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

2. BASIC ANATOMY

4. 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

5. Median Nerve PRONATER TERES FDS ANTERIOR INTEROSSEOUS NERVE

6. Ulnar Nerve MEDIAN NERVE ULNAR NERVE

8. SYMPTOMS 1.Pain 2.Loss of function 3.Cosmesis

9. Examination Look Move Feel (Special tests)

12. Surface anatomy Palmar

13. Surface Anatomy

17. Pain Localised Wrist Generalised hand and arm

18. Radial Wrist pain

20. B.Movements Passive movements -extension

21. B.Movements Passive movements -flexion

22. PALPATION Dorsal

23. Palpation & Special Test

24. Scaphoid -the waist in the anatomical snuffbox -painful non union can be tested by the grinding test Axial pressure along 1 st metacarpal with wrist in radial deviation -crepitus can be felt in OA of the CMC joint or scaphoid non union

25. Surface anatomy Dorsal LISTER’S TUBERCLE

26. Surface anatomy Dorsal SCAPHOLUNATE LIGAMENT

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

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

29. Surface anatomy Ulnar head Dorsal

30. Surface anatomy Ulnar styloid Dorsal

31. 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

32. Examination of DRUJ

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

34. 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

35. 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 2 nd metacarpal -simultaneous pressure is applied on the dorsal and ulnar aspect of this bone with the index & middle finger

36. Diffuse Arm Pain

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

38. Surface anatomy Palmar

40. 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

41. 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)

42. Loss of Function Deformity Instability

51. COSMESIS Swelling Deformity

52. COMMON SWELLINGS

59. Elbow examination

60. Look Muscle wasting Swelling or effusion Deformity e.g. cubitus varus /valgus

62. Carrying angle of the elbow Males:2-22 deg Females :2-26 deg

63. Feel Relationship and Tenderness over both epicondyles and olecranon process,radial head Tenderness over ulnar nerve region

64. Palpation of ulnar nerve

65. Relationship between both epicondyles & olecranon process 3 bony landmarks Medial epicondyle Lateral epicomndyle Olecranon process Equilateral triangle in flexion Straight line in extension

66. Move Extension/hyperextension Flexion –screening /actual measurement Pronation-screening/actual measurement Supination-screening/actual measurement

67. Flexion & Extension

68. Pronation & Supination