Upper limb pathologies 1

Question 1

Rotator cuff muscles function

Answer 1

stabilize the humeral head in the glenoid, physiological movement of shoulder

Question 2

rotator cuff muscle shoulder pain

Answer 2

subacromial pain syndrome/ impingement, rotator cuff tendinopathy, rotator cuff tears

Question 3

what causes rotator cuff tendinopathy- tendon compression

Answer 3

tendon compression- extrinsic factors- compression between greater tubercle of humerus and superior aspect glenoid, intrinsic- tendon pathology that occurs within the tendon

Question 4

what causes rotator cuff tendinopathy- other

Answer 4

tendon overuse/ underuse, genetics, nutrition

Question 5

risk factors for rotator cuff shoulder pain

Answer 5

over 50’s, people with diabetes, people who work with their shoulder above 90°- overuse

Question 6

clinical presentation- rotator cuff related shoulder pain

Answer 6

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

Question 7

painful arc- rotator cuff related shoulder pain

Answer 7

flexion abduction- begins pain free, then 90° is pain, then as they reach full abduction there is no pain

Question 8

management- rotator cuff related shoulder pain

Answer 8

surgery of phsyio- exercises to improve scapula rhythm- increase lower trap activities, strengthening
exercise, education, load magnification

Question 9

lateral epicondylitis

Answer 9

most common overuse syndrome in the elbow. tendinopathy involving the extensor muscles of forearm
affects 1-3% of population
most common in 40/50s

Question 10

prognosis, cause and risk factors- lateral epicondylitis

Answer 10

prognosis- most cases are self limiting
cause- excessive/ repetitive use- musicians, racquet sport
smoking and obesity are risk factors

Question 11

lateral epicondylitis- clinical presentation

Answer 11

pain located around lateral epicondyle of elbow pain often radiates down in line with extensors
variable pain- intermittent/ continuous, varying in severity

Question 12

lateral epicondylitis- clinical presentation- aggravating

Answer 12

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

Question 13

lateral epicondylitis and medial epicondylitis- physiotherapy

Answer 13

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

Question 14

lateral epicondylitis and medial epicondylitis - treatment other

Answer 14

NSAID, corticosteroid injection, shockwave therapy, surgery

Question 15

medial epicondylitis

Answer 15

overuse tendinopathy, similar to tennis elbow but affecting the CF origin of the flexors and pronators, less common than LE, involves PT and FCR

Question 16

medial epicondylitis- who is affected

Answer 16

age 40-60, female>male, associated with manual work,

Question 17

medial epicondylitis- clinical presentations

Answer 17

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

Question 18

medial epicondylitis- affect

Answer 18

reduced grip strength, can involve ulna nerve (20%)- may have P and N of 5th and half of 4th MC

Question 19

De quervains tenosynovitis

Answer 19

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

Question 20

De quervains tenosynovitis- who is affected

Answer 20

40-50 year olds, common in men, common in new mothers

Question 21

De quervains tenosynovitis- how does it develop

Answer 21

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

Question 22

De quervains tenosynovitis- clinical presentation

Answer 22

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

Question 23

De quervains tenosynovitis- medical treatment

Answer 23

NSAIDs, splinting- immobilize thumb- can calm fingers down, but pain may come back after removed, corticosteroid injection, surgery

Question 24

De quervains tenosynovitis- physioterhapy

Answer 24

splinting, load management- increase ability of tendon to withstand load, education, exercises

Question 25

strains

Answer 25

muscle or tendon injury involving over contracting or lengthening of muscles that causes tearing of collagen

Question 26

where are strains common

Answer 26

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

Question 27

management for strains

Answer 27

depends on severity of strains, POLICE/PRICE, mobilization ASAP- encourages better healing, proprioception, endurance training, surgery

Question 28

sprains

Answer 28

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

Question 29

management of sprains

Answer 29

POLICE/ PRICE, early mobilization, early weight bearing, exercises education, return to sport, surgery

Question 30

carpal tunnel syndrome

Answer 30

most common peripheral nerve enlargement syndrome, median nerve is compressed where it passess through the carpal tunnel

Question 31

what causes carpal tunnel syndrome

Answer 31

oedema, tendon inflammation, hormonal changes, manual activities can contribute to nerve compression in this area

Question 32

carpal tunnel syndrome risk factors

Answer 32

diabetes, type 1 and 2, menopause, hypothyroidism, obesity, arthritis, pregnancy

Question 33

carpal tunnel syndrome prognosis

Answer 33

depends on severity of symptoms, mild to moderate- respond well to conservative, servere- more likely to require surgery

Question 34

carpal tunnel syndrome- clinical presentation

Answer 34

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

Question 35

carpal tunnel syndrome- more severe cases

Answer 35

weaknesses of median nerve innervated muscles, atrophy

Question 36

carpal tunnel syndrome- how to test

Answer 36

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

Question 37

carpal tunnel syndrome- tenneles sign test and phalens test

Answer 37

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

Question 38

carpal tunnel syndrome- management

Answer 38

education- lifestyle modification, load management, splinting- night time, exercise, corticosteroid injection, surgery, mild carpal tunnel- should be recovering within 6 weeks

Question 39

repetitive strain injury

Answer 39

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

Question 40

causes of RSI

Answer 40

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

Question 41

symptoms RSI

Answer 41

pain and tenderness in your muscles and joints, aches, stiffness, tingling, numbness, weakness, cramp