upper limb

• frozen shoulder:

  • pain and limited ROM
  • unknown cause
  • inflammation of synovial membrane and contracted thickened joint capsule
  • inflammation caused scarred tissue
  • common in women(gender)
  • AROM PROM limits lateral rotation and abduction
  • acute tenderness when palpate shoulder

  stage

  freezing phrase (2-9 months): pain and increased stiffness

  frozen phrase (4-12 months): stiffening stabilise with reduced pain

  thawing phrase (6 months to 4 years up): increase movement with reduced pain
• frozen shoulder treatment:

  subcromial corticosteroid injection: reduce inflammation

  capsular distension: inject sterile fluid help stretch and expand joint capsule

  surgery: open surgery cut tight thickend joint capsule
• traumatic rotator cuff tear:

  • caused by fall onto shoulder/ outstretched arm
  • surgery required

  degenerate rotator cuff tear:

  both rotator cuff tear leads to weakness in abduction and lateral rotation, restricted AROM normal PROM
• osteoarthrtis

  • more common in women (gender) and age above 60
  • primary OA triggered by no factor, secondary OA triggered identifiable underlying cause
  • breakdown of joint cartilage
  • intermittent sharp diffused pain
  • eased with rest and warmth
  • crunching noise
  • decreased AROM PROM in flexion, abduction and lateral rotation
  • abnormal x ray
  • palpable crepitus

  special treatment

  corticosteroid injection: reduce inflammation and provide temporary pain relief

  total shoulder replacement: shoulder joint replaced with artificial component
• muscle tear: grade 123

  • result from trauma or degenerative change
  • rest ease pain
  • restricted AROM
  • acute tenderness
  • visual deformity
• epicondylitis(tennis elbow)

  • pain region of epicondyle of elbow
  • worsened by using or stretching
  • caused by repetitive strain or small injury leads to inflammation
  • pain when palpate specific muscle
  • pain during strength test
  • pain when AROM PROM

  special treatment

  patelet rich plasma: extract blood, inject patelet rich solution into affected area

  surgery: remove damaged tissue
• bone fracture:

  • pain
  • swelling
  • deformity
  • common bone fracture: proximal humerus/ distal radius/scaphoid
• complex regional pain syndrome STAM

  sensory:

  • allodynia: experience pain from normally non painful stimuli
  • hypo/hyperalgesia: change in pain sensitivity
  • hypo/hyperesthesia: change in temperature pressure sensitvity

  trophic(physical appearance):

  • change in skin, hair, nails

  autonomic nervous system:

  • swelling, edema, excess sweating

  motor:

  • muscle weakness
  • muscle tendon shortened, restrict movement
• de quervain

  • inflammation of synovial tendon sheath of abductor pollicis longus and extensor pollicis brevis
  • more common in women and old people
  • associated with rheumatoid, overuse or trauma
  • pain on thumb side
  • snow crunching sensation
  • swelling
  • pain when palpation
  • pain when strength test
  • pain when AROM PROM
• pulled elbow:

  • radial ulnar annular ligament tear
  • previous trauma
  • elbow extended and palm down
  • NO swelling NO deformity NO bruising NO tenderness
  • resistance and pain when palm up