Patients’ dexterity and self-care depend largely on the integrity and function of their upper limbs. Upper limb injuries are common in all life situations from daily activities, to sports, leisure and job tasks. Generally, there are two types of injuries, acute injury which occurs as a consequence of a more rapid or high energy single impact and an overuse injury which results from low energy but high frequency insult. Understanding the mechanism of these injuries is essential for both prevention and their management.
The spectrum of probable upper limb injuries is extensive and therefore medical consultation is necessary in individual circumstances. Prompt medical attention and treatment plan adherence are critical for recovery and full restoration of function after a traumatic event.
Common Types of Upper Injuries:
The upper limb is susceptible to a range of injuries, both acute and chronic, due to its complex anatomy, environmental exposure and performance of repetitive tasks. Some of the most common types of upper limb injuries include:
Fractures can result from accidents, falls, or sports-related impacts. Minor fractures will heal spontaneously with minimal immobilization. Displaced or unstable fractures will need surgical reduction and fixation. Fractures occur in any upper limb bones, but most commonly in digits or long bones (radius or humerus).
Joint Sprains and Dislocations
Sprains involve the stretching or tearing of joint ligaments and capsule. Dislocations involves a complete the displacement of joint with rupture to ligaments and joint capsule. Shoulder dislocations are particularly common after a fall directly on a shoulder or indirectly on a hand. They cause an intense pain and loss of movement. Small finger joints also dislocate from direct trauma or finger entrapment. Dislocation need an immediate intervention to reduce the joint. Sprains on the other hand heal spontaneously on most occasions.
Muscle and Tendon Strains and Ruptures
Strains refer to the overstretching or partial tearing of muscles or tendons and result from sudden movements or overexertion. Hands are prone to complete tendon ruptures or tendon cuts, these injuries necessitate immediate surgical intervention.
Tendinitis is the inflammation of a tendon, often caused by repetitive motions, such as those seen in activities like tennis or typing.
Nerve Entrapment Syndrome
Upper limbs (more than lower limbs) are prone to a specific overuse syndrome leading to nerve compression. These most commonly affect median or ulnar nerve. They can result from a repetitive injury and often lead to numbness, tingling, and weakness in the hand or hole upper limb. Occasionally a surgical intervention is necessary.
The symptoms of upper limb injuries vary widely depending on the type of injury, its severity and injury site. Common symptoms include pain, swelling, redness, bruising, tenderness, stiffness, and difficulty in moving the affected joint or in lifting and manipulating objects. Depending on the injury’s severity, individuals might feel sharp or dull pain, instability, or a snapping sensation and function loss in the case of a tendon rupture.
Upper limb injuries can be caused by a variety of factors:
Depending on the injury’s severity, non-surgical treatments include:
When conservative treatment is insufficient, surgical intervention might be recommended:
A fracture may need either reduction, fixation or both. A closed reduction of a fracture may be necessary to realign bone fragments, further, the limb will be immobilised with a cast.
Occasionally, the fracture site needs open surgery to realign the broken bone. Further, metal rods, nails, screws and plates can be used to stabilise the broken bone, until the fragments heal together. The bone heals on average between 6 weeks to 6 months.
Either sedation or formal surgery may be needed to put the dislocated joint back in its proper position. After a successful reduction, there might still be a need for further surgical joint stabilisation.
Ligament Repair or Reconstruction
Surgical repair or reconstruction is often required for complete ruptures of ligaments to avoid joint instability.
Tendon Repair or Tendon Reconstruction
Most of the acute tendon ruptures necessitate tendon sutures. Several chronic ruptures may need tendon reconstruction or tendon transfer.
Most of the complete or partial nerve injuries need microsurgical nerve repair.
This minimally invasive technique aids in diagnosing and treating injuries and pathologies inside joints. It allows inspection of the joint and necessary reconstructions being performed through minimal incisions.
Severe joint damage as a consequence of acute trauma, old injury or chronic overuse might necessitate joint replacement with an artificial joint surface (such as shoulder, elbow or minor hand joint replacement).
Upper limb injuries can have a significant impact on an individual’s daily life, affecting their ability to work, perform hobbies, and engage in social activities. Prompt and appropriate treatment, whether surgical or non-surgical, plays a crucial role in ensuring optimal recovery and restoration of function.