuse of the thumb, overuse may involve eccentric lowering of the wrist into ulna deviation with load
De quervains tenosynovitis- who is affected
40-50 year olds, common in men, common in new mothers
De quervains tenosynovitis- how does it develop
swelling of sheath, leading to eventual thickening of sheath, adhesions may develop between the tendon and the sheath which restrict normal tendon movement, enclosed tendons can become constricted
De quervains tenosynovitis- clinical presentation
pain on radial side of wrist that can be referred to the thumb, aggravated by resisted thumb extension/ abduction, or by stretching the affected tendons (finkelstein test), tender to palpate
De quervains tenosynovitis- medical treatment
NSAIDs, splinting- immobilize thumb- can calm fingers down, but pain may come back after removed, corticosteroid injection, surgery
De quervains tenosynovitis- physioterhapy
splinting, load management- increase ability of tendon to withstand load, education, exercises
strains
muscle or tendon injury involving over contracting or lengthening of muscles that causes tearing of collagen
where are strains common
in 2 joint muscles, movement at one joint increases the tension of muscles and leads to overstretching of muscle, or eccentric contraction during deceleration phase , more common in type 2 muscle fibres
management for strains
depends on severity of strains, POLICE/PRICE, mobilization ASAP- encourages better healing, proprioception, endurance training, surgery
sprains
stretch and/or tear of a ligament, usually caused by the joint being forced suddenly outside its usual ROM, and tearing inelastic collagen, 3 grades, common in ankle
management of sprains
POLICE/ PRICE, early mobilization, early weight bearing, exercises education, return to sport, surgery
carpal tunnel syndrome
most common peripheral nerve enlargement syndrome, median nerve is compressed where it passess through the carpal tunnel
what causes carpal tunnel syndrome
oedema, tendon inflammation, hormonal changes, manual activities can contribute to nerve compression in this area
carpal tunnel syndrome risk factors
diabetes, type 1 and 2, menopause, hypothyroidism, obesity, arthritis, pregnancy
carpal tunnel syndrome prognosis
depends on severity of symptoms, mild to moderate- respond well to conservative, servere- more likely to require surgery
carpal tunnel syndrome- clinical presentation
intermittent nocturnal paraesthesia that increases in frequency, then develops into waking hours, loss of sensation, pain, symptoms are likely to follow median nerve disruption, but can spread over a wider area, can progress to difficulty with fine motor tasks
carpal tunnel syndrome- more severe cases
weaknesses of median nerve innervated muscles, atrophy
carpal tunnel syndrome- how to test
test strength of thumb, add/ abd, flex/ ext, to be affected, test sensation of hand- light touch likely to be affected, need to differentiate with nerve compression from spine
carpal tunnel syndrome- tenneles sign test and phalens test
tenneles- tap area where median nerve passess through carpa tunnel- see symptoms,
phalens test- put hand in position that causes compression and hold it there for a period of time and look for symptoms
carpal tunnel syndrome- management
education- lifestyle modification, load management, splinting- night time, exercise, corticosteroid injection, surgery, mild carpal tunnel- should be recovering within 6 weeks
repetitive strain injury
aches and pain in your body caused by repetitive movements or poor posture while doing certain activities, type 1 RSI= caused by health conditions (carpal tunnel or tendonitis)
Type 2- symptoms don’t fit in with any health conditions- no swelling or problems with nerves
causes of RSI
doing repetitive activities, doing an activity that involves lifting or carrying heavy objects, carrying out an activity for long periods, poor posture, using vibrating condition
symptoms RSI
pain and tenderness in your muscles and joints, aches, stiffness, tingling, numbness, weakness, cramp
