Upper Limb problems Flashcards
What is Carpal tunnel syndrome?
parasthesiae in the median nerve innervated digits - thumb and radial 2 and a half
What can cause carpal tunnel syndrome?
rheumatoid arthritis
diabetes - anything causing fluid retention
pregnancy
weakness of the adductor pollicus brevis
How is carpal tunnel syndrome diagnosed?
Tinnels test - percus the median nerve
Phalens test - hold wrist hyper flexed to reduce space in the carpal tunnel
How is carpal tunnel syndrome managed?
wrist splints at night
carpal tunnel decompression
steroid injections
What is cubital tunnel syndrome?
compression of the ulnar nerve behind the medial epicondyle
What is cubital tunnel syndrome due to?
tight band of fascia forming the roof of the tunnel or due to tightness at the intermuscular septum as the nerve passes through or between the two heads at the origin of the flexor carpi ulnaris
What is the presentation of cubital tunnel?
parasthesiae at the ulnar 1 and a half fingers
Tinnels test positive
Froments test positive
What is the treatment for cubital tunnel syndrome?
surgical release
ulnar nerve decompression
What is the general presentation of frozen shoulder?
gradual onset of pain
gradual decrease of stiffness (over 2-9 months)
What are the signs of frozen shoulder?
loss of external rotation
thickening of the coracohumeral ligament
decrease in joint volume
Who does frozen shoulder affect?
50-60 year olds
diabetics very prone to it
What is the treatment for frozen shoulder?
physiotherapy and analgesia
intraarticular gleno-humeral injections
if no help, manipulation under anaesthetics can help or arthroscopic release
What causes a rotator cuff tear?
degenerative changes in the tendon
trauma
What age group is affected by rotator cuff tears?
> 60 year olds - usually asymptomatic
What are the different types of rotator cuff tears?
partial and full thickness - involve the supraspinatous
large - involves the infraspinateous and the subscapularis
What is the presentation of a rotator cuff tear?
weakness of initiation of abduction - supraspinatous
weakness of internal rotation - subscapularis
weakness of external rotation - infraspinatous
may see some muscle wasting
How is a rotator cuff tear treated?
physio, rest, sling, NSAIDs, analgesia etc..
if no help -> subacromial depression and rotator cuff repair
How is a rotator cuff tear investigated?
MRI
Ultrasound
What is acute calcific tendonitis?
calcium deposits in the supraspinatous tendon cause severe shoulder pain
How is acute calcific tendonitis diagnosed?
Xray - seen proximal to the greater tubersity
How is acute calcific tendonitis treated?
subacromial steroid injections and local anaesthetic injections
pain goes away as calcium reabsorbs
What is shoulder instabitlity?
painful abnormal translational movement, subluxation and/or recurrent dislocation
younger they are - more likely to reoccur
What age group does shoulder instability affect? males or females?
20-30year olds
females
sporty
What is more common: anterior or posterior shoulder dislocation?
anterior due to trauma
What can occur alongside anterior shoulder dislocations?
Blankart lesions - repaired by open stabilisation
glenoid fractures
humeral head fractures
How can a traumatic anterior shoulder dislocation be treated?
reduction
rest and physiotherapy - 6 week sling
How is a shoulder instablity investigated?
MRI arthrogram
Xray - more than 2 planes
When would a posterior shoulder dislocation occur?
epileptic fits
electrocution
What is the treatment for an acute shoulder dislocation/
IV analgesia and sedation
What is impingement syndrome?
tendons of the rotator cuff (usually supraspinatous) are compressed in the subacromial space during movement which produces pain
What is the characteristic sign of impingement syndrome?
painful arc - between 60 and 120 degrees
What are the causes of impingement syndrome?
tendonitis
subacromial bursitis
acromioclavicular OA with osteophytes
hooked acromion rotator cuff tear
What is the general presentation of someone with impingement syndrome?
30-40 years old
pain radiating to deltoid and upper arm
tenderness in lateral edge of the acromion
Hawkins kennedy test positive
How is impingement syndrome investigated?
Xray
What is the treatment for impingement syndrome?
steroid injections physiotherapy rest NSAIDs and analgesia arthroscopic or open subacromial decompression if nothing else works
What action does the radiocapitellar joint perform?
pronation and supination
What action does the humero-ulnar joint perform?
flexion and extension
