Common Pathologies of the Upper Limb 2

Question 1

Describe the pathophysiology of adhesive capsulitis (frozen shoulder)

Answer 1

Formation of excessive scar tissue or adhesions across GH

Question 2

Describe the risk factors for adhesive capsulitis

Answer 2

Female: Male - 70:40
Age > 40
Trauma
HLA-B27+ve
Diabetes
Hyperthyrodism
CVD, CAD
History of Dupitrons

Question 3

What are the four phases of adhesive capsulitis?

Answer 3

1 - shoulder pain, especially at night (synovitis without adhesion)
2- stiffness develops (synovitis, synovial proliferation)
3 - profound, global loss of ROM, pain at ER (synovitis resolved, significant adhesions)
4 - chronic stage, persistent stiffness, minimal pain (synovitis resolved, advanced adhesions)

Question 4

What is the clinical presentation of adhesive capsulitis

Answer 4

First pain, followed by gradual loss of ROM (LR first)

Passive ROM with firm, painful end feel

Question 5

What are the surgical treatments of adhesive capsulitis

Answer 5

MUA, capsular release (CH ligament, rotator interval, contracted capsule)

Question 6

What part of the clavicle is most commonly fractured

Answer 6

Mid shaft>Lateral> Medial

Question 7

What population is most affected by proximal humerus fracture and how is it managed

Answer 7

Elderly women, collar and cuff 2-3/52, followed by active management, typically progress slowly

Question 8

Give and explain 3 types of distal radius fracture

Answer 8

Colles’ - extra-articular, dorsally displaced
Smiths’ - anterior displacement
Bartons’ - intra-articular, also associated with RCJ dislocation

Question 9

What part of scaphoid is most commonly injured and which is most problematic

Answer 9

Waist>prox pole> distal pole

Prox pole has poor blood supply - risk of AVN, 5% non-union

Question 10

Describe what occurs in RA

Answer 10

Inflammatory disease with extra-articular involvement, synovium infiltrated by immune cells, fibroblasts and inflammatory cells lead to osteoclast generation leading to bone erosion

Question 11

Describe the risk factors for RA

Answer 11

NA and Europe
Female to Male - 2-3:1
Increased with age
Genetic, smoking, air pollution, obesity, low vitamin D

Question 12

Describe the clinical presentation of RA

Answer 12

Polyarthritis of small joints of hands

Joint stiffness in morning, fatigue, deformity, pain, weakness, restricted mobility

Question 13

Describe what happens during an anterior shoulder dislocation and what structures may also be injured

Answer 13

Often abduction/ external rotation
Humeral head displaces anterior-inferiorly
Associated with Hills-Sachs lesions, Bankart lesions, fracture of anterior glenoid, concurrent RC injury, axilla/ brachial plexus at risk

Question 14

Give 3 lesions that you may also see with an anterior shoulder dislocation

Answer 14

SLAP - superior labrum, anterior and posterior
HAGL - humeral avulsion of GH ligament
ALPSA - anterior labroligamentous periosteal sleeve avulsion

Question 15

When might a posterior shoulder dislocation occur and what concurrent injuries might you see

Answer 15

Blow to front of shoulder, injuries to RC (subsc.) and posterior labrum

Question 16

Describe shoulder instability

Answer 16

Disruption of the dynamic and static stabilisers of the GHJ leading to dislocation, subluxation or apprehension

Question 17

What are the causes of shoulder instability?

Answer 17

Traumatic (dislocation, damage to stabilisers)

Atraumatic (hypermobility/ EDS)

Question 18

What is Dupuytren disease?

Answer 18

Nodular hypertrophy and contracture of the superficial palmar fascia, flexion contraction of the MCP and PIP joints, leading to LOF

Question 19

Describe the aetiology of Dupuytren disease

Answer 19

Males> Females
Most common in Northern Europeans
Average age of onset = 60
Environmental factors - alcohol intake, smoking, manual labour, low BW/BMI, use of anticonvulsants

Question 20

What procedures are used surgically for Dupuytrens

Answer 20

Simple fasciotomy
Fasciectomy
Dermofasciectomy