Upper Limb Diseases

Shoulder Dislocations: 

  • Most common shoulder dislocation? Anterior (arm is abducted + externally rotated, squared-off shoulders)
  • Most commonly missed shoulder dislocation? Posterior (arm is adducted + internally rotated)
  • Most important X-ray to diagnose shoulder dislocation? Axillary view
  • If you do MRI -> will show bankart lesion (anterior inferior labrum tear)
  • Positive apprehension test -> needs surgery
  • Age is #1 factor to tell if the pt will re-dislocate
  • Treatment for first dislocation: traction + counter-traction
  • Treatment for recurrent dislocations: physiotherapy, then arthroscopy repair of teared labrum
  • Most common complication in young? Redislocation and axillary N injury
  • Most common complication in elderly? Rotator cuff tear

Rotator Cuff injury: 

  • First stage is bursitis -> then tear
  • Pt will complain of pain, can’t lay on his\her side, stiffness, weakness
  • First action lost -> internal rotation
  • Know the different tests done in physical examination:
    • Impingement
      • Painful arc: active abduction will cause pain after 90-120°
      • Neer sign: shoulder IR + passively forward flex the arm
      • Hawkin’s test: flex elbow and shoulder 90° + internally rotate the shoulder
    • Supraspinatus: empty can test: jobe’s test
    • Subscapularis: lift off test
    • Infraspinatus: resisted ER w\ arm by side
    • Teres minor: Hornblower’s sign: 90° shoulder abduction, elbow 90° flexion + resist ER
    • Biceps:
      • Speed’s test: forward flex shoulder 90°, supinate forearm, resisted downward force
      • Yergason’s test: arm by side, elbow 90° flex, resist supination
    • AC joint: cross arm test: FF shoulder 90, adduct arm horizontally
  • Dx: MRI
  • First line treatment: physio, NSAIDs, steroid injection, US shockwaves -> if not working (3-12 mo) -> surgical decompression
  • If young patient with acute tear -> cuff repair w\in 6 wks
  • Left untreated; will lead to rotator cuff arthopathy:
    • Arthritis due to rotator cuff dysfunx -> proximal humerus migration
    • Swelling, atrophy SS\IS, fluid sign (GHJ fluid in soft tissue)
    • Tx is hemiarthropathy (reverse shoulder)

UL diseases 1


Frozen Shoulder; Adhesive Capsulitis: 

  • “Essential lesion” is CHL contracture of the rotator interval
  • Diabetes, cervical spondylosis, hypothyroid, female
  • Stages:
    1. Inflammation: hot, painful, some dec ROM -> injections, NSAIDs
    2. Frozen stage: dec pain, more loss of ROM
    3. Thawing stage: slow improvement
  • First line is conservative: blah, blah
  • If left untreated, it will disappear in 12-18 months, but the pt will end up w\ stiffness, so prompt treatment is important!

Avascular Necrosis:

  • Less common, better prognosis than hip AVN
  • Anterolateral branch = arcuate artery = artery of Laing
  • Causes: ASEPTIC: Anemia, Sickle cell, EtOH, Pancreatitis, Thyroid\Trauma, Idiopathic\Iatrogenic, Caisson’s
  • Stages: 
    • Stage 1: normal
    • Stage 2: sclerosis
    • Stage 3: crescent
    • Stage 4: collapse
    • Stage 5: glenoid involvement
  • First line treatment: conservative
  • If the head is not collapsed -> decompression
  • If the head is collapsed -> replace


  • Can be primary OA, or not (after trauma)
  • First line: conservative
  • If unresponsive: total shoulder replacement (bc both the head and glenoid are affected)


  • Most common side of overuse tendon injury? Osteotendinous junction
  • Conservative: rest, analgesia, physio, US shockwave, brace -> for 3-6 mo
  • If failed -> surgery (debride the tendon)
  • Most common is epicondylitis (Tennis elbow) -> ECRB

De Quervain’s Tenosynovitis: 

  • Inflammation of first extensor compartment of the hand (EPB, APL)
  • Finkelstein’s test
  • Conservative, if failed; surgical release

UL diseases 2

Carpal Tunnel Syndrome: 

  • MCC is idiopathic
  • Risk factors: female, obese, pregnant, hypothyroid, RA, age, CRF, alcohol, DM, repetitive motion
  • Most sensitive test -> carpal tunnel compression test
  • Most reliable test -> nerve conduction studies
  • Conservative (NSAIDs, night splints), if failed; surgical decompression

UL diseases 3



Download the PDF version: here


  • Dr. Wazzan AlJuhani’s lecture

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