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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
Common MOI for rotator cuff
- fall on outstretched arm - fall on outer shouler - heavy pushing/pulling
26
Symptoms of rotator cuff
- 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
Examination for rotator cuff tear
- normal ROM - pain on stressing affected endon - weakness of affected tendon if significant tear - bursitis/impingement
28
Radiology for rotator cuff tears
- 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
Treatment of rotator cuff tears
- 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
Impingement syndrome
- 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
Exam for impingement
- painful arc - crepitus above 60 degrees - normal glenohumeral ROM - normal strength - Hawkins kennedy test - Neer's test
32
Hawkins kennedy test:
- at 90 degrees of elbow flexion, do internal rotation by pushing down on patients forearm - compress subacromial space
33
Neer's test
- at full elbow extension, internally rotate and flex the arm while stabilizing the scapula - jams the humeral head into the acromion
34
Radiology for impingement
- clinical diagnosis, X ray not usually needed - Xray if chronic symptoms, Acromial spurs or AC joint osteophytes - confirm on ultrasound
35
Treatment of impingement
- REST - ICE - NSAID - subacromial injection - physiotherapy
36
Biceps tendonitis
- 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
Examination for biceps tendonitis
- bicipital groove tenderness - look for subacromial impingement - tendon rupture - test biceps strength - Yergason test Speeds test
38
Yergason test
- 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
Treatment of biceps tendonitis
- 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
Ruptured biceps tendon
- popeye sign - rarely get significant weakness - short head of biceps and brachioradialis provide 80/85% of elbow flexor strength
41
Adhesive capsulitis
- also called "frozen shoulder" - usually self limiting - may have preceding trauma
42
Risk factors for adhesive capsulitis
- diabetes - disuse - hypo and hyperthyroidism - high cholesterol
43
Adhesive capsulitis clinical features
- 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
Radiology for adhesive caspulitis
- 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
Treatment of adhesive capsulitis
- watchful waiting - NSAIDS - steroid injection - hydrodilatation - manipulation under anesthesia - gentle exercise when pain free
46
Lateral epicondylitis: " tennis elbow"
>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
Clinical features of lateral epicondylitis
- 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
Lateral epicondylitis treatment
- RICE - NSAIDS - analgesics - activity modification - counterforce strap - range of motion exercise - deep friction massage - steroid injection
49
Medial epicondylitis: Golfer's elbow
- inflammation of the common flexor tendons at medial epicondyle - repetitive flexion of the wrist, pitching, golf swing, swimming backstroke
50
Clinical diagnosis of medial epicondylitis
- tenderness over medial epicondylke - pain on resisted wrist volar flexion - X ray negative - ultrasound
51
Management of medial epicondylitis
- RICE, NSAIDS, analgesics - activity modification - counterforce strap - ROM exercise - deep friction massage - steroid injection
52
DE quervain's tenosynovytis
- 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
De Quervains treatment
- RICE - NSAIDS - activity modification - thum spica splint - cortisone injection - operative release rarely required
54
Trigger finger
- catching sensation or locking phenomena - pain in affected finger - catching and locking episode - palpable nodule over MCP joint - thickening along affected flexor tendon
55
Trigger finger treatment
- change of activity - splint - use of NSAID - CS injection - surgery for severe cases

Block 2 - MSK (38 decks)

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