Upper Limb Pathologies

Question 1

What does epidemiology mean?

Answer 1

Study of frequency rate of a disease.

Question 2

What does aetiology mean?

Answer 2

The process of how a disease comes about.

Question 3

What are the common clinical presentations of upper limb disorders?

Answer 3

Pain and dysfunction

Question 4

What are the 3 types of joint disorders?

Answer 4

Degenerative
Inflammatory
Traumatic

Question 5

What changes occur in a tendonopathy or arthritis?

Answer 5

Increase in cell numbers,
Disorganisation of collagen and tissue,
Ground substances changes,
New blood vessels and nerves form (neovascularization)

Question 6

How does the changes of a tendonopathy occur?

Answer 6

Overload occurs,
Overload is detected by cells,
Some cells become active (reactive stage),
Agreecan is produced which is hydrophilic so suck in water to the tissue,
Stress on cells causes increased apoptosis,
Over time the tissue degenerates and structure is lost,
Providing opportunities for vascular penetration and new blood vessels.

Question 7

What are the risk factors for a tendonopathy?

Answer 7

Anything that increases the rate of wear and repair.
Eg. Obesity, tendon load, gender (oestrogen protects tendons)
, diabetes.

Question 8

What is tennis elbow (lateral epicondylitis) and what are the causes and give the clinical manifestation/symptoms?

Answer 8

Pain and tenderness at the lateral side of the elbow due to the radial head compressing against the ECRB AND ECRL.
It normally occurs due to:
Repetitive activity involving the extensor tendon of the forearm,
Poor technique in racquet sports,
Computer uses ,
in over 50’s predominately.

Symptoms Include:
Pain in area with activities that cause stress to the tendon eg stretching the tendon

Question 9

What’s the difference between golfers elbow and tennis elbow?

Answer 9

Golfers elbow is pain and tenderness on the medial side where as tennis elbow is on the lateral side.

Question 10

What is a frozen shoulder or adhesive capsulitis?

Answer 10

A thickened and inflamed shoulder joint capsule, which causes the shoulder to become stiff causing an alteration to capsular pattern.
Mostly occur to 50 year olds.

Question 11

What is the process of osteoarthritis?

Answer 11

There is a break down in cartilage due to over stress on the tissue,
Cells become stimulated and produce to much GAG’s/PGS,
this causes water to be sucked into the cartilage causing it to fibrillate weakening the cartilage and creating ulcerations and disappearing of cartilage,
Osteophyte formation occurs where new bone tries to form to spread the weight load through the tissue.
Bone also thickens (sclerosis),
Leading to alterations in the synovial membrane.

Question 12

What tendonopathy do we most commonly see in the upper limb?

Answer 12

Rotator cuffs-most commonly supraspinnatus,
Long head of biceps,
Tennis/golfers elbow = lateral/medial epicondyalgia,
Extensor pollocks brevis

Question 13

What are the three stages of adhesive capsulitis/ frozen shoulder?

Answer 13

1. Freezing stage- severe pain and decreased ROM
2. Frozen stage- stiffness and pain my be present
3. Thawing stage-minimal pain and gradual improvement of range of motion

Question 14

What deformities can you see in the hand with either RA or OA?

Answer 14

Boutonnière deformity for thumb,
Ulnar deviation of the metacarpophalangeal joint,
Swan neck deformity of fingers

Question 15

Who normally suffers from carpal tunnel syndrome?

Answer 15

Normally women aged 40 to 50

Question 16

What is dequervains tenosynovitis?

Answer 16

Thickening of the tendon sheath around the extensor pollicis brevis and abductor pollicis longus.
Normally due to overuse of the thumb, or eccentric lowering of the wrist in ulna deviation with a heavy load.eg holding heavy plate

Most common in women.

Question 17

What is dupuytrens contracture?

Answer 17

Hypertrophy and Contracture of the superficial palmar fascia/ aponeurosis.
Giving a stiff tight hand.