Symptoms & signs due to compression of brachial plexus & /or subclavian vessels at root of neck
80% 30-50 years
F:M = 2:1
Uncommon
Thoracic Outlet forms communication at root of neck
- for passage of nerves and vessels from mediastinum to axilla
C5, 6 from Upper trunk
Posterior triangle
- arises upper trunk and passes backward through posterior triangle
- under belly of omohyoid
- deep to trapezius to the suprascapular notch
Runs through suprascapular notch
Patients usually complain of subluxation rather than dislocation
- rarely requires reduction
Different entity to acute posterior dislocation usually
Rare
1. Ligamentous laxity > 50%
- commonly associated with MDI
- posterior only 20%
- posterior & inferior 20%
Rare
- 2% of acute dislocations
Often missed
- < 1/ 52 25%
- < 6/52 25%
- < 6/12 25%
- > 6/12 25%
Post-traumatic (type III clavicle fractures)
Idiopathic
1. OA with osteophytes
- contribute to impingement
2. Osteolysis with resorption & gross osteoporosis
Injury to ulnar collateral ligament of thumb MCPJ
Initial description
- chronic laxity of British gamekeeper's thumb's
- no specific trauma
- secondary to breaking pheasant's neck
Acute trauma
- snow ski
- ball games
Valgus / forced abduction
UCL
Adolescents & young adults
Usually between 12 - 21 years
Throwing athletes / gymnasts
Little Leaguer's Elbow
- combination of capitellar OCD and MCL injury
- a repetitive throwing injury / seen in pitchers
1. Trauma & Overuse
Common throwing sports / gymnastics
Lateral : Medial 9:1
4th & 5th decades
- M = F
- 75% dominant arm
50% of regular tennis players
- especially > 2 hrs / week
Insertion pathology / Enthesopathy
Over-extension of the elbow with supination / pronation
Lateral epicondyle
- anconeus from posterior face
- ECRB and EDC from anterior face (CEO)
Dominant arm of middle aged men
- between 40 and 60
Sudden dramatic event
- sporting / weightlifting injury
- resisting heavy extension load
Degenerative changes seen on histology
Complete
- retracted / rupture of lacertus fibrosis
- minimally retracted
Usually occurs in young people
- often previous history of tendonitis ± steroid injections
Usually at level of inferior pole of patella
- less common at tibial tubercle
- mid-substance ruptures rare
Severe pain
Palpable defect
Extensor deficit / unable to SLR
Patella alta / high riding patella