Common upper limb problems
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Common conditions that can occur due to prolonged desk jobs include repetitive strain injuries, musculoskeletal issues like cervical spondylosis and tennis elbow, and nerve-related issues like carpal tunnel syndrome. Symptoms include pain, swelling, tingling and weakness. Treatment options depend on the specific condition but may include rest, splinting, anti-inflammatory medications, physical therapy, steroid injections, and surgery. Prevention through exercise and activity modification is important to avoid potential long-term damage.
![Non- Operative Treatment options
Topical NSAIDs
Oral NSAIDs
Orthotic devices
Physiotherapy
Autologous blood injection-79% had
improvement of Nirschl scores
J Hand Surg [Am]. 2003 Mar;28(2):272-8](https://image.slidesharecdn.com/commonupperlimbproblems-130220040020-phpapp02/85/Common-upper-limb-problems-14-320.jpg)
Common upper limb problems
- 1. Common Conditions occurring due to Desk jobs Dr. Deepthi Nandan Adla MS(Orth)osm, MSc (Orth eng.) UK, FRCS, FRCS(Tr&Orth), CCT UK Consultant Orthopaedic Surgeon (Upper limb) Apollo Hospitals, Hyderabad
- 2. Repetitive strain Conditions occurring due to repeated use of a certain movement Forceful exertions Repetition Awkward postures Mostly affects office workers Sedentary jobs
- 3. Conditions Musculoskeletal Cervical spondylosis Shoulder impingement Tennis elbow/Golfers elbow Trigger finger/ DeQuervain’s tenosynovitis Nerve related Carpal tunnel syndrome Cubital Tunnel syndrome Nerve root compression
- 4. Symptoms Muscle/tendon problems Pain Swelling Weakness Nerve related Tingling/altered sensation Weakness
- 5. Tendon problems: Dequervain’s History New, repetitive activity Pain over thumb side of the wrist Pain on making a fist, grasping or holding objects
- 6. Examination Swelling Thickening Tenderness
- 7. Treatment Activity modification NSAID Splintage – thumb widely abducted Some reports of low success rates Most reports suggest ineffective
- 8. Steroid Injection 60 – 80% improved Soluble steroid One or two injections depigmentation fat atrophy
- 9. Surgical Release Day case procedure Local anaesthesia Transverse incision Release tendon
- 10. Tennis/Golfers elbow First described by Runge in 1873 ‘Schreibers Krampfes’ (writers cramps) Incidence General population: 0.6% Tennis players: 9% Age: 35 and 50 years, with an equal distribution between males and females Associated Rotator cuff problems: 20-40%
- 11. Etiology Multiple microtraumatic events Disruption of the internal structure of the tendon and degeneration of the cells and matrix JBJS 81:259-278 (1999) Hypovascular zones Eccentric tendon stresses Microscopic degenerative response
- 12. Presentation Pain outer aspect (Tennis elbow )of elbow/ inner aspect (Golfers) Increases with activity Lifting objects Sometimes pain at rest Palapation Tenderness Special test Resisted wrist extension Elbow flexion Elbow Extension
- 13. Investigation X ray Bony spur Calcification Arthritis Ultrasound Tendon integrity Synovitis of Elbow
- 14. Non- Operative Treatment options Topical NSAIDs Oral NSAIDs Orthotic devices Physiotherapy Autologous blood injection-79% had improvement of Nirschl scores J Hand Surg [Am]. 2003 Mar;28(2):272-8
- 15. Literature: Steroid/Physio/wait RCT 6 weeks Pain/function improved in: 92% (57) of steroid group 47% (30) for physiotherapy 32% (19) for wait-and-see One year: 69% (43) for injections 91% (58) for physiotherapy 83% (49) for a wait-and-see policy Lancet 2002
- 16. Operative treatment Surgery to repair the tendon
- 17. Conclusion Confirm diagnosis Need assessment by surgeon to confirm diagnosis NSAIDs Physio Surgey if: Unresolved after non op treatment H/O trauma and pain after injury Tear in the tendon
- 18. Carpal Tunnel Syndrome Incidence: 1-3 cases per 1000 persons per year Prevalence: 50 cases per 1000 persons aged in their 30s and 50s Women are affected 2-3 times more often
- 19. Association of CTS in computer workers BMC Musculoskeletal Disorders 2008, 9:134
- 20. Symptoms Pins and needles Pain The pain may travel up the forearm. Numbness of finger Dryness of the skin Weakness of muscles
- 21. Anatomy Contents:Nine flexor tendons Tendons Median Nerve
- 22. Cause of carpal tunnel syndrome Nerve function v/s pressure in tunnel (healthy people) Tingling @ 40mmhg Complete motor and sensory block at 50 mmHg Carpal tunnel pressure: 5.3 mmHg during rest 16.8–18.7 mmHg static on the mouse 28.8–33.1 mmHg while dragging mouse
- 23. Examination Dry pulps Wasting of Thenar muscles Tinels
- 24. Investigations Nerve conduction test Confirm Diagnosis Assess nerve function Double crush/Polyneuropathy Prognosis Base line, if recurrence
- 25. Non-operative Night splint (good for patients with nocturnal symptoms) Activity modification (avoid aggravating activity) NSAIDs
- 26. Treatment NSAIDS Physiotherapy Activity modification Surgery
- 27. Operative treatment Indications: Failed non-operative treatment Motor weakness Procedure: Local anesthesia.
- 29. Shoulder Impingement syndrome Pain in shoulder Increases with activity Clicking sensation in shoulder Pain with overhead activities/ reaching for seat belt, changing gears/wearing cloths
- 30. Assessment Shoulder surgeon to assess to confirm diagnosis Complex joint Needs thorough knowledge Understanding poor among general orthopedic surgeons Newer techniques available to help improve pain
- 31. Treatment Pain medication Activity modification Physio To improve scapular position Strengthen a specific group of muscles Injection into shoulder To be done by shoulder specialist
- 32. If not treated Continued rubbing of tendon in shoulder Tear of tendon Arthritis
- 33. Procedure General anaesthetic Key hole/arthroscopic surgery 2-3 small cuts around shoulder Assess shoulder and the tendons Shaving of the boney spur
- 35. Results 90-95% good results Pain (sharp catching pain) improves If wear/tear changes in tendon some residual pain is possible
- 36. Conclusion Prevention better than cure Regular exercises Try activity modification Physiotherapy If still not better: Surgery Exceptions: Nerve compressions: carpal/ cubital tunnel Tendon tear in shoulder (Rotator cuff tear)
- 37. Thank you Contact: deepthi.adla@gmail.com 7893844800