Upper Limb Conditions

Question 1

Erbs palsy

Answer 1

Excessive increase in angle between the neck and shoulder

Trauma or baby birth (dystocia)

C5 and C6

Present with:
Adduction
Medially rotated 
Elbow extension 
Wrist flexion
Pronation

Question 2

Erbs palsy affected muscles

Answer 2

Biceps brachii - MN - C5 -C7
Corocobrachialis  - MN
Brachialis- MN
Deltoid - AN - C5 - C6
Teres minor - AN 
Brachioradialis- RN - C5-T1

Question 3

Klumpke’s palsy

Answer 3

Forced hyperextension or hyperabduction

C8-T1

Claw hand 
Hyperextension of MCPJ 
Flexion of IPJ
Abduction of thumb 
Wasting of interossei

Question 4

Claw hand

Answer 4

Seen in klumpke’s palsy

Hyperextension of MCPJ
Flexion of IPJ
Abduction of thumb
Wasting of interossei

Question 5

Axillary lymphadenopathy

Answer 5

Enlargement of axillary lymph nodes due to:
Infection 
Metastases of breast cancer 
Leukaemia or lymphoma 
Malignant melanoma metastases 

Axillary lymph node dissection - danger of damage to long thoracic nerve or thoracodorsal nerve

Question 6

Fracture of the scapula

Answer 6

Uncommon
Very chest trauma - RTA
Does not require fixation - muscle tone

Question 7

Fractures of the surgical neck of the humerus

Answer 7

Frequent
Blunt trauma
FOOSH

Circumflex arteries at risk
Axillary nerve damage

Cannot abduct
Regimental badge area parasaethesia

Question 8

Rupture of the biceps tendon

Answer 8

50+ yrs old minimal trauma
Something snap in shoulder whilst lifting
Flexion at alelbow produces firm lump - Popeye sign

Question 9

Triceps tendon reflex test

Answer 9

C7

Elbow extension

Question 10

Dislocated shoulder

Answer 10

Common
Visible swelling, deformity and bruising around shoulder
Restricted movement

95% are anterior

Hand behind head - hyperabduction and external rotation

Question 11

Bankart lesion

Answer 11

Labral tear of glenoid labrum
Sometimes bone fragments torn off
In anterior dislocation

Question 12

Hill-Sachs lesion

Answer 12

Dent in the posterolateral numeral head

Question 13

Posterior dislocation

Answer 13

Less common
Violent muscle contraction:
Epileptic seizure
Electrocution

Arm internally rotated
Adducted
Squaring of shoulder
Prominent corocoid process

Question 14

Inferior dislocation

Answer 14

Forceful traction of arm when fully extended over the head - hyperabduction

Damage to
nerves
Blood vessels
Rotator cuffs

Question 15

Clavicle fractures

Answer 15

Common in mid clavicular area - middle third

FOOSH or on shoulder

Question 16

Indication for surgical fixation in clavicle dislocations

Answer 16

Complete displacement 
Severe displacement 
Open fractures 
Neurovascular compromise
Floating shoulder

Question 17

Position of arm and clavicular fragments in displaced midclavicular fracture

Answer 17

Sternocleiodmastoid - elevates medial segment
Shoulder drops - unable to hold lateral aspect up by trapezius
Pectoralis major - Adducted

Suprascapular nerve may be damaged
Supraclavicular nerve damage (C3 - C4) - upper chest paraesthesia

Question 18

Rotator cuff tear

Answer 18

Common
Tendons commonly affected
Supraspinatous tendon most common - tear at greater tubercle

Age related degeneration - degenerative microtrauma

Anterolateral shoulder pain
Radiating down arm
Pain on flexion and leaning on elbows
Weakness of shoulder abduction

Question 19

Tenocyte

Answer 19

Tendon cell apoptosis due to oxidative stress

Question 20

Impingement syndrome

Answer 20

Supraspinatus tendon impinges on the coroco-acromial arch
Irritation
Inflammation

Causes:
Dull Pain (60 - 120 degrees abduction )
Weakness
Limited range of movement 
Grinding and popping sensation 

During abduction and flexion of shoulder

Question 21

Causes of impingement syndrome

Answer 21

Narrowing of space between the corocoacromial arch and humerus

E.g

Thickening of corocoacromial ligament
Inflammation of supraspinatus tendon
Subacromial osteophytes

Question 22

Calcific supraspinatus tendinopathy

Answer 22

Deposits of hydroxyapatite in supraspinatus tendon

Acute chronic pain 
Aggravated by abduction and flexion of arm above shoulder 
Stiffness
Catching 
Reduced range of movement 

Regional hypoxia - tenocytes - differentiate into Chondrocytes - cartilage

Question 23

Adhesive capsulitis

Answer 23

Frozen shoulder
Capsule of glenohumeral joint becomes inflamed and stiff
Restricted movement
Chronic constant pain
Worse at night
Exacerbated by movement and cold weather

Idiopathic

Risks:
Female 
Epilepsy 
Diabetes 
Trauma 
CT disease 

Long periods of inactivity

Question 24

Treatment of adhesive capsulitis

Answer 24

Analgesia
Physiotherapy
Anti - inflammatory
Manipulation under anaesthesia