619 9/30 GLA pt 2 Functional UL

Shoulder Imaging

typically done secondarily for pain and trauma

obtained AP or PA with external and internal rotation

occasionally axillary and axillary y views are done, especially for dislocation/subluxation/scapular fracture

clavicle is a separate radiographic study

When you perform an axillary or axillary y imaging?

shoulder dislocation, shoulder subluxation, scapular fracture

Imaging Modality Strengths

Normal Shoulder AP Film

look at long component if they have chest pain, as that could be pneumothorax

Shoulder AP X-Ray Labeled

Shoulder Y-View

lots of mach overlap, sometimes difficult interpretation but can be useful for dislocation/sublocation

Coronal T1 Shoulder MRI

Calcific Tendonitis

chronic pain from calcification

Osteoarthritis

especially common on the shoulder joint of the side of the dominant hand

can have bony spurs

PA and Lateral Humerus Radiograph

Axial T1 MRI Through Arm

Elbow AP Labeled

Lateral Elbow X-Ray

Olecranon Bursitis

often due to gout

Wrist AP X-Ray

Hand PA X-Ray

Subperiosteal Resorption in Phalanges

commonly due to hyperparathyroidism

loss of bones in phalanges

Distal Forearm/Wrist T1 MRI Axial

median nerve is especially important

Ganglion Cyst

most common soft tissue mass of the hand and wrist, more common in women adjacent to tendons and joints

most prevalent from 10-40 yo

Carpal Tunnel Borders

transverse carpal ligament spanning from the pisiform medially to scaphoid bone laterally

base is formed by remaining carpal bones of hand

Contents of Carpal Tunnel

median nerve

flexor tendons (flexor pollicis longus, flexor digitorum profundus tendons, flexor digitorum superficialis tendons)

Carpal Tunnel Syndrome

compression of median nerve as it travels though carpal tunnel

pain or paresthesia in area innervated by median nerve, weakness of hand or clumsiness, worse at night or when wrist is flexed/extended

Sensory Innervation of Median Nerve

Carpal Tunnel Syndrome Diagnosis

initial is based on clinical presentation, electrodiagnostic studies can be used to comfirm

Ultrasound for Carpal Tunnel

it is now being used a little, and could detect abnormalities even in the presence of normal nerve conduction studies

Carpal Tunnel Ultrasound Procedure

supinate wrist on comfortable and stable surface, place linear probe at crease of wrist

Wrist Ultrasound Labeled

Short Axis Carpal Tunnel Medial

Short Axis Carpal Tunnel Lateral

Short Axis Carpal Tunnel Distal

Structures to Identify on the Carpal Tunnel Ultrasound

pisiform and scaphoid bones

transverse carpal ligament

flexor tendons

median nerve

radial artery

ulnar artery

Erb’s Palsy Damage

C5-6, over-separation of head and shoulder

Motor Effects of Erb’s Palsy

localized to superior part of upper limb

weakened shoulder abduction (deltoid m) → adducted at rest

weakened shoulder flexion (anterior arm)

loss of shoulder lateral rotators → medially rotated at rest

Sensory Effects of Erb’s Palsy

C5 & 6 dermatomes

lateral shoulder loss (axillary n)

lateral arm loss (from branch of radial n)

lateral forearm loss (from lateral cutaneous n of forearm)

Wrist Drop

when additional injury caused by erb’s palsy impacts C7, resulting in loss of forearm supinators and weakened extension by radial n, also loss of sensation on C7 dermatome

Wrist Drop Test

test radial n, hold wrist normal, wrist and digits will flex

Klumpke’s Palsy Damage

loss of C8-T1 becasue of over-seperation fo shoulder and trunk

Klumpke’s Palsy Motor Effects

total claw hand

forearm digit flexors unaffected

Klumpke’s Palsy Sensory Effects

loss of sensation over majority of hand (medial, ulnar, radial n)

Total Claw Hand

damage to the inferior trunk (with klumpke’s palsy) causes the dip and pip joints to flex, while the mcp joints extend

Additional Issues that May Occur with Claw Hand

sensory loss to C8-T1 dermatomes

damage associated with proximal branches that arise from the inferior trunk

Ulnar Claw/Partial Claw

injury to ulnar nerve, patient is asked to extend fingers

mcps will hyperextend, pip and dip will flex (often more prominently in digits 4 and 5)

Additional Issues That Might Occur with Ulnar Claw

wasting (atrophy) of hypothenar eminence

loss of sensation to medial hand

“Ape Hand” Deformity

damage to recurrent branch of median n, patient is asked to touch fingertips

they will be unable to oppose and have an adducted thumb

Additional Issues That Might Occur with “Ape Hand” Deformity

wasting (atrophy) of thenar eminence, if the injury is proximal then there will also be loss of sensation on some of the lateral hand

Benediction Sign (Hand of Benediction)

damage to proximal median n, patient is asked to make a fist

digits 4&5 will flex, digits 1-3 will extend

Additional Issues That Might Occur with Benediction Sign (Hand of Benediction)

wasting of thenar eminence, loss of sensation to lateral palmar hand