Upper Limb Disorders

Wrist Fractures

The most common mechanism of this injury is FOOSH = Fall onto an outstretched hand.

Colle's fracture is a transverse fracture of the distal radius, causing the distal portion to displace posteriorly

Scaphoid fracture presents with tenderness in the anatomical snuffbox. The complication that can occur here is Avascular necrosis as the scaphoid bone only has a single blood supply, so a fracture can cut this off.

Shoulder Dislocation

This is most commonly an Anterior dislocation.

A key complication here is Axillary nerve (C5, C6) damage, which will present with sensory loss over the lateral deltoid, and motor loss of deltoid and teres minor. Another complication that can occur here is a Rotator cuff tear.

When examining these patients, it's always very important to check for vascular and nerve damage; pulses, sensation, movement.

Rotator Cuff Tear

Muscles involved are - SITS:

• Supraspinatus (abduction)

• I

  nfraspinatus (external rotation)

  
  

• Teres Minor (external rotation)

• Subscapularis (internal rotation)

A tear of a muscle here can either be due to an acute injury or age-related degenerative changes e.g. tennis.

Imaging - US or MRI

Adhesive Capsulitis (Frozen Shoulder)

Inflammation and fibrosis of joint lead to adhesions (scarring), which bind and tighten the capsule around the joint and restrict its movement. A key risk factor for this occuring is Diabetes Mellitus.

2 types:

• Primary – spontaneous w/o a trigger

• Secondary – response to trauma, surgery, or immobilisation

It tends to present with:

• Gradual onset pain and stiffness of the shoulder with reduced movement

  • Pain worsens initially and persists for weeks-months

  • Stiffness can persist for months-years

• Symptoms gradually resolve over time

Epicondylitis

This is a type of repetitive strain injury.

2 types:

• Lateral epicondylitis (Tennis elbow)

• Medial epicondylitis (Golfer’s elbow)

It presents with pain and tenderness at the epicondyle, and weakness in grip strength.

Olecranon Bursitis

Inflammation of bursa, which causes swelling. This can be caused by:

• Repetitive damage e.g. leaning on elbow

• Trauma

• RA or Gout

• Infection (Septic bursitis)

It presents with a swollen, warm, tender, fluid-filled joint bursa.

It's managed with Rest, Analgesia, Ice, Compression, and Aspiration.

DeQuervain’s Tenosynovitis

This is a type of repetitive strain injury e..g. thumb abduction in office workers or musicians.

This is where there's inflammation and swelling of the tendons of the Abductor pollicis longus and Extensor pollicis brevis at the base of the thumb.

It presents with pain on the radial side of the wrist, weakness, numbness, and tenderness.

Trigger Finger

Flexor tendons of fingers pass through several sheaths. Trigger finger is where there’s thickening/tightening of these sheaths, therefore preventing the tendon moving under it smoothly.

It presents with:

• Pain and tenderness

• Popping or clicking sound

• Finger gets stuck in flexed position