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Block 2 - MSK > Lecture 24- Upper Limb Soft Tissue Disorders > Flashcards

Lecture 24- Upper Limb Soft Tissue Disorders Flashcards

1
Q

Skeletal muscle function

A
  • enable us to move

- convert body’s chemical energy into a physical contraction

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2
Q

Tendon function

A
  • binds muscle to bone
  • transmit force between muscle and bone
  • enable muscle belly to be at a convenient distance from joint
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3
Q

Ligaments function

A
  • bind bone to bone
  • stabilise joint
  • hold skeleton together
  • transmit load from bone to bone
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4
Q

Enthesis function

A
  • binds tendon/ligament to bone
  • stable anchorage to the skeleton
  • protects bone attachment sites to bone by dissipating stress
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5
Q

Bursa function

A
  • cushions locates at points of friction
  • DEEP: allow muscles to glide over each other and over prominences of bone
  • SUPERFICIAL: cushions between skin and bone
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6
Q

Acute injury definition

A
  • usually occurs from a known incident
  • definite moment of onset
  • signs and symptoms develop rapidly
  • relatively predictable pattern of events
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7
Q

Bruise/contusion

A
  • acute soft tissue injury of blood vessels

- direct force applied to the body resulting in compression and bleeding into soft tissue

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8
Q

Muscle/tendon injury

A
  • strain: acute soft tissue injury
  • muscles over stretching or contracting too quickly, resulting in a partial or compelte tear of the muscle and/or tendon fibres
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9
Q

Are muscles or tendon most commonly damaged in acute injuries?

A

MUSCLES

  • tendons are much stronger
  • damage is usually to muscle belly or musculotendinous junction
  • tendons weaken with age, medication and comorbidities
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10
Q

Grading of soft tissue injury

A
  • Grade 1: minimal tear
  • Grade 2: partial tear
  • Grade 3: complete tear
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11
Q

Sprain

A
  • ligament acute soft tissue injury

- joint forced beyong normal ROM -> results in overstretching and tearing of ligament that supports the joint

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12
Q

Bursa injury

A
  • aseptic: direct blow or fall -> hemarthrosis (eg Gout)

- Septic: dangerous. Insect bite or cut/abrasion. Hematogenous spread

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13
Q

Healing response of soft tissue

A
  • bleeding: hematoma
  • inflammatory: remove debris, recruit repair cells
  • Proliferation: fibroblast collagen synthesis
  • REmodelling: organisation of scar tissue
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14
Q

RICE THERAPY

A
  • first 2 days
  • Rest
  • ice 20 min 4-8 times a day
  • compression to reduce swelling
  • elevation above heart -> reduce swelling
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15
Q

Rehabilitation phase

A
  • restore ROM, strength, flexibility
  • graded exercise program
  • surgery for grade III
  • depends on extent and type of injury
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16
Q

Time needed for full recovery

A
  • mild sprain/strain: 3-6 weeks
  • moderate: 2-3 months
  • severe: 8-12 months
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17
Q

Chronic disorders definition

A
  • insidious onset
  • develops and worsens over time
  • persists for >3 months
  • may occur as a result of repetitive load or stress (microtrauma)
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18
Q

Healthy tendons

A
  • brilliant white color
  • high mechanical strength
  • good flexibility
  • dry mass 30%, water 70%
  • mostly collagen type I
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19
Q

Changes in tendinosis

A
  • disorganised collagen
  • cellularity of rounded tenocytes
  • switch to majority of type III collagen
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20
Q

Supraspinatus injury

A
  • abducts arm at the shoulder joint during the first 10-15 percent
  • pulls humerus medially against glenoid fossa
  • empty can sign
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21
Q

Infraspinatus/ teres minor injury

A
  • external rotator and adductor of shoulder

- ask to asct like a penguin

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22
Q

Subscapularis

A
  • internal rotation
  • pulls humerus forward and downward
  • ” scratch your back”
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23
Q

Bursae in shoulder joint

A
  • biceps tenosynovium
  • subcoracoid bursa
  • subacromial bursa
24
Q

Rotator cuff pathology

A
  • 85% of shoulder problems
  • by age 60, over 50% have a tear
  • most tears are degenerative
  • usually starts in supraspinatus and spreads
  • tears do not heal on their own -> grow larger
25
Q

Common MOI for rotator cuff

A
  • fall on outstretched arm
  • fall on outer shouler
  • heavy pushing/pulling
26
Q

Symptoms of rotator cuff

A
  • many patients dont have pain
  • pain localized along lateral arm
  • pain with numerous activities
  • lying on affected side, overhead movements
  • shoulder weakness, loss of motion
  • catching sensation when shoulder is moved
  • night pain
  • pain on active > passive movement
27
Q

Examination for rotator cuff tear

A
  • normal ROM
  • pain on stressing affected endon
  • weakness of affected tendon if significant tear
  • bursitis/impingement
28
Q

Radiology for rotator cuff tears

A
  • abnormal rotator cuff signal after trauma may represent strain rather than tear
  • X ray -> high riding humeral head is indicative of full thickness supraspintus tear
29
Q

Treatment of rotator cuff tears

A
  • ICE
  • NSAIDS
  • restrict aggravating motion
  • weight pendulum
  • steroid injection if persistent symptoms
  • graded physiotherapy
  • surgery for young patients or patients with full tear or dominant arm
30
Q

Impingement syndrome

A
  • compression of rotator cuff tendons and subacromial bursa between greater tuberosity and acromion
  • repetitive overhead motions
  • main cause of rotator cuff tendonitis
  • can lead to bursitis, partial or full rotator cuff tears
  • symptoms similar to tendinitis, tears
31
Q

Exam for impingement

A
  • painful arc
  • crepitus above 60 degrees
  • normal glenohumeral ROM
  • normal strength
  • Hawkins kennedy test
  • Neer’s test
32
Q

Hawkins kennedy test:

A
  • at 90 degrees of elbow flexion, do internal rotation by pushing down on patients forearm
  • compress subacromial space
33
Q

Neer’s test

A
  • at full elbow extension, internally rotate and flex the arm while stabilizing the scapula
  • jams the humeral head into the acromion
34
Q

Radiology for impingement

A
  • clinical diagnosis, X ray not usually needed
  • Xray if chronic symptoms, Acromial spurs or AC joint osteophytes
  • confirm on ultrasound
35
Q

Treatment of impingement

A
  • REST
  • ICE
  • NSAID
  • subacromial injection
  • physiotherapy
36
Q

Biceps tendonitis

A
  • inflammation of long head of buceps
  • usually due to repetitive lifting or reaching
  • inflammation, microtering, degenerative changes
  • up to 10% of patients have spontaneous rupture
  • anterior shoulder pain
  • worse with lifting or overhead reaching
  • often patients point to bicipital groove
37
Q

Examination for biceps tendonitis

A
  • bicipital groove tenderness
  • look for subacromial impingement
  • tendon rupture
  • test biceps strength
  • Yergason test
    Speeds test
38
Q

Yergason test

A
  • elbows flexed with forearms in front
  • patient actively resists external rotation
  • tendon may pop out of bicipital groove when downward pressure applied to forearm
39
Q

Treatment of biceps tendonitis

A
  • reduce inflammation
  • strengthen biceps muscle and tendon
  • prevent rupture
  • Ice, NSAIDS
  • avoid aggravating motion
  • weight pendulum
  • elbow flexion toning exercise
  • steroid injection
  • surgical referral if refractory
40
Q

Ruptured biceps tendon

A
  • popeye sign
  • rarely get significant weakness
  • short head of biceps and brachioradialis provide 80/85% of elbow flexor strength
41
Q

Adhesive capsulitis

A
  • also called “frozen shoulder”
  • usually self limiting
  • may have preceding trauma
42
Q

Risk factors for adhesive capsulitis

A
  • diabetes
  • disuse
  • hypo and hyperthyroidism
  • high cholesterol
43
Q

Adhesive capsulitis clinical features

A
  • 3 classic stages: pain (freezing stage), stiffness (frozen stage), resolution (thawing stage)
  • frozen stage characterized by pain and restriction of all movements of the shoulder
  • range of motion is smooth and pain free, then stops suddenly
  • normal strength is the pain free range
44
Q

Radiology for adhesive caspulitis

A
  • clinical diagnosis
  • Xray to exclude other factors
  • MRI enhancement of joint capsule and synovial membrane
  • 4 mm thickening is 70% sensitive and 95% specific
45
Q

Treatment of adhesive capsulitis

A
  • watchful waiting
  • NSAIDS
  • steroid injection
  • hydrodilatation
  • manipulation under anesthesia
  • gentle exercise when pain free
46
Q

Lateral epicondylitis: “ tennis elbow”

A

> 10% of cases are due to tennis

  • degeneration of origin of ECRB
  • repetitive extension of wrist, throwing
  • microtrauma to insertion of extensor muscle of lateral epicondyle
47
Q

Clinical features of lateral epicondylitis

A
  • aching pain in region of lateral epicondyle after activity
  • localized tenderness over lateral epicondyle
  • pain with hand shakes, lifting briefcase
  • pain with resistive wrist extension, pronation and third finger extension
48
Q

Lateral epicondylitis treatment

A
  • RICE
  • NSAIDS
  • analgesics
  • activity modification
  • counterforce strap
  • range of motion exercise
  • deep friction massage
  • steroid injection
49
Q

Medial epicondylitis: Golfer’s elbow

A
  • inflammation of the common flexor tendons at medial epicondyle
  • repetitive flexion of the wrist, pitching, golf swing, swimming backstroke
50
Q

Clinical diagnosis of medial epicondylitis

A
  • tenderness over medial epicondylke
  • pain on resisted wrist volar flexion
  • X ray negative
  • ultrasound
51
Q

Management of medial epicondylitis

A
  • RICE, NSAIDS, analgesics
  • activity modification
  • counterforce strap
  • ROM exercise
  • deep friction massage
  • steroid injection
52
Q

DE quervain’s tenosynovytis

A
  • inflammation of sheath surround abductor pollicis longus and extensor pollicis brevis
  • painful thumb abduction
  • new mothers lifitng babies
  • pain and swelling over radial styloid
  • Finkelstein’s maneuver
53
Q

De Quervains treatment

A
  • RICE
  • NSAIDS
  • activity modification
  • thum spica splint
  • cortisone injection
  • operative release rarely required
54
Q

Trigger finger

A
  • catching sensation or locking phenomena
  • pain in affected finger
  • catching and locking episode
  • palpable nodule over MCP joint
  • thickening along affected flexor tendon
55
Q

Trigger finger treatment

A
  • change of activity
  • splint
  • use of NSAID
  • CS injection
  • surgery for severe cases

Block 2 - MSK (38 decks)

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