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 neckroots unite  trunks
• Trunks – superior,
middle, inferior
• Each trunk divides into
 anterior & posterior
division
• Division  form 3
cords
• Cords – names
indicated by
relationship with
Median
Nerve
PRONATER TERES
PRONATER TERES
ANTERIOR INTEROSSEOUS
NERVE
FDS
Ulnar Nerve
MEDIAN NERVE
ULNAR
NERVE
SYMPTOMS
1. Pain
2. Loss of function
3. Cosmesis
Examination
• Look
• Move
• Feel (Special tests)
Surface anatomy
Palmar
Surface Anatomy
Pain
• Localised Wrist
• Generalised hand and arm
B.Movements
Passive movements
-extension
B.Movements
• Passive movements
-flexion
PALPATION
Dorsal
Palpation & Special Test
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
Surface anatomy
LISTER’S TUBERCLE
Dorsal
Surface anatomy
SCAPHOLUNATE LIGAMENT
Dorsal
B.Movements
• Active movement
-pronation
B.Movements
• Active movement
• -supination
Surface anatomy
Ulnar head
Dorsal
Surface anatomy
Ulnar styloid
Dorsal
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
Examination of DRUJ
Palpation & Special Test
• FCU & Pisiform
bone
• -feel the tendon and
pisiform bone with the
tip of the index finger
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
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
Diffuse Arm Pain
Cross section through carpal
tunnel
• Roof is formed by the
tranverse carpal
ligament
• Floor and wall formed
by the carpal bones
Surface anatomy
Palmar
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
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)
Loss of Function
• Deformity
• Instability
COSMESIS
• Swelling
• Deformity
COMMON SWELLINGS
Elbow examination
Look
• Muscle wasting
• Swelling or effusion
• Deformity e.g. cubitus varus /valgus
Carrying angle of the elbow
• Males:2-22 deg
• Females :2-26
deg
Feel
•Relationship and Tenderness over both
epicondyles and olecranon process ,radial head
•Tenderness over ulnar nerve region
Palpation of ulnar nerve
Relationship between both epicondyles
& olecranon process
•
•
•
•
3 bony landmarks
Medial epicondyle
Lateral epicomndyle
Olecranon process
• Equilateral triangle in
flexion
• Straight line in
extension
Move
•
•
•
•
Extension/hyperextension
Flexion –screening /actual measurement
Pronation-screening/actual measurement
Supination-screening/actual measurement
Flexion & Extension
Pronation & Supination