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UPPER LIMB PATHOLOGY - RAPID ASSESSMENT

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

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  1. UPPER LIMB PATHOLOGY - RAPID ASSESSMENT Murali Bhat www.ukorthocare.com

  2. BASIC ANATOMY

  3. 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

  4. Median Nerve PRONATER TERES PRONATER TERES FDS ANTERIOR INTEROSSEOUS NERVE

  5. Ulnar Nerve MEDIAN NERVE ULNAR NERVE

  6. SYMPTOMS Pain Loss of function Cosmesis

  7. Examination Look Move Feel (Special tests)

  8. Surface anatomy Palmar

  9. Surface Anatomy

  10. Pain Localised Wrist Generalised hand and arm

  11. Radial Wrist pain

  12. B.Movements Passive movements -extension

  13. B.Movements Passive movements -flexion

  14. PALPATION Dorsal

  15. Palpation & Special Test

  16. 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

  17. Surface anatomy Dorsal LISTER’S TUBERCLE

  18. Surface anatomy Dorsal SCAPHOLUNATE LIGAMENT

  19. B.Movements Active movement -pronation Ulnar Wrist Pain

  20. B.Movements Active movement -supination Ulnar Wrist Pain

  21. Surface anatomy Dorsal Ulnar head

  22. Surface anatomy Dorsal Ulnar styloid

  23. 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

  24. Examination of DRUJ

  25. Palpation & Special Test FCU & Pisiform bone -feel the tendon and pisiform bone with the tip of the index finger

  26. 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

  27. 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

  28. Diffuse Arm Pain

  29. Cross section through carpal tunnel Roof is formed by the tranverse carpal ligament Floor and wall formed by the carpal bones

  30. Surface anatomy Palmar

  31. 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

  32. 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)

  33. Loss of Function Deformity Instability

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