Upper limb injury Notes


Osmosis High-Yield Notes

This Osmosis High-Yield Note provides an overview of Upper limb injury essentials. All Osmosis Notes are clearly laid-out and contain striking images, tables, and diagrams to help visual learners understand complex topics quickly and efficiently. Find more information about Upper limb injury:

Dislocated shoulder

Radial head subluxation (Nursemaid elbow)

Rotator cuff tear

NOTES NOTES UPPER LIMB INJURY GENERALLY, WHAT IS IT? PATHOLOGY & CAUSES ▪ Upper limb joint damage, dislocation ▪ Weakening/damaging of ligaments, tendons → distortion of normal anatomical joint structure, function loss/impairment MRI ▪ Damaged ligaments and soft tissue Ultrasound ▪ Soft tissue damage ▪ Tendon dislocations OTHER DIAGNOSTICS CAUSES ▪ Trauma, overuse SIGNS & SYMPTOMS ▪ Pain, swelling, numbness ▪ Reduced range of motion ▪ Visible/palpable malformations DIAGNOSIS DIAGNOSTIC IMAGING X-ray ▪ Dislocation ▪ Distorted articular spaces ▪ Fractures ▪ Physical examination ▫ Reduced range of motion ▫ Visible dislocation ▫ Swelling TREATMENT MEDICATIONS ▪ Pain management ▫ Sedation, analgesia SURGERY ▪ Joint reduction OTHER INTERVENTIONS ▪ Rest, ice ▪ Physical rehabilitation OSMOSIS.ORG 715
DISLOCATED SHOULDER osms.it/dislocated-shoulder PATHOLOGY & CAUSES ▪ Humeral head detaches from glenoid fossa in glenohumeral joint ▪ Loose ligaments provide high mobility, but are prone to injury in abduction/external rotation TYPES Anterior dislocation ▪ Most common ▪ Blow to extended, raised, outwardly turned arm → damaged inferior glenohumeral ligament SIGNS & SYMPTOMS Shoulder feels unstable/like it’s “rolling out” Shoulder pain (can radiate down arm) Limited range of motion Visible displacement Injured/compressed axillary artery: hematoma/weak distal pulse ▪ Stretched axillary nerve: shoulder area numbness ▪ ▪ ▪ ▪ ▪ Posterior dislocation ▪ Strong muscle cramp/electric shock ▪ Associated with tuberosity, surgical neck fractures of humerus Inferior dislocation ▪ Uncommon ▪ Force applied to completely raised arm (e.g. individual falls, tries to grab onto something above) ▪ Highest incidence of axillary nerve, artery injuries CAUSES ▪ Force from fall/blow → ligaments tear/ stretch → humeral head slips out of position RISK FACTORS ▪ Previous dislocations ▪ Sports COMPLICATIONS ▪ Axillary artery, nerve damage from injury/ while performing reduction 716 OSMOSIS.ORG Figure 121.1 An X-ray image of the shoulder demonstrating an anterior dislocation. DIAGNOSIS DIAGNOSTIC IMAGING X-ray ▪ Two views necessary ▫ Anteroposterior view (AP) ▫ Lateral view ▪ Anterior dislocation: humeral head is in front of glenoid
Chapter 121 Upper Limb Injury ▪ Posterior dislocation: humeral head is in place in AP view ▪ Fractured bones MRI ▪ Damaged ligaments (contrast enhancement for better visualisation) CT angiogram ▪ Arterial damage TREATMENT ▪ Reduction ▫ Perform as soon as possible for easier reduction, less chance of complications ▫ e.g. Hill–Sachs lesion/compression fractures on humeral head ▪ Immobilisation, rest ▫ Age < 30 → three weeks ▫ Age > 30 → 7–10 days Figure 121.2 An X-ray image of the left shoulder demonstrating a Hill–Sachs lesion. A Hill–Sachs lesion is a posterolateral compression fracture that occurs as a result of recurrent anterior dislocations of the shoulder. NURSEMAID'S ELBOW osms.it/nursemaids-elbow PATHOLOGY & CAUSES ▪ Dislocation of radial head in elbow joint ▫ Pulled elbow/radial head subluxation CAUSES ▪ Pulling extended arm makes annular ligament slip above radial head ▪ Lifting/swinging child ▪ Common in children < six years old SIGNS & SYMPTOMS DIAGNOSIS DIAGNOSTIC IMAGING X-ray ▪ When fracture suspected TREATMENT OTHER INTERVENTIONS ▪ Reduction ▫ Supination, elbow flexion ▫ Hyperpronation (less painful) ▪ Child refuses to bend/use affected arm ▫ Fear of pain ▪ Holds affected arm in prone position, close to body ▪ Inability to supinate OSMOSIS.ORG 717
ROTATOR CUFF TEAR osms.it/rotator-cuff-tear PATHOLOGY & CAUSES ▪ One/more tendons of rotator cuff tear(s) ▫ Supraspinatus, infraspinatus, teres minor, subscapularis comprise the rotator cuff ▪ Most common shoulder problem ▫ Occurs in all age groups TYPES By course ▪ Acute tears ▫ Strong force damages tendons (e.g. rowing, powerlifting) ▪ Chronic tears ▫ Prolonged repetitive motions (especially overhead moves) ▫ Tendon degeneration: aging, blood supplies worsen ▫ Tendons become irritated, inflamed while passing through narrowed gaps ▪ Weakness, instability, restricted range of motion ▪ Compressed nerves → numbness DIAGNOSIS DIAGNOSTIC IMAGING X-ray ▪ Anteroposterior view ▫ Sclerosis, cyst formation, smaller gap between acromion, humerus ▪ Lateral view ▫ State of acromion ▪ Axillary view ▫ Humeral head position MRI ▪ Connective tissue visualization ▪ Size, location of damage ▪ Swelling By amount of damage ▪ Partial thickness tears ▫ Damaged supraspinatus tendon ▪ Full thickness tears ▫ Damaged supraspinatus, infraspinatus, subscapularis, biceps tendon By exterior/interior factors ▪ Exterior factors ▫ Tendon impingement due to curved/ hooked acromion ▪ Interior factors ▫ Small repetitive injuries over prolonged period → tendon degeneration SIGNS & SYMPTOMS ▪ “Arc of pain” (pain while lowering arm) ▪ Night pain 718 OSMOSIS.ORG Figure 121.3 An MRI scan of the shoulder in a non-orthogonal plane demonstrating a complete tear of the supraspinatus and infraspinatus tendons.
Chapter 121 Upper Limb Injury Ultrasound ▪ Evaluate tear extent ▪ Tendon dislocations OTHER DIAGNOSTICS Supraspinatus injuries ▪ Active painful arc & drop arm test ▫ Fully raise arm, then steadily lower it back ▫ If pain occurs → positive test ▪ Jobe’s test (aka “empty can”) ▫ Individual raises straight arm 90°, flexes forward 30° with thumb pointing down → resists attempt to depress arm ▫ Pain without weakness → tendinopathy ▫ Pain with weakness → tendon tear Infraspinatus, teres minor injuries ▪ Test external rotation ▫ Individual attempts external rotation of arm, examiner provides resistance Subscapularis injuries ▪ Gerber’s lift-off test ▫ Place hand behind back → push backwards against resistance ▪ Supine Napoleon test ▫ Individual lays down, places hand on abdomen with elbow flexed 90° → attempts to raise elbow while examiner secures hand, shoulder Impingement test ▪ Neer test ▫ Individual flexes pronated arm (with thumb pointing downwards) above head ▪ Hawkins test ▫ Individual raises arm 90° with halfflexed elbow → examiner attempts to internally rotate shoulder TREATMENT MEDICATIONS ▪ Pain management ▫ NSAIDs SURGERY ▪ Small tears → arthroscopically ▪ Large tears → open surgical repair OTHER INTERVENTIONS ▪ Rest, ice ▫ Pain, inflammation management ▪ Physical therapy ▫ Restore range of motion ▪ Strengthen muscles that support joint ▪ Exercises for preserving neurologic control OSMOSIS.ORG 719

Osmosis High-Yield Notes

This Osmosis High-Yield Note provides an overview of Upper limb injury essentials. All Osmosis Notes are clearly laid-out and contain striking images, tables, and diagrams to help visual learners understand complex topics quickly and efficiently. Find more information about Upper limb injury by visiting the associated Learn Page.