Upper Extremities Clinical Considerations

What is a sprain/strain?

Injury to collateral ligaments of joint potentially resulting in instability

What is lateral epicondylitis?

Inflammation of extensor tendon at its insertion of lateral epicondyle

What is tennis elbow?

Lateral epicondylitis

What is the medial epicondylitis?

Common flexor tendon inflammation at the insertion to medial epicondyle humerus

What is golfers elbow?

Medial epicondylitis

What is nursemaids elbow?

Radial head subluxation from under annular ligament

What is little leaguer’s elbow?

Open growth plates with excessive valgus stress causing lateral compression and medial distraction

How do elbow dislocations typically happen?

Ulna slides posterior to distal humerus

What can occur with elbow dislocation?

Volkmann’s ischemic contracture

What is Volkmann’s ischemic contracture?

Compromise of brachial artery leading to necrosis of forearm muscles

What can a supracondylar fracture lead to?

Volkmann’s ischemic contracture

What is calcific supraspinatus tendinitis?

Deposition of calcium in supraspinatus tendon which may irritate overlying subacromial bursa

What are the common ways the GH joint dislocates?

Inferior and anterior

What is a SLAP lesion?

Superior Labral tear from Anterior to Posterior

What results from fracture of the surgical neck of the humerus and dislocation of the shoulder joint?

Axillary nerve injury

What is the result of axillary nerve injury?

Presence of a small area of lost or diminished sensation over the inferior half of deltoid

What is the most commonly fractures carpal bone?

Scaphoid

What is impacted with scaphoid fracture? What can this lead to?

Blood supply from radial artery - avascular necrosis

What is the most commonly subluxated carpal bone?

Lunate

What can occur from subluxated lunate?

Avascular necrosis

What is a ganglion cyst?

Benign swelling over joint or tendon attached to capsule

What are the contents of the carpal tunnel?

Median nerve, tendons of flexor digitorum superficialis and profundus, tendon of flexor carpi radialis and flexor pollicis longus

What are symptoms of carpal tunnel?

Pain and/or paresthesia over thumb to middle and lateral half of ring finger and weakness and atrophy of thenar muscle

What are the contents of the tunnel of guyon?

Ulnar nerve and arery

What can cause an impingement of the tunnel of guyon?

Fracture of hook of hamate, cyclist’s palsy, swelling, compression

What are symptoms of impingement of the tunnel of guyon?

Pain and/or paresthesia of skin over pinky and medial half of ring fingers and weakness and atrophy of hypothenar muscles

What does the C5 deep tendon reflex impact?

Biceps tendon

What does the C6 deep tendon reflex impact?

Brahioradialis

What does the C7 deep tendon reflex impact?

Triceps tendon

What causes Erb-Duchenne’s palsy?

Over stretch of upper trunk (C5, C6) of brachial plexus

What does Erb-Duchenne’s palsy affect?

Structures supplied by suprascapular nerve, nerve to subclavius, part of musculocutaneous nerve, and axillary nerve

What causes Klumpke’s palsy?

Excessive abduction of the arm, presence of cervical rib, or malignant metastasis from lungs

What does Klumpke’s palsy affect?

Muscles of distal forearm and hand and all muscles innervated by the ulna and more distal radial and median innervated muscles

What muscles are affected in injury to the axillary nerve?

Teres minor, deltoid, GH joint

What muscles are impacted in injury to musculocutaneous nerve?

Coracobrahialis, biceps brachii, brachialis → los of flexion of forearm at elbow joint

Affects of injury to radial nerve in axilla and radial groove?

Triceps, anconeus, and long extensor paralyzed leading to wrist drop

Affects of injury to deep radial nerve?

Loss of extension of fingers

Affects of injury to ulnar nerve?

Flexor carpi ulnaris and medial half of flexor digitorum profundus affected → flexion of wrist joint resulting in abduction

What nerve is associated with claw hand?

Ulnar nerve

Actions lost with injury to ulnar nerve?

Abduction and adduction of medial 4 digits, adduction of thumb, hyperextension of MCP and flexion in IP of 4th and 5th digits

Affects of injury to median nerve?

Pronator muscles of forearm and long flexors of wrist and fingers EXCEPT flexor carpi ulnaris and medial ½ of flexor digitorum profundus

What nerve is impacted in hand of benediction?

Median nerve