Upper limb soft tissue injury

Question 1

Definition

Answer 1

Injuries of the upper limb involve the muscles, ligaments, and tendons
- Can result from acute trauma or repetitive stress (overuse injuries).

Question 2

Acute injury examples

Answer 2

Sprains
Strains

Question 3

Overuse injuries

Answer 3

• Tendonitis
• Tenosynovitis = Inflammation of the sheath surrounding a tendon.

Question 4

Epidemiology

Answer 4

Sport: inadequate warm-up or poor conditioning
Occupations involving repetitive movements: e.g. typing
Ageing: degeneration of soft tissues
Poor ergonomics

Question 5

Frozen Shoulder

Answer 5

Typical mechanism of injury: Primary or secondary to trauma, surgery or reduced mobilisation
S+S:
- Painful phase, followed by stiffness (active and passive movement particularly on external rotation)
- Subsequent “thawing” to resolution. Total duration is 1-3 years

Question 6

Supraspinatus tendinopathy

Answer 6

Typical mechanism of injury: Overhead activities compounded by joint space narrowing, for example due to osteophyte formation
S+S:
- Positive empty can test
- Painful arc: pain on shoulder abduction between 60-120 deg

Question 7

Rotator cuff tear (supraspinatus, infraspinatus, teres minor, subscapularis)

Answer 7

Typical mechanism of injury: Trauma, repetitive activity, esp overhead activities, or chronic degeneration
S+S:
- Shoulder pain and weakness
- Special tests for localisation: Neer’s, Hawkin’s, and Gerber’s lift-off

Question 8

Medial epicondylitis

Answer 8

Typical mechanism of injury: repative use: golfer’s elbow

S+S:
- Pain at the medial epicondyle radiating down the forearm
- Pain on wrist flexion and pronation
- Paraesthesia in the ulnar nerve distribution

Question 9

Lateral epicondylitis

Answer 9

Typical mechanism of injury: Repetative use: tennis elbow

S+S:
- Pain on resisted wrist extension

Question 10

De Quervains tenosynovitis

Answer 10

Typical mechanism of injury: repetitive strain injury

S+S:
- Radial wrist pain, over the radial styloid process
- Pain on resisted thumb abduction
- Finkelstein’s test positive

Question 11

Dupuytren’s contracture

Answer 11

Typical mechanism of injury: Inflammation

RF:
- Increasing age
- Fhx
- Male
- Diabetes
- Use of vibrating tools in manual labour

S+S:
- Hard, palmer nodules
- Fixed finger flexion
- The most commonly affected digit is the ring finger

Question 12

Diagnosis

Answer 12

Diagnosis often clinical
Investigations:
- X-ray
- USS
- MRI

Question 13

Treatment

Answer 13

FIRST LINE =
- RICE (Rest, Ice, Compression, Elevation)
- Analgesia: titrated to pain according to WHO pain ladder. Para -> NSAIDS -> Steroid injections
- Physio

Second line = Surgery: for high grade injuries

Question 14

Complications

Answer 14

• Chronic pain or intability
• Recurrence due to inadequate rest or rehabilitation
• Loss of function