DISORDERS OF THE UPPER LIMB

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DISORDERS OF THE UPPER LIMB
NOTE THIS PRESENTATION DOES NOT REPLACE
ATTENDANCE OR INFORMATION GIVEN IN THE
LECTURE. IT IS INTENDED AS A HIGHLIGHT FOR THE
TOPIC.

• DR DEVDAS SHRIYAN
• MS ORTH., D.ORTH., MSc TRAUMA(UK),
  Fellow Inst Accident Surgery(UK)
• Consultant, Dept of Orthopedics
• King Fahd Hospital of the University, Al-Khober,
  KSA.
• Professor/ FMR Chairman, Dept of Orthopedics
• Adi. Institute of Medical Science, Karnataka,
  India.

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SHOULDER EXAMINATION

• Inspection
• Surface from the front
• Surface anatomy from behind

                                             
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SHOULDER EXAMINATION

• ANATOMY

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SHOULDER EXAMINATION

• ANATOMY

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SHOULDER EXAMINATION

• INSPECTION
• Look for
• Wasting or asymmetry of shoulder height,
• Scapular position
• Muscle bulk
• Observation from behind

                             
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SHOULDER EXAMINATION

• PALPATION.
• .

                                                
                   
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SHOULDER EXAMINATION

• MOVEMENTS
• Abduction
• Adduction
• Flexion
• Extension
• Internal, External rotation
• Active external rotation with elbows at side

                                                
                  
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SHOULDER EXAMINATION

• MOVEMENTS
• External rotation active at 90 degrees
• 
  abduction

                                                
                  
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SHOULDER EXAMINATION

• MOVEMENTS
• Internal rotation active
• Measure the level of the spine of tip of middle
  finger on each side

                                                
               
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SHOULDER EXAMINATION

• MOVEMENTS
• Resisted movements - external rotation.

                                                
                 
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SHOULDER EXAMINATION

•   
• MOVEMENTS
• Resisted movements
• Subscapularis lift off test
• (Gerber's test).
• Push away from the spine against resistance.

                                                
                 
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SHOULDER EXAMINATION

• MOVEMENTS
• Resisted movements - deltoid. Resisted abduction
  at 90 degrees with the arm in neutral rotation

                              
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DISORDERS OF THE UPPER LIMB

• FROZEN SHOULDER / PERIARTHRITIS
• (ADHESIVE CAPSULITIS)
• Pain
• Reduced range of motion
• Commonly occurs in diabetics
• Stiffness
• Restriction of passive movement in all range

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DISORDERS OF THE UPPER LIMB

• FROZEN SHOULDER / PERIARTHRITIS
• (ADHESIVE CAPSULITIS)

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DISORDERS OF THE UPPER LIMB

• FROZEN SHOULDER / PERIARTHRITIS
• (ADHESIVE CAPSULITIS)
• STAGING OF DISEAE
• CLINICAL STAGE
• Painful Gradual onset of diffuse pain
• Stiff Decreased ROM, affects ADL
• Thawing Gradual return of motion

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DISORDERS OF THE UPPER LIMB

• Impingement syndrome

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DISORDERS OF THE UPPER LIMB

• FROZEN SHOULDER / PERIARTHRITIS
• (ADHESIVE CAPSULITIS)
• TREATMENT
• NSAID
• Physiotherapy
• Local steroid
• Manipulation under anesthesia
• Role of arthroscopy controversial

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DISORDERS OF THE UPPER LIMB

• OLECRANON BURSITIS
• TENNIS ELBOW
• GOLFERS ELBOW
• CUBITAL TUNNEL SYNDROME
• ANTERIOR INTEROSSEOUS SYNDROME
• CARPAL TUNNEL SYNDROME
• TRIGGER FINGER
• DE QUERVAIN TENOSYNOVITIS
• OCCUPATIONAL HAND CRAMP
• GANGLION
• GAME KEEPERS THUMB

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DISORDERS OF THE UPPER LIMB

• OLECRANON BURSITIS
• Causes
• Acute trauma (eg, falling onto a hard floor or a
  playing field with artificial turf and landing on
  the olecranon process)
• Minor cumulative trauma, such as repetitive
  rubbing of the olecranon region against a desktop
  during writing
• Infection due to abrasion or laceration at the
  site or due to seeding from hematogenous spread
  by bacteremia
• Inflammation as part of a systemic inflammatory
  process (eg, rheumatoid arthritis) or crystal
  deposition disease (eg, gout, pseudogout)

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DISORDERS OF THE UPPER LIMB
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DISORDERS OF THE UPPER LIMB

• Treatment
• Ice packs 20 to 30 minutes every 3 to 4 hours for
  2 to 3 days or until the pain and swelling go
  away
• Wrapping an elastic bandage around your elbow to
  keep the bursa from swelling more
• Aspiration bursa fluid by with a needle and
  syringe
• Taking anti-inflammatory medication
• Protecting elbow with a pad.
• Surgical removal of the bursa -In some
  longstanding (chronic) olecranon bursitis.

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DISORDERS OF THE UPPER LIMB
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DISORDERS OF THE UPPER LIMB
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DISORDERS OF THE UPPER LIMB

• TENNIS ELBOW
• Also called lateral epicondylitis.
• Degeneration of extensor muscle origin from
  lateral epicondyle of humerus.
• Extensor carpi radialis brevis origin commonly
  involved.
• Result of overuse injuries poor technique in
  racket sports.

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DISORDERS OF THE UPPER LIMB
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DISORDERS OF THE UPPER LIMB

• TENNIS ELBOW
• CLINICALLY
• Tenderness over lateral epicondyle.
• Common in younger age group.
• Increased tenderness by resisted wrist extension.

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DISORDERS OF THE UPPER LIMB
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DISORDERS OF THE UPPER LIMB

• TENNIS ELBOW
• TREATMENT
• Rest, NSAID.
• Orthotic support designed to decentralize area of
  stress (Tennis elbow strap).
• Ultrasonography, electrical stimulation.
• Stretching, strengthening, equipment
  modification.
• Local injection.
• Surgical release.

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DISORDERS OF THE UPPER LIMB
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DISORDERS OF THE UPPER LIMB

• GOLFERS ELBOW
• (MEDIAL EPICONDILITIS OF HUMERUS)
• Medial epicondylitis is commonly known as
  golfer's elbow.
• CAUSES
• Golf swing is a common cause of medial
  epicondylitis.
• Repetitive activities can also lead to golfer's
  elbow
• Throwing, chopping wood with an ax, running a
  chain saw
• Using many types of hand tools.
• Any activities that stress the same forearm
  muscles can cause symptoms of golfer's elbow.

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DISORDERS OF THE UPPER LIMB

• GOLFERS ELBOW
• (MEDIAL EPICONDILITIS OF HUMERUS)
• Medial epicondylitis is commonly known as
  golfer's elbow.

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DISORDERS OF THE UPPER LIMB

• CUBITAL TUNNEL SYNDROME
• Compression of ulnar nerve under the cubital
  tunnel.
• Course through arch of flexor carpi ulnaris
  origin.
• Causes UN trapped, irritated, subluxed.
  
• Osteophte, cubitus valgus,
  
• work related excessive
  repetitive flexion.

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DISORDERS OF THE UPPER LIMB

• CUBITAL TUNNEL SYNDROME

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DISORDERS OF THE UPPER LIMB

• CUBITAL TUNNEL SYNDROME

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DISORDERS OF THE UPPER LIMB

• CUBITAL TUNNEL SYNDROME

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DISORDERS OF THE UPPER LIMB

• CUBITAL TUNNEL SYNDROME

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DISORDERS OF THE UPPER LIMB

• ANTERIOR INTEROSSEOUS SYNDROME
• Compression of anterior inter-osseous nerve in
  the forearm.
• Muscles supplied are radial half of FDF, FPL,
  Pronator quadratus.
• Decreased pinch between thumb index finger.
• Decreased strength of pronation
• Treatment conservative / operative.

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DISORDERS OF THE UPPER LIMB

• CARPAL TUNNEL SYNDROME
• Compression of the median nerve at the wrist
  under flexor retinaculum.
• Females are more affected.
• Causes Idiopathic
• Pregnancy
• Trauma
• Rheu. arthritis

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DISORDERS OF THE UPPER LIMB

• CARPAL TUNNEL SYNDROME

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DISORDERS OF THE UPPER LIMB

• CARPAL TUNNEL SYNDROME
• CLINICALLY
• Wasting of thenar eminence.
• Weakness of thenar muscles.
• Loss of sensation over radial 3 ½ fingers on
  volar aspect.

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DISORDERS OF THE UPPER LIMB

• CARPAL TUNNEL SYNDROME

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DISORDERS OF THE UPPER LIMB

• CARPAL TUNNEL SYNDROME
• Treatment
• Medication
• Physical Therapy
• Wrist Brace
• Conservative Treatment
• Surgical Treatment Release of flexor retinaculum
  open surgery / endoscopic

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DISORDERS OF THE UPPER LIMB

• CARPAL TUNNEL SYNDROME

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DISORDERS OF THE UPPER LIMB

• CARPAL TUNNEL SYNDROME

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DISORDERS OF THE UPPER LIMB

• GANGLION
• Accumulation of synovial fluid adjacent to a
  joint capsule or tendon sheath.
• Most common tumor of the hand.
• The fluid in the pseudocyst contains mainly
  hyaluronic acid.
• Common location is dorsum of the hand.

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DISORDERS OF THE UPPER LIMB

• GANGLION
• TREATMENT
• Aspiration steroid injection.
• Excision.

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DISORDERS OF THE UPPER LIMB

• TRIGGER FINGER
• Stenosing tenosynovitis of the digital flexor
  tendons.
• Snapping occurs on extension of the flexed
  fingers.
• Painful finger movement which catch in mid
  position.
• Trauma/diabetes mellitus.

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DISORDERS OF THE UPPER LIMB

• TRIGGER FINGER

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DISORDERS OF THE UPPER LIMB

• TRIGGER FINGER
• TREATMENT
• NSAID
• Local injection.
• Surgical release.

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DISORDERS OF THE UPPER LIMB

• TRIGGER FINGER

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DISORDERS OF THE UPPER LIMB

• DE QUERVAINS TENOSYNOVITIS
• Inflammation of tendon sheath of first
  compartment.
• New job, repetitive grasping.
• Pain over radial styloid, swelling
• Finkelstein test positive.
• D/D Scaphoid, first carpo-metacarpal OA

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DISORDERS OF THE UPPER LIMB

• DE QUERVAINS TENOSYNOVITIS

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DISORDERS OF THE UPPER LIMB

• DE QUERVAINS TENOSYNOVITIS
• Treatment
• Limit grasping activities.
• (Gardeners, painters etc)
• Local steroid/ Surgery

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DISORDERS OF THE UPPER LIMB

• OCCUPATIONAL HAND CRAMP
• Due to repetitive injury
• Pain, fatigue
• Involuntary contraction of the flexors, extensors
  when they grasp a pen or place hand on target
  instrument
• Treatment Stop doing activities, reduce tension

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DISORDERS OF THE UPPER LIMB

• GAME KEEPERS THUMB

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DISORDERS OF THE UPPER LIMB

• GAME KEEPERS THUMB
• Treatment
• If the ligaments are only partially torn, they
  usually heal without surgery.
• Your thumb will be immobilized for four to six
  weeks in a special cast, called a thumb spica
  cast.
• Surgery for stener leision, complete tears.

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DISORDERS OF THE UPPER LIMB

• GAME KEEPERS THUMB