Upper limb pathology rapid assessment
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UPPER LIMB PATHOLOGY - RAPID ASSESSMENT. Murali Bhat www.ukorthocare.com. BASIC ANATOMY. Root - between scalenus anterior & scalenus posterior muscles with Subclavian artery Inferior part of neck- roots unite  trunks Trunks – superior, middle, inferior

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UPPER LIMB PATHOLOGY - RAPID ASSESSMENT

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UPPER LIMB PATHOLOGY - RAPID ASSESSMENT

Murali Bhat

www.ukorthocare.com


BASIC ANATOMY


Root- between scalenus anterior & scalenus posterior muscles with Subclavian artery

Inferior part of neck- roots unite  trunks

Trunks – superior, middle, inferior

Each trunk divides into  anterior & posterior division

Division form 3 cords

Cords – names indicated by relationship with axillary artery


Median Nerve

PRONATER TERES

PRONATER TERES

FDS

ANTERIOR INTEROSSEOUS

NERVE


Ulnar Nerve

MEDIAN NERVE

ULNAR NERVE


SYMPTOMS

Pain

Loss of function

Cosmesis


Examination

Look

Move

Feel (Special tests)


Surface anatomy

Palmar


Surface Anatomy


Pain

Localised Wrist

Generalised hand and arm


Radial Wrist pain


B.Movements

Passive movements

-extension


B.Movements

Passive movements

-flexion


PALPATION

Dorsal


Palpation & Special Test


Palpation & Special Test

Scaphoid

-the waist in the anatomical snuffbox

-painful non union can be tested by the grinding test

Axial pressure along 1st metacarpal with wrist in radial deviation

-crepitus can be felt in OA of the CMC joint or scaphoid non union


Surface anatomy

Dorsal

LISTER’S TUBERCLE


Surface anatomy

Dorsal

SCAPHOLUNATE LIGAMENT


B.Movements

Active movement

-pronation

Ulnar Wrist Pain


B.Movements

Active movement

-supination

Ulnar Wrist Pain


Surface anatomy

Dorsal

Ulnar head


Surface anatomy

Dorsal

Ulnar styloid


Palpation & Special Test

TFCC

Clamp both radius & ulna

The other hand applies axial loading in ulnar deviation

Carpus is pronated & supinated

TFCC is assessed for pain and clicking


Examination of DRUJ


Palpation & Special Test

FCU & Pisiform bone

-feel the tendon and pisiform bone with the tip of the index finger


Palpation & Special Test

Piso-triquetral joint

-by applying gentle thumb pressure on the pisiform towards the midline

-FCU tendon,push against resisted flexion and ulnar deviation


Palpation & Special Test

Hook of hamate

-can be tender in non union

-place thumb on pisiform and move distally 1-2 cm and

-radially along a line joining the pisiform to the neck of the 2nd metacarpal

-simultaneous pressure is applied on the dorsal and ulnar aspect of this bone with the index & middle finger


Diffuse Arm Pain


Cross section through carpal tunnel

Roof is formed by the tranverse carpal ligament

Floor and wall formed by the carpal bones


Surface anatomy

Palmar


Thoracic Outlet Syndrome

  • Five clinical syndromes

    • Major arterial syndrome

    • Minor arterial syndrome

    • Venous obstruction syndrome

    • True neurogenic thoracic outlet syndrome

    • Disputed neurogenic thoracic outlet syndrome

  • Generally: pain, weakness, numbness and tingling, swelling, fatigue or coldness in the arm and hand


Neurological Disturbance

  • Usually in C8 andT1 distribution but may also involve entire hand

  • if numbness extend to ulnar border of forearm or upper arm, increased likelihood of thoracic outlet or root aetiology (since these are medial cutaneous nerves of forearm and arm territories, not ulnar nerve)


Loss of Function

Deformity

Instability


COSMESIS

Swelling

Deformity


COMMON SWELLINGS


Elbow examination


Look

Muscle wasting

Swelling or effusion

Deformity e.g. cubitus varus /valgus


Carrying angle of the elbow

Males:2-22 deg

Females :2-26 deg


Feel

  • Relationship and Tenderness over both epicondyles and olecranon process ,radial head

  • Tenderness over ulnar nerve region


Palpation of ulnar nerve


Relationship between both epicondyles & olecranon process

3 bony landmarks

Medial epicondyle

Lateral epicomndyle

Olecranon process

Equilateral triangle in flexion

Straight line in extension


Move

Extension/hyperextension

Flexion –screening /actual measurement

Pronation-screening/actual measurement

Supination-screening/actual measurement


Flexion & Extension


Pronation & Supination


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