Topic Overview

🩺 Clinicoanatomical Problems – Joints of Upper Limb

---

1. A young man sustains a fall on his outstretched hand. The wrist shows dorsal displacement of the distal radius with a “dinner-fork” deformity.

Diagnosis: Colles’ fracture
Anatomical Basis:

• Fracture of distal radius ~2.5 cm above wrist joint.

• Fragment displaced dorsally and radially.

• Involves radiocarpal joint stability.
  Clinical Features:

• Dorsal tilt of distal radius.

• Prominent styloid process of ulna.

• Pain and restricted wrist motion.
  Complications:

• Median nerve compression.

• Stiff wrist or Sudeck’s osteodystrophy.

---

2. A 60-year-old woman complains of shoulder stiffness and severe pain, unable to lift her arm overhead.

Diagnosis: Adhesive capsulitis (Frozen Shoulder)
Anatomical Basis:

• Fibrosis and inflammation of shoulder capsule and surrounding bursae.

• Restricted movement in all directions.
  Predisposing Factors: Diabetes, post-injury, prolonged immobilization.
  Treatment: Physiotherapy, steroid injection, capsular release.

---

3. A cricketer experiences pain on attempting abduction of the shoulder between 60°–120°.

Diagnosis: Painful Arc Syndrome (Supraspinatus Tendinitis)
Anatomical Basis:

• Inflammation or tear of supraspinatus tendon under coracoacromial arch.

• Compression during mid-abduction.
  Tests: Positive “Empty Can” (Jobe’s) test.

---

4. A driver falls with shoulder abducted and externally rotated. The shoulder appears flattened with a palpable bulge below clavicle.

Diagnosis: Anterior Dislocation of Shoulder
Anatomical Basis:

• Weak inferior capsule → head of humerus displaced anteroinferiorly.

• May injure axillary nerve.
  Clinical Features:

• Flattened contour, loss of deltoid tone.

• Loss of sensation over “regimental badge area.”

---

5. A tailor complains of pain on the lateral aspect of elbow aggravated by wrist extension.

Diagnosis: Tennis Elbow (Lateral Epicondylitis)
Anatomical Basis:

• Overuse of common extensor origin (ECRB).

• Microtears and inflammation at lateral epicondyle.
  Test: Pain on resisted wrist extension.

---

6. A golfer presents with tenderness over the medial epicondyle worsened by wrist flexion.

Diagnosis: Golfer’s Elbow (Medial Epicondylitis)
Anatomical Basis:

• Strain of common flexor origin at medial epicondyle.

• Involves pronator teres and FCR.

---

7. A child suddenly lifted by the hand cries and refuses to move the elbow; forearm held pronated.

Diagnosis: Pulled Elbow (Nursemaid’s Elbow)
Anatomical Basis:

• Subluxation of head of radius from annular ligament in the superior radioulnar joint.
  Treatment: Supination and flexion of elbow to reposition radial head.

---

8. A tennis player reports pain along radial side of wrist, worsened by thumb movement.

Diagnosis: De Quervain’s Tenosynovitis
Anatomical Basis:

• Inflammation of synovial sheath of abductor pollicis longus and extensor pollicis brevis (first dorsal compartment).
  Test: Finkelstein’s test positive.

---

9. A carpenter presents with pain and clicking at the base of thumb during gripping.

Diagnosis: Osteoarthritis of 1st Carpometacarpal Joint
Anatomical Basis:

• Degeneration of saddle joint between trapezium and 1st metacarpal.

• Loss of smooth gliding motion → pain during opposition.

---

10. A skier falls with thumb forcefully abducted, leading to pain and swelling at its base.

Diagnosis: Gamekeeper’s (Skier’s) Thumb
Anatomical Basis:

• Rupture of ulnar collateral ligament of the 1st MCP joint.

• Causes instability and weak pinch grip.

---

11. A student develops swelling over the posterior elbow after prolonged leaning.

Diagnosis: Olecranon Bursitis (Student’s Elbow)
Anatomical Basis:

• Inflammation of subcutaneous olecranon bursa due to frictional trauma.

---

12. A typist develops tingling in thumb, index, and middle fingers, worse at night.

Diagnosis: Carpal Tunnel Syndrome
Anatomical Basis:

• Compression of median nerve beneath flexor retinaculum.

• Affects thenar muscles and lateral 3½ fingers.
  Tests: Phalen’s and Tinel’s signs.

---

13. A 12-year-old boy with an elbow fracture develops claw-like contracture of fingers.

Diagnosis: Volkmann’s Ischemic Contracture
Anatomical Basis:

• Brachial artery injury in supracondylar fracture → ischemic necrosis of flexors → fibrosis and flexion deformity.

---

14. A typist has dorsal wrist swelling with jelly-like consistency.

Diagnosis: Ganglion Cyst
Anatomical Basis:

• Herniation of synovial membrane of wrist joint or tendon sheath.

• Commonly on dorsum of wrist near scapholunate ligament.

---

15. A laborer complains of forearm rotation pain after fracture of ulna.

Diagnosis: Monteggia Fracture-Dislocation
Anatomical Basis:

• Fracture of upper third of ulna with dislocation of radial head at proximal radioulnar joint.

---

16. A person sustains a distal radius fracture with dislocation of distal radioulnar joint.

Diagnosis: Galeazzi Fracture-Dislocation
Anatomical Basis:

• Fracture of radius in distal third → disruption of distal radioulnar joint.

---

17. A patient with chronic rheumatoid arthritis develops ulnar deviation of fingers.

Diagnosis: Rheumatoid Deformity at MCP Joints
Anatomical Basis:

• Destruction of joint capsule and ligaments → displacement of extensor tendons to ulnar side.

---

18. A mechanic presents with finger locking during flexion that suddenly “snaps” on extension.

Diagnosis: Trigger Finger
Anatomical Basis:

• Thickening of fibrous flexor sheath (A1 pulley) at MCP level → tendon entrapment.

---

19. A boxer develops swelling at 2nd and 3rd MCP joints with pain on movement.

Diagnosis: Boxer’s Knuckle
Anatomical Basis:

• Inflammation of extensor tendon sheath and dorsal capsule of MCP joints due to repetitive trauma.

---

20. A laborer notices flexion deformity of ring and little fingers with thickened palmar skin.

Diagnosis: Dupuytren’s Contracture
Anatomical Basis:

• Progressive fibrosis of palmar aponeurosis → flexion of MCP and PIP joints.

---

✅ Summary Insight

The joints of the upper limb are commonly affected by trauma, overuse, and inflammatory conditions.
Clinical correlation requires identifying the joint type, stability factors, and nearby neurovascular structures for accurate diagnosis.