Week 1 Msk Pathology Upper Limb Flashcards
What’s function of rotator cuff
Stabilises humoral head in the glenoid
Physiological movement of the shoulder
What related shoulder pain could occur due to the rotator cuff
Sub-acromial pain syndrome (impingement) Rotator cuff tendinopathy Rotator cuff tears Also various theories have been produced to the explain the pathogenesis of rotator cuff tendinopathy: - tendon compression - extrinsic and intrinsic factors - Tendon overuse/underuse - Genetics - nutrition
What clinical presentation can show for shoulder pain
- Pain and impairment of shoulder movement and function, usually during shoulder elevation and lateral rotation
- numerous factors, but excessive or mal adaptive load stem to be a major influence
How can you manage the shoulder pain
Surgery Physiotherapy Exercise Education Load modification
Explain lateral epicondylitis (tennis elbow)
Tendinopathy involving extensor muscles of forearm
Affects 1-3% of population, male and female
More common in 40/50s
Prognosis - most cases are self limiting
Smoking and obesity are risk factors
ECRB is most commonly affected
Sup, ECRL, ED, EDM, ECU
Excessive/repetitive use can cause it - musicians, computer users, manual workers, racquet sports
Clinical presentation for lateral epicondylitis
Pain located around the lateral epicondyle of the elbow, usually radiating in line with extensors.
Variable pain reported - intermittent/continuous, varying in severity.
Typically aggravated by resisted wrist/ finger extension, forearm supination.
Stretching the tendon can also reproduce symptoms, as can gripping
Lateral epicondylitis management
Physiotherapy: Load management Exercise Brace/taping Education
Other: NSAIDs Corticosteroid Shockwave therapy Surgery
Explain medial epicondylitis (golfers elbow)
Normally affects origins of flexors and pronators Less common than lateral epicondylitis Age 40-60 Associated with golf, manual workers Involves pronator teres and FCR
Clinical presentation for medial epicondylitis
Pain on medial aspect of elbow - tender on palpation.
Aggravated by resisted/ repetitive wrist flexion or pronation, valgus stress, stretching.
Aggravated by throwing/gripping
Reduced grip strength
Can involve ulnar nerve 20%
Medial epicondylitis management
Physiotherapy: Load management Exercise Education Taping/bracing
Other: NSAIDs Shockwave therapy Corticosteroid injections Surgery
De Quervain’s tenosynovitis
Reactive thickening 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 the wrist into ulnar deviation with load.
More common in women and new mothers
Mostly 40-50s
De quervains - pathophysiology
Inflammation of synovial sheaths of EPB, APL.
Swelling of the sheaths, leading to eventual thickening of the sheath.
Adhesions may develop between the tendon and the sheath which restricts normal tendon movement.
Enclosed tendons can become constricted.
De Quervains clinical presentation
Pain on radial side of the wrist that can be referred to the thumb.
Aggravated by resisted thumb extension/abduction, or by stretching the affected tendons (finkelstein test).
Pain on palpation of affected tendons
De Quervains management
Medical: NSAIDs Splinting Corticosteroid injection Surgery
Physiotherapy: Splinting Load management Education Exercises
What’s a strain
Muscle or tendon injury - involves over contracting or lengthening a muscle causing tearing of collagen - grade 1, 2 and 3 Two joint muscles Eccentric contractions (deceleration phase) Muscles with higher percentage of type 2 fibres
Strain management
Depends on severity of strain - healing times POLICE/PRICE Mobilisation - as soon as possible Strength/loading Proprioception Endurance training Surgery
What’s a sprain
Stretchy and /or tear of a ligament
Usually caused by the joint being forced suddenly outside of its usual ROM, and in elastic fibres are stretched too far
Grades 1,2 and 3
Prognosis - most recover with conservative management
Sprain management
Depends on severity - healing times POLICE/PRICE Early mobilisation Early weight bearing Exercises Education Return to sport (if applicable) Surgery
Explain Carpal tunnel
Most common peripheral nerve entrapment syndrome.
Median nerve is compressed where it passes through the carpal tunnel.
Oedema, tendon inflammation, normal changes, manual activity can contribute to nerve compression in this area.
1 in 10 people develop carpal tunnel at some point
Female> male, more significant difference with increasing age
Carpal tunnel risk factors
Diabetes type 1 and 2 Menopause Hypothyroidism Obesity Arthritis Pregnancy
Carpal tunnel prognosis
Depends on severity of symptoms
Middle to moderate - respond well to conservative
Severe - more likely to require surgery
Carpal tunnel clinical presentation
Intermittent nocturnal paraesthesia, that increases in frequency then develops into waking hours.
More severe cases - weakness of median nerve innervatee muscles, atrophy.
Pain
Symptoms likely to follow medial nerve distribution, but can spread over a wider area.
Can progress to difficulty with fine motor tasks
Carpal tunnel management
Education - lifestyle modification Load management Splinting - night time Exercise Corticosteroid injection Surgery
