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Sports Injuries Lecture Week 9 - Upper Limbs

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bethdrysdale94's version from 2017-01-17 13:58

Section

Question Answer
What are the three bones that make up the shoulder joint?clavicle, scapula and humerus
What is the proper name for the shoulder joint?Glenohumeral joint
What are the four muscles of the rotator cuff?Supraspinatus, Infraspinatus, Teres minor and Subscapularis.
What movements does each muscle of the rotator cuff perform?Supra - abducts. Infra and Teres - externally rotate. Sub - internally rotates
What movements often injure the rotator cuff muscles?Overhead movements eg in building, swimming or tennis
What happens if repeated abduction irritates the bursa and rotator cuff?inflammation - impingement. If the impingement is on the tendon then it is called overuse tendinitis.
Which tendon usually tears with overuse?Supraspinatus tendon
What is the Abley scratch test?Patient attempts to touch opposite scapula from above and below. testing for abduction and external rotation (above) and adduction and internal rotation (below) - pain, popping sensation, or difficulty. Compare to the other shoulder (flexibility ranges from person to person)
What are the tests examining for impingement?Hawkins-Kennedy: elevate patients arm forward to 90 degrees. internally rotate shoulder by pulling forearm (flexed) downward with force. observe for pain, popping, suggests subacromial impingement or RC tendinitis. Neer's: Patient fully pronates arm, Assessor flexes arm with force. Feel scapula, should be stabilised. pain is a sign of subacromial impingement
How do you rule out acromioclavicular joint dysfunction when looking for impingement?Cross arm test: patient raises arm to 90 degrees then adducts arm. pain at acromioclavicular joint suggests dysfunction. Impingement pain should not occur during this test.
How do you test for rotator cuff tears?Empty can test: patient abducts shoulder to 90 degrees, in foward flexion with thumb pointing down. then elevates arm against resistance. look for true weakness and distinguish from weakness due to pain. Infra/Teres test: arms at side, patients flexes elbow to 90 degrees and performs external rotation against resistance. look for true weakness (at full range) and distinguish from weakness due to pain (certain limb angle)
How do you treat impingement?Rest, cessation of painful activity. physical therapy to improve range of motion. posture and strengthening exercises, NSAIDs. CSteroid injections and local anaesthetic may be used for persistent problems. SURGERY: arthroscopic to remove impinging structure. or to widen subacromial space (resecting distal clavical and osteophyte excision)
How do you treat rotator cuff tears?conservative at first. When full painless motion restored, muscle strengthening exercises. Patients with functional deficit and athletes involved in overhead and throwing sports, consider surgical repair.
What is the post-op rehab recommendations for rotator cuff tear repair?oral pain medicine and ice pack to relieve pain. Arm immobilised for 6 weeks for muscle to heal. Passive exercises for motion range, active exercise for strength.
What clinical outcome tests can be used to indicate outcome post-op RC repair?University of California at LA (UCLA) Shoulder Rating Scale, American Shoulder and Elbow Surgeons (ASES) Shoulder Rating Scale
What are the score ranges for the UCLA Shoulder Rating Scale?Max 35 points, 34-35 excellent, 28-33 good, below 27 poor.
What are the clinical terms for tennis elbow?Lateral epicondylitis (inflammation)/ epicondylalgia (pain)
What is tennis/golfers elbow?Acute or chronic inflammation of extensor muscle tendons for the forearm on the lateral elbow side (lateral epicondyle). (TENNIS). If its on the medial side then its called golfers elbow.
What actions cause pain in tennis elbow?gripping, lifting, wrist extension, turning a door handle, opening a jar etc. stiffness in morning, weakness in forearm
What causes tennis elbow?Repetitive strain injury, overuse and failed healing. Traumatic injury from direct contact to lateral epicondyle. Forceful extension. Incorrect playing tennis. - Non inflammatory and chronic changes of extensor carpi radialis brevi muscle.
What physical examination tests can be done for tennis elbow?Cozen's: Patient extends elbow and performs active wrist extension against resistance. Pain at lateral aspect of elbow indicates tennis elbow. Chair Lift test: patient grasps back of a chair whilst standing. attempts to raise it whilst hands are on top of chair back - pain on lateral elbow = positive test
How do you treat tennis elbow?80-95% treated without surgery. RCT suggests wrist extensor eccentric exercise with rubber bar reduces pain and tenderness.
How can you prevent tennis elbow?Decrease playing time if already injured. Stay in good physical shape. Strengthen muscles of forearm, upper arm and traps. Use appropriate equipment according to your size, and strength. Tennis elbow bands or sleeves may relieve discomfort.
Bones of the handsMetacarpals and Phalanges (if you don't know this bad luck pal, so much effort to type)
Bones of the wrists. Some Lovers Try Positions That They Can't Handle
What do DIP and PIP mean?Distal interphalangeal and Proximal interphalangeal Joints
What is Mallet finger?Extensor tendon stretched or torn due to object striking end of finger. Pain and swelling at DIP. Inability to extend and flexion often impaired. Passive range of extension impaired = surgery to clear joint blockage
What occurs in 1/3 of patients with Mallet finger?Avulsion fracture.
How do you treat Mallet finger?DIP splinted in neutral or hyper extended position for six weeks DO NOT FLEX OR MUST START SIX WEEKS AGAIN. May participate in sports during splinting.
Central Slip extensor tendon injuryWhen PIP is forcibly flexed while actively extended - common in basketball. Must be treated or Boutonniere deformity may occur. Hold finger PIP joint at 15-30 degrees flexion and if patient cannot extend, injury is present.
How do you treat central slip extensor injury?Splint joint in fully extended position for 6 weeks. full extension not possible then patient should go to orthopaedics for possible surgery
What is flexor digitorum profundus tendon injury?Jersey finger - usually occurs when finger gets caught on other players jersey. Forced extension of DIP joint during active flexion. Most commonly ring finger
How do you treat jersey finger?Splinting not useful. Surgery is necessary to reattach tendon back to bone. then plastic splint whilst fingers flexed for six weks.
Collateral Ligament InjuriesForces lateral movement at interphalangeal joints. usually PIP joint involved and called "jammed fingers" - common in basketball. Compare laxity with other unaffected fingers. Xray for avulsion fractures. if joints are stable without fracture - tape injured finger to unaffected finger. if ring finger affected, tape to fifth digit as isolated fifth digit easily gets injured.
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