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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

UPPER LIMB PATHOLOGY - RAPID ASSESSMENT

Murali Bhat

www.ukorthocare.com

slide4
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
Median Nerve

PRONATER TERES

PRONATER TERES

FDS

ANTERIOR INTEROSSEOUS

NERVE

ulnar nerve
Ulnar Nerve

MEDIAN NERVE

ULNAR NERVE

symptoms

SYMPTOMS

Pain

Loss of function

Cosmesis

examination
Examination

Look

Move

Feel (Special tests)

slide17
Pain

Localised Wrist

Generalised hand and arm

b movements
B.Movements

Passive movements

-extension

b movements1
B.Movements

Passive movements

-flexion

slide22

PALPATION

Dorsal

palpation special test1
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

slide25

Surface anatomy

Dorsal

LISTER’S TUBERCLE

slide26

Surface anatomy

Dorsal

SCAPHOLUNATE LIGAMENT

b movements2
B.Movements

Active movement

-pronation

Ulnar Wrist Pain

b movements3
B.Movements

Active movement

-supination

Ulnar Wrist Pain

slide29

Surface anatomy

Dorsal

Ulnar head

slide30

Surface anatomy

Dorsal

Ulnar styloid

palpation special test2
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

palpation special test3
Palpation & Special Test

FCU & Pisiform bone

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

palpation special test4
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 test5
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

cross section through carpal tunnel
Cross section through carpal tunnel

Roof is formed by the tranverse carpal ligament

Floor and wall formed by the carpal bones

thoracic outlet syndrome
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
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
Loss of Function

Deformity

Instability

cosmesis
COSMESIS

Swelling

Deformity

slide60
Look

Muscle wasting

Swelling or effusion

Deformity e.g. cubitus varus /valgus

carrying angle of the elbow
Carrying angle of the elbow

Males:2-22 deg

Females :2-26 deg

slide63
Feel
  • Relationship and Tenderness over both epicondyles and olecranon process ,radial head
  • Tenderness over ulnar nerve region
relationship between both epicondyles olecranon process
Relationship between both epicondyles & olecranon process

3 bony landmarks

Medial epicondyle

Lateral epicomndyle

Olecranon process

Equilateral triangle in flexion

Straight line in extension

slide66
Move

Extension/hyperextension

Flexion –screening /actual measurement

Pronation-screening/actual measurement

Supination-screening/actual measurement

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