Captulo 7

PATOLOGIA DO MEMBRO SUPERIOR Patologia do ombro Fracturas As fracturas podem envolver a clavcula, colo do mero e omoplata. A clavcula o osso do organismo que mais se fractura. H um ponto fraco a a 1/3 da extremidade externa. Nesta fractura a espdua o osso tende a descer. As fracturas da clavcula e do colo do mero so provocadas em geral por quedas, colises ou acidentes de automvel. Como a omoplata est protegida pelo trax e msculos circundantes, a sua fractura rara, podendo observar-se em acidentes de automovel, quase sempre associada a leses do trax.

http://www.upmc.com/healthmanagement/managingyourhealth/healthreference/diseases/?chunkiid=11956

http://en.wikipedia.org/wiki/Clavicle_fracture

http://en.wikipedia.org/wiki/Clavicle_fracture
Fig. 7.1 Fracturas da clavicula

Luxaes As luxaes so frequentes. Como os tendes e ligamentos esto essencialmente nas regies superior e anterior, nas luxaes o mero tem tendncia a se deslocar para baixo. Como os principais ligamentos cruzam a face superior da articulao, mais frequente a luxao inferior do mero, na direco da axila. A luxao acromio-clavicular conhecida como espadua separada. A luxao esternoclavicular separa a clavcula do esterno. Na luxao glenohumeral a separao pode ser para diante ou para trs.

Luxation of the outer end of the clavicle upward, showing the coracoid process acting as a fulcrum. As the outer end of the clavicle rises, the lower angle of the scapula is carried toward the median line and the acromion process is depressed and torn loose from the clavicle above. http://chestofbooks.com/health/anatomy/Human-Body-Construction/Dislocations-Of-The-Clavicle.html

Fig. 7.2 Luxaes da clavicula

Bursites A bursite infra-acromial pode tornar-se muito dolorosa quando o deltide comprime a bolsa durante o movimento do ombro.

Ombro congelado A cpsula da articulao gleno-umeral inflama-se e torna-se rgida e forma adeses que limitam grandemente os movimentos da articulao. Esta situao dura seis meses a mais de trs anos. Muitas vezes a causa desconhecida mas nalguns casos est associada a imobilizao por fractura ou a traumatismos.

http://www.nlm.nih.gov/medlineplus/ency/imagepages/8811.htm

http://www.shoulderdoc.co.uk/images/uploaded/frozen_shoulder_01a_large_shoulderdoc.jpg Cortesia de Lennard Funk Salford University

Fig. 7.3 Ombro congelado

Dor no ombro A dor no ombro pode dever-se a presso da coifa dos rotadores ou a leses dar ar ticulaes gleno-umeral ou acromioclavicular. Todavia a maior parte das vezes provem de leses do pescoo.

Patologia da articulao do cotovelo Bursite olecraneana A bursite olecraniana a inflamao da bolsa serosa do olecranio e pode ser provocada pela frico excessiva contra uma superficie dura cotovelo do estudante.

http://en.wikipedia.org/wiki/File:Bursitis_Elbow_WC.JPG
Fig. 7.4 Bursite olecraniana

Fracturas Na fig. 7.5 exemplificamos algumas fracturas.

http://www.joint-pain-expert.net/shoulder-fracture.html Cortesia de Dr Akshay Agnihotri

http://www.joint-pain-expert.net/elbow-fracture-in-children.html Cortesia de Dr Akshay Agnihotri

Fractura supracondiliana

http://www.joint-pain-expert.net/supracondylar-fracture.html Cortesia de Dr Akshay Agnihotri

Fractura do condilo lateral

http://www.joint-pain-expert.net/elbow-fracture-in-children.html Cortesia de Dr Akshay Agnihotri

Fig. 7.5 - Exemplos de fracturas do cotovelo

Luxaes A cabea do rdio pode ser subluxada do ligamento anular do rdio cotovelo da enfermeira. Tambem pode surgir ao levantar uma criana com uma s mo.

Fig. 7.6 Luxao do cotovelo

Artrite do cotovelo

http://www.tennent.net/html/info/ec-arthritis.htm
Fig. 7.7 Artrite do cotovelo

Cotovelo do tenista e do golfista

So epicondilites. No cotovelo do tenista est envolvido est envolvido o tendo extensor comum e no do golfista o epicondilo medial. Os utilizadores frequentes de computador podem ter epicondilites.

Cotovelo do tenista

http://www.arc.org.uk/arthinfo/patpubs/6044/6044.asp

http://www.arc.org.uk/arthinfo/patpubs/6044/6044.asp
Fig. 7.8 Cotovelo do tenista

Cotovelo do golfista

http://en.wikipedia.org/wiki/File:Gray329-Medial_epicondyle_of_the_humerus.png

http://www.shoulder doc.co.uk/article.asp?article=431 Cortesia de Lennard Funk Salford University

Fig. 7.9 Cotovelo do golfista

Tnel do canal crpico O carpo cncavo adiante. uma passagem estreita formada pela aponevrose dos flexores e os ossos do carpo. Por este canal passam o nervo mediano e vrios tendes musculares.

http://www.arc.org.uk/arthinfo/patpubs/6008/6008.asp
Fig. 7.10 Tnel do canal carpico

Em caso de inflamao excessiva desenvolve-se um edema que comprime o nervo mediano. frequente com o uso frequente do teclado de computador.

http://www.arc.org.uk/arthinfo/patpubs/6008/6008.asp
Fig. 7.11 Sindroma do canal carpico

Tendinite do bicipete

http://www.shoulderdoc.co.uk/article.asp?article=722 Cortesia de Lennard Funk Salford University

Fig. 7.12 Tendinite do bicipete

Canal de Guyon O nervo cubital passa atravs de um tnel no pulso, o canal de Guyon entre o pisiforme e o osso grande. O sindroma do canal de Guyon surge por hiperuso do pulso como alpinismo e apertos de mo muito frequentes.

http://en.wikipedia.org/wiki/File:Gray422.png

http://en.wikipedia.org/wiki/File:Gray815.png
Fig. 7.13 Canal de Guyon

BIBLIOGRAFIA Artrite do cotovelo http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=239&topcategory=Arm http://www.handuniversity.com/topics.asp?Topic_ID=2 http://www.allaboutarthritis.com/AllAboutArthritis/layoutTemplates/html/en/contentdispla y/arthritisAndYourJoints/elbow.htm http://www.hss.edu/conditions_14149.asp

Bursite olecraneana http://www.patient.co.uk/showdoc/23069168/ http://orthoinfo.aaos.org/topic.cfm?topic=A00028 http://www.handuniversity.com/topics.asp?Topic_ID=3

Compresso do nervo cubital http://orthoinfo.aaos.org/topic.cfm?topic=A00069 http://emedicine.medscape.com/article/1244885-overview http://en.wikipedia.org/wiki/Ulnar_nerve_entrapment http://www.ssoc.co.za/nerve-entrapment.html Ilustraes - compresso do nervo cubital http://catalog.nucleusinc.com/generateexhibit.php?ID=13370 http://findlaw.doereport.com/generateexhibit.php?ID=540&ExhibitKeywordsRaw=&TL= 4294967295&A=42409

Cotovelo do golfista http://www.mayoclinic.com/print/golferselbow/DS00713/DSECTION=all&METHOD=print http://en.wikipedia.org/wiki/Medial_epicondylitis http://www.orthogate.org/patient-education/elbow/medial-epicondylitis-golferselbow.html http://www.brianmac.co.uk/articles/scni44a2.htm http://www.handuniversity.com/topics.asp?Topic_ID=4 http://emedicine.medscape.com/article/327860-overview

Cotovelo do tenista http://orthoinfo.aaos.org/topic.cfm?topic=A00068 http://en.wikipedia.org/wiki/Tennis_elbow http://www.mayoclinic.com/health/tennis-elbow/DS00469 http://hcd2.bupa.co.uk/fact_sheets/html/tennis_elbow.html http://www.tennis-elbow.net/tenniselbow.htm http://www.emedicinehealth.com/tennis_elbow/article_em.htm http://www.arc.org.uk/arthinfo/patpubs/6044/6044.asp http://www.handuniversity.com/topics.asp?Topic_ID=5 http://emedicine.medscape.com/article/1231903-overview http://orthoinfo.aaos.org/topic.cfm?topic=a00068 http://sportsmedicine.about.com/cs/elbow/a/elbow2.htm http://www.nlm.nih.gov/medlineplus/ency/article/000449.htm

Dor no cotovelo http://www.freemd.com/elbow-pain/visit-virtual-doctor.htm

http://www.medicinenet.com/elbow_pain/article.htm http://arthritis.about.com/od/elbow/Elbow_Pain_Causes_Symptoms_Diagnosis_Treatm ent_Pain_Relief.htm Entorses do cotovelo http://www.aurorahealthcare.org/yourhealth/healthgate/getcontent.asp?URLhealthgate =%2211882.html%22 http://www.ccptr.org/KDC/rehab_of_elbow_injuries.htm

Fracturas do antebrao http://orthoinfo.aaos.org/topic.cfm?topic=A00039 Fracturas do brao http://orthoinfo.aaos.org/topic.cfm?topic=A00078

Fracturas da cabea do rdio http://orthoinfo.aaos.org/topic.cfm?topic=A00073 Fracturas do cotovelo http://www.emedicinehealth.com/broken_elbow/article_em.htm http://www.patient.co.uk/showdoc/40024963/ http://www.assh.org/Content/NavigationMenu/PatientsPublic/HandConditions/ElbowFra ctures/ElbowFractures.htm http://orthoinfo.aaos.org/topic.cfm?topic=A00037 Fracturas do olecranio http://orthoinfo.aaos.org/topic.cfm?topic=A00503

Fracturas do mero proximal http://www.emedx.com/emedx/diagnosis_information/shoulder_disorders/proximal_hu merus_fracture_outline.htm

Luxao do cotovelo http://www.ori.org.au/bonejoint/shoulder/introduction.htm http://www.emedx.com/emedx/diagnosis_information/shoulder_disorders/shoulder_disl ocation_outline.htm

Tnel crpico http://www.arthroscopy.com/sp04004.htm http://www.arc.org.uk/arthinfo/patpubs/6008/6008.asp http://www.repetitive-strain.com/causes.html http://orthoinfo.aaos.org/topic.cfm?topic=A00005 http://www.nlm.nih.gov/medlineplus/carpaltunnelsyndrome.html http://www.handuniversity.com/topics.asp?Topic_ID=17 Tnel de Guyon http://orthoinfo.aaos.org/topic.cfm?topic=A00025 http://www.handuniversity.com/topics.asp?Topic_ID=41

Patologia das mos e dedos

Dedo em martelo Deve-se leso dos tendes dos extensores A ponta do dedo cai sem haver flexo muscular. O dedo cai e no se endireita

http://www.eatonhand.com/hw/hw015.htm Cortesia do dr. Eaton

http://www.orthosports.com.au/hand_mallet.html
Fig. 7.14 Dedo em martelo

Acontece quando aplicada uma fora sbita na ponta dedo, por exemplo ao fazer a cama, provocando o estiramento ou ruptura do tendo que poder levar a arrancar fragmentos de osso.

http://www.eatonhand.com/hw/hw015.htm Cortesia do dr. Eaton

Fig. 7.15 Aplicao de uma fora subita

http://www.eatonhand.com/hw/hw015.htm Cortesia do dr. Eaton

Fig. 7.16 Arrancamento do tendo

http://www.orthosports.com.au/hand_mallet.html

http://www.eatonhand.com/hw/hw015.htm Cortesia do dr. Eaton

Fig. 7.17 Arrancamento do osso

Fractura do escafoide frequente nas quedas com a mo estendida.

http://www.joint-pain-expert.net/scaphoid-fracture.html Cortesia de Dr Akshay Agnihotri

Fractura recent

Fresh fracture - You broke your scaphoid bone recently. The broken pieces are not in their correct position: this is called a displaced fracture. Your scaphoid is very unlikely to heal (unite) without an operation. If your scaphoid fracture does not heal, you will have further problems. Old fracture - non-union - It may be many months since you broke your scaphoid bone. Perhaps you did not know that you had broken your scaphoid, so you were not treated and your break did not heal. Alternatively, you may have had your wrist in a plaster cast and despite this your break has still not healed. A break that has not healed is called a non-union.

http://www.privatehealth.co.uk/private-operations/orthopaedic/scaphoid-fracture/ Fractura antiga

Fig. 7.18 Fracturas do escafoide

Polegar do esquiador Deve-se leso do ligamento cubital colateral que pode chegar a arrancar um fragmento de osso.

http://www.orthosports.com.au/hand_skier.html
Fig. 7.19 Fractura do esquiador

Artrite do polegar

http://www.handsurgery.com/arthritis.html
Fig. 7.20 Artrite do polegar

Dupuytren uma contractura provocada pelo espessamento da aponevrose que cobre a palma da mo. Comea por pequenos ndulos nas palmas das mos. Nalguns doentes formam-se cordes que obrigam flexo dos dedos para a palma da mo, impedindo que se estendam para voltarem posio original. A sua causa desconhecida.

http://www.eatonhand.com/hw/hw009.htm Cortesia do dr.Eaton

http://www.dupuytren-online.info/
Fig. 7.21 - Dupuytren

Artrite das mos As mais frequentes so as da base do polegar e as interfalangicas proximais e distais Tambm se observam no punho. Podem-se desenvolver ndulos sseos, os nodulos de Heberden e de Bouchard.

http://en.wikipedia.org/wiki/File:Heberden-Arthrose.JPG

Fig. 7.22 Ndulos de Heberden e Bouchard

Artrite da base do polegar a artrite da articulao trapeziometacarpica do polegar que articula o trapzio com o 1 metacarpo.

http://www.handsurgery.com/arthritis.html
Fig. 7.23 Artrite do polegar

mais frequente nas mulheres com mais de 40 anos. Manifesta-se por uma dor profunda na base do polegar, podendo ser afectados os movimentos de oposio e preenso. Em casos graves o polegar colapsa para a palma da mo, criando uma deformidade em zigue-zague. As artrites das outras articulaes metacarpo-falangicas so mais raras.

Artrite reumatide da mo Podem ser atingidas todas as articulaes da mo. uma doena sistmica altamente incapacitante.

Dedo em gatilho a tenosinovite estenosante. Os tendes dos msculos da mo ao entrarem na mo passam por uma srie de anais, as polias, que orientam o tendo como as guias de uma cana de pesca. Quando se forma um edema ou surge um ndulo o escorregamento do tendo dificultado ou impedido o que leva contraco do dedo, que muitas vezes fica bloquedo.

Tendonite de de Quervain a inflamao dos tendes do polegar na base do punho.Manifesta-se por dores no punho.

Quistos ganglionares So pequenas tumefaces que aparecem nas mos e nos punhos.

http://en.wikipedia.org/wiki/File:Cyst_Profile2.JPG

CYSTS
GENERAL

http://www.orthosports.com.au/hand_ganglion.html

http://www.joint-pain-expert.net/ganglion.html Cortesia Dr Akshay Agnihotri

Fig. 7.24 Quistos ganglionares

Fractura de Bennett Fractura associada a luxao do l metacrpico. D uma grande instabilidade na articulao. Ocorre no futebol.

http://www.orthosports.com.au/hand_bennett.html

http://www.joint-pain-expert.net/bennett-fracture.html Cortesia de Dr Akshay Agnihotri

http://www.joint-pain-expert.net/bennett-fracture.html Cortesia de Dr Akshay Agnihotri

You can not do this movement if you have Bennett Fracture

http://www.joint-pain-expert.net/bennett-fracture.html Cortesia de Dr Akshay Agnihotri

Fig. 7.25 Fractura de Benett

Fractura do boxeur a fractura do 5 metacrpico.

http://www.orthosports.com.au/hand_boxer.html
Fig. 7.26 - Fractura do boxeur

Fracturas dos dedos

Proximal phalanx collateral ligament avulsion fracture.

Proximal phalanx base fracture with dorsal angulation.

Proximal interphalangeal joint dorsal fracturedislocation.

Middle phalanx oblique shaft fracture.

Distal interphalangeal joint mallet finger or fracture dislocation.

http://www.eatonhand.com/hw/hw010.htm Cortesia do dr. Eaton

Fig. 7.27 Fracturas dos dedos

BIBLIOGRAFIA Artrites das articulaes da mo http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=307&topcategory=Hand http://www.info.gov.hk/elderly/english/healthinfo/healthproblems/oa_hand-e.htm http://www.assh.org/Public/HandConditions/Pages/ArthritisOsteoarthritis.aspx

Artrite reumatide das mos http://www.assh.org/Public/HandConditions/Pages/ArthritisRheumatoidArthritis.aspx http://arthritis.about.com/od/arthqa/f/ulnardeviation.htm http://emedicine.medscape.com/article/401271-overview Ilustraes artrites das articulaes das mos http://arthritis.about.com/od/handandfingers/ig/Arthritis-Hand-Gallery/ Artrite dos dedos http://www.handuniversity.com/topics.asp?Topic_ID=13

Artrite do polegar http://www.mayoclinic.com/health/thumb-arthritis/DS00703 http://www.handsurgery.com/arthritis.html http://orthoinfo.aaos.org/topic.cfm?topic=A00210 http://www.arthritiseducation.com/learn_thumb.htm http://www.handuniversity.com/topics.asp?Topic_ID=24

Dedo em gatilho http://orthoinfo.aaos.org/topic.cfm?topic=A00024 http://www.handuniversity.com/topics.asp?Topic_ID=28 http://www.mayoclinic.com/health/trigger-finger/DS00155 http://www.assh.org/Public/HandConditions/Pages/TriggerFinger.aspx

Dedo em martelo http://www.eatonhand.com/hw/hw015.htm http://www.orthosports.com.au/hand_mallet.html http://www.orthosports.com.au/hand_mallet.html http://orthoinfo.aaos.org/topic.cfm?topic=A00018 http://www.handuniversity.com/topics.asp?Topic_ID=19

De Quervain (tenosinovite estenosante) http://www.handuniversity.com/topics.asp?Topic_ID=45

Dupuytren http://www.eatonhand.com/hw/hw009.htm http://orthoinfo.aaos.org/topic.cfm?topic=A00008 http://health.yahoo.com/musculoskeletal-overview/dupuytren-s-disease-topicoverview/healthwise--ue4603.html http://en.wikipedia.org/wiki/Dupuytren%27s_contracture http://orthopedics.about.com/cs/handcondiitions/a/dupuytrens.htm http://www.dupuytren-online.info/ http://www.handuniversity.com/topics.asp?Topic_ID=27

Fractura de Benett http://www.orthosports.com.au/hand_bennett.html Fractura do boxeur http://www.orthosports.com.au/hand_boxer.html Fractura distal do rdio http://orthoinfo.aaos.org/topic.cfm?topic=A00412 Fracturas do escafoide http://www.arthroscopy.com/sp04013.htm http://www.handuniversity.com/topics.asp?Topic_ID=30 http://orthoinfo.aaos.org/topic.cfm?topic=A00012&return_link=0 Fracturas dos ossos das mos e punhos http://orthoinfo.aaos.org/topic.cfm?topic=A00257 http://orthoinfo.aaos.org/topic.cfm?topic=A00011 http://www.eatonhand.com/hw/hw010.htm Polegar do esquiador http://www.orthosports.com.au/hand_skier.html Polegar do guarda-redes http://www.handuniversity.com/topics.asp?Topic_ID=29 Quistos ganglionares das mos http://www.eatonhand.com/hw/hw013.htm http://emedicine.medscape.com/article/1243454-overview http://orthoinfo.aaos.org/topic.cfm?topic=A00006 http://en.wikipedia.org/wiki/Ganglion_cyst http://www.emedicinehealth.com/ganglion_cyst/article_em.htm http://www.assh.org/Public/HandConditions/Pages/GanglionCysts.aspx