Upper limb problems Flashcards
what is impingement syndrome
when the tendons of the rotator cuff are compressed in the tight subacromial space during movement, producing pain
degrees of painful arc
60-120 abduction
causes of impingement
tendonitis, subacromial bursitis, acromioclavicular OA with inferior osteophyte, a hooked acromion and rotator cuff tear
where does the pain radiate to in impingement
deltoid and upper arm
where may tenderness be felt in impingement
below the lateral edge of the acromion
what test recreates the pain of impingement?
Hawkins-Kennedy
which movement usually causes a rotator cuff tear
sudden jerk
which muscle is usually involved in rotator cuff tear
supraspinatus
where can large tears extend to?
subscapularis and infraspinatus
sign of supraspinatus problem
weakness of initiation of abduction
sign of subscapularis problem
weakness of internal rotation
sign of infraspinatus problem
weakness of external rotation
characteristics of adhesive capsulitis
progressive pain and stiffness in patients between 40-60 which usually resolves in 18-24m
main clinical sign of adhesive capsulitis
loss of external rotation
conditions associated with adhesive capsulitis
diabetes, hypercholesterolaemia, Dupuytren’s disease
what happens in adhesive capsulitis
the capsule and glenohumeral ligaments become inflamed then thicken and contract
characteristics of acute calcific tendonitis
calcium deposition in supraspinatus tendon
where is the calcium seen on Xray in acute calcific tendonitis
just proximal to greater tuberosity
what is shoulder instability
painful abnormal translational movement or subluxation/recurrent dislocation
type of surgery used for recurrent dislocation
Bankart repair - reattaches labrum and capsule to anterior glenoid
what does inflammation of the tendon of the long head of biceps cause
anterior shoulder pain with pain on resisted biceps contraction
where does the long head of biceps tendon attach
glenoid labrum
What is tinel’s test
percussion over the median or ulnar nerve in order to reproduce symptoms of carpal/cubital tunnel syndrome
what is phalen’s test
hold the wrists hyperflexed in order to decrease the space in the carpal tunnel and reproduce the symptoms of carpal tunnel syndrome
non-operative treatment in carpal tunnel syndrome
wearing splints at night
injection of corticosteroid
surgical treatment of carpal tunnel syndrome
carpal tunnel decompression - division of transverse carpal ligament under local anaesthetic
muscles which are weak in cubital tunnel syndrome
1st dorsal interosseous and adductor pollicis
clinical features of tennis elbow
painful and tender lateral epicondyle and pain on resisted middle finger/wrist extension
what may done for arthritis of the radio-capitellar joint which has failed non-operative management
surgical excision of the radial head
lifting weight restriction in total elbow replacement
2.5kg
how do patients usually present in calcific tendonitis
grey and sweaty - important to rule out septic arthritis
which direction of shoulder dislocation is most likely
anterior
light bulb sign on X-ray
posterior shoulder dislocation
features of traumatic shoulder instability
TUBS - traumatic, unilateral, bankart, surgery
features of atraumatic shoulder instability
AMBRI - atraumatic, multidirectional, bilateral, rehabilitation, inferior capsular shift
froments sign positive
cubital tunnel syndrome - ulnar nerve compression
