Injuries of the Upper Limb

Question 1

What type of injuries is the shoulder more prone to?

Answer 1

Soft tissue, rather than bony

Question 2

What is the pathology of a rotator cuff (RC) injury?

Answer 2

Inflammation of RC, associated bursitis & impingement of RC against CA ligament

Question 3

What is the mechanism of a RC injury?

Answer 3

Repetitive microtrauma - intensity, frequency and duration of training load exceeds ability of tissue to recover and adapt

Question 4

What are the pathomechanics of a RC injury?

Answer 4

1) Wringing out of blood supply in supraspinatus and biceps tendon on internal rotation & adduction
2) Impingement of RC against CA ligament
3) Narrowing of subacromial canal
4) Role of muscle imbalance

Question 5

What is the history of a RC injury?

Answer 5

Pain with/after activity, pain with overhead activity, pain lying on shoulder

Question 6

What is considered in the examination of an RC injury?

Answer 6

Painful arc of movement (80-120 degrees abduction), positive impingement signs

Question 7

What investigations are used for a RC injury?

Answer 7

X-ray, ultrasound, MRI

Question 8

How is an RC injury graded?

Answer 8

Grade I: Pain after activity
Grade II: Pain during/after activity
Grade III: Prolonged pain throughout the day

Question 9

What is the pathology of the RC injury grades?

Answer 9

Grade I: Inflammation of tendon
Grade II: Partial tear
Grade III: Complete tear

Question 10

What is the treatment for an RC injury?

Answer 10

Reduction of activity, NSAIDs, physio, address muscle imbalances, surgery (arthroscopy or open)

Question 11

What is the mechanism of a GH dislocation?

Answer 11

Actue injury, fall onto point of shoulder/outstretched hand, abduction and external rotation

Question 12

What is considered in the examination of a GH dislocation?

Answer 12

Obvious deformity, pain, loss of function of arm

Question 13

What investigation is used for a GH dislocation?

Answer 13

X-ray

Question 14

What is the treatment for a GH dislocation?

Answer 14

Reduction, further investigation (MRI), long-term (conservative vs surgery)

Question 15

What is the mechanism of a GH sublaxation?

Answer 15

Partial dislocation, articular surfaces remain in partial contact with each other but no longer aligned

Question 16

What is the history of a GH sublaxation?

Answer 16

Pain with activity, feeling of instability, dead arms with trauma

Question 17

What is considered in the examination of a GH sublaxation?

Answer 17

Pain in the apprehension position, increased GH translation

Question 18

What investigation is used for a GH sublaxation?

Answer 18

X-ray, MRI

Question 19

What is the treatment for a GH sublaxation?

Answer 19

Conservative: Strength of RC, scapula stabilisers

Surgery

Question 20

What is the glenoid labrum?

Answer 20

Fibrocartilage rim surrounding the articular surface of the glenoid

Question 21

What is the mechanism of a glenoid labrum injury?

Answer 21

Associated with dislocation/sublaxation and acute trauma, SLAP lesion

Question 22

What is the history of a glenoid labrum injury?

Answer 22

Shoulder pain with activity, may be acute or painful click

Question 23

What is considered in the examination of a glenoid labrum injury?

Answer 23

Pain with overhead activities, positive O’Brien test

Question 24

What investigation is used for a glenoid labrum injury?

Answer 24

MRI anthrogram, arthroscopy

Question 25

What is the treatment for a glenoid labrum injury?

Answer 25

Surgery (arthroscopy or open)

Question 26

What is the mechanism of an AC joint injury?

Answer 26

Fall onto point of shoulder

Question 27

What is the history of an AC joint injury?

Answer 27

Mechanism, pain especially with overhead/cross body activities

Question 28

What is considered in the examination of an AC joint injury?

Answer 28

Tender over AC joint, deformity

Question 29

How is an AC joint injury graded?

Answer 29

Grade I: No widening of joint Grade II: Partial widening of joint Grade III: Complete rupture of joint

Question 30

What is the treatment for an AC joint injury?

Answer 30

Grade I: Rest, ice, NSAIDs, strength, physio, corticosteroid injection (takes 10-14 days) Grade II: As above (takes 4-6 weeks) Grade III: Treated conservatively or surgically (takes 3 months)

Question 31

What is the mechanism of a clavicle fracture?

Answer 31

Fall onto outstretched hand, direct blow, fall onto point of shoulder

Question 32

What is the history of a clavicle fracture?

Answer 32

Mechanism, immediate pain, deformity

Question 33

What is considered in the examination of a clavicle fracture?

Answer 33

Obvious deformity, tenderness, pain with movement of arm

Question 34

What investigation is used for a clavicle fracture?

Answer 34

X-ray, CT scan

Question 35

What is the treatment for a clavicle fracture?

Answer 35

Usually conservative - sling for 6 weeks, mobilise elbow hand & wrist Surgery - plate, pin

Question 36

What is lateral epicondylitis?

Answer 36

Inflammation of the lateral epicondyle at insertion of the common extensor tendon (tennis elbow)

Question 37

What is the mechanism of lateral epicondylitis?

Answer 37

Overload of the bony insertion due to repetitive micro trauma, tightness in the extensor muscles of the forearm and hand

Question 38

What is the history of lateral epicondylitis?

Answer 38

Pain, tenderness, feeling weak with grip

Question 39

What is considered in the examination of lateral epicondylitis?

Answer 39

Tender lateral epicondyle, pain with resisted wrist and finger extension

Question 40

What is the treatment for lateral epicondylitis?

Answer 40

Ice, NSAIDs, corticosteroid injection, graded eccentric strength program

Question 41

What are the contributing factors of lateral epicondylitis?

Answer 41

Grip size, compression of common extensor tendon, technique, racquet size

Question 42

What is medial epicondylitis?

Answer 42

Inflammation of the medial epicondyle at the insertion of the common flexor tendon (golfer's elbow)

Question 43

What is forearm insertion syndrome?

Answer 43

Inflammation of radial wrist extensors and/or thumb extensors

Question 44

Why may scaphoid fractures not heal properly?

Answer 44

Limited blood supply - risk of avascular necrosis

Question 45

What is the mechanism of a scaphoid fracture?

Answer 45

Fall onto outstretched hand

Question 46

What is the history of a scaphoid fracture?

Answer 46

Mechanism, pain in wrist with activity

Question 47

What is considered in the examination of a scaphoid fracture?

Answer 47

Tender in anatomical snuffbox

Question 48

What investigations are used for a scaphoid fracture?

Answer 48

X-ray, CT, MRI

Question 49

What is the treatment of a scaphoid fracture?

Answer 49

Scaphoid plaster, repeat x-rays, plaster immobilisation/surgery