Common Injuries to the Upper Extremities

Maribel G. Castro-Enano, M.D. CPU College of Medicine

Palmar Creases
Radial Longitudinal Crease partially encircles thenar eminence Proximal Transverse Palmar Crease commences on the lateral border of the palm with the radial longitudinal crease Midpalmar Crease landmark for the hypothenar eminence Distal Transverse Palmar Crease begins at or near the cleft b/n the 2nd and 3rd fingers and cross the palm

 Digital Flexion Creases

Proximal Flexion Crease lies on the root of the digit Middle Flexion Crease lies over the proximal IP joint Distal Flexion Crease lies proximal to the distal IP joint

 Skin ridges on the ventral ends of the digits (FINGERPRINTS)

for identification purposes reduce slippage when grabbing or holding objects

 Potential fascial spaces

May become infected (e.g. puncture wound to the hand) determine the extent and direction of spread of pus formed by the infection depending on the site of infection, pus will accumulate in the thenar, hypothenar or adductor compartments Untreated infection may spread to carpal tunnel then anterior to pronator quadratus and its fascia

Common Injuries to Joints/Muscles

GOLFERS ELBOW
Painful musculoskeletal condition that follow repetitive use of the superficial muscles of the anterior aspect of the forearm (e.g. golfing)

PULLED/SLIPPED ELBOW
Subluxation of the head of the radius Sudden lifting by the upper limb when the forearm is pronated Sudden pulling tears the distal attachment of the annular ligament (neck of radius)

 COLLES FRACTURE
Transverse fracture of the distal 2-3 cm of the radius Fragment is displaced proximally causing shortening of the radius silver fork deformity or dinner fork deformity

LUNATE BONE DISLOCATION

Anterior dislocation common Displaced lunate may compress median nerve against the flexor retinaculum

 SHOULDER JOINT DISLOCATION

Direct or indirect injury Anterior dislocation caused by excessive extensive and lateral rotation of the humerus Head of humerus is driven anteriorly Hard blow to the humerus when the shoulder joint is fully abducted

 TENOSYNOVITIS
Inflammation of the flexor tendons and digital synovial sheath secondary to infection Digits swell and movement becomes painful

DUPUYTRENS CONTRACTURE
progressive fibrosis of the palmar aponeurosis resulting in shortening and thickening of the fibrous bands that extend from the aponeurosis to the bases of the phalanges MCP joint cant be straightened

 ELBOW TENDONITIS
tennis elbow, lateral epicondylitis follow repetitive pronation-supination of the foremarm Pain and point tenderness at or just distal to the lateral epicondyle

GANGLION
Cystic nontender swelling of atendon on the dorsum of the wrist or hand Flexion swelling larger ; extension swelling smaller

 ANATOMICAL SNUFFBOX TENDERNESS

usually due to fracture of the scaphoid bone Localized tenderness

COMMON NERVE INJURIES

WRIST DROP
Saturday Night Palsy Due to injury or lesion to the radial nerve

PRONATOR SYNDROME
Compression of the median nerve near the elbow Nerve may be compressed between the 2 heads of the pronator teres Pain and tenderness on the proximal aspect of the forearm

 ULNAR NERVE ENTRAPMENT

compression of the ulnar nerve at the elbow Numbness and tingling of the medial part of the palm, and 4th and 5th digits

CARPAL TUNNEL SYNDROME

Compression of the median nerve at the carpal tunnel

MEDIAN NERVE INJURY

usually due to slashing of the wrist

 CLAWHAND OR BENEDICTINE SIGN

Ulnar nerve injury in distal part of the forearm 4th and 5th digits are hyperextended at the MCP joint and somewhat flexed at the IP joint

 Occasionally there is a communication between the median and ulnar nerves in the forearm
Clinically important because even with complete lesion of the median nerve, some muscles may not be paralyzed and lead to an erroneous conclusion that the median nerve has not been damaged

THANK YOU GOOD LUCK!