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
