GP / VTS Survival guide: Upper LImb Dr Panteleimon Yat-Ling Stewart Chan MB BS BSc(Hons) MRCS(Eng) MRCGP Health and Medical Education in the Workplace Module 7LMS0165-0901-2018

Framework – “Keep It Simple” Introduction Housekeeping, including mobiles I am a GP with a background in Orthopaedic Surgery, holding both MRCGP & MRCS status. Further to my standard GP role, I provide sub-specialist (GPwSI – GP with Specialist Interest) care for my practice’s patients in the form of second opinions & minor operations & injections, saving the practice & the local NHS services from many secondary care referrals. My interest amongst this is in Upper Limb problems. PGCMedEd / MSc Health and Medical Education – Feedback please Framework – “Keep It Simple” Panteleimon Chan - Health and Medical Education in the Workplace Module 7LMS0165-0901-2018

Aims & Objectives Review & revise the common conditions affecting the shoulder, elbow, wrist & hand; their assessment & their management Be able to examine each of the following in an OSCE / CSA – style format: shoulder, elbow, wrist & hand NB – High volume of content which I would normally deliver over 2 sessions, combined into 1 session as due to time constraints. Prior knowledge & experience? Go to www.menti.com and use the code 33 37 49 Panteleimon Chan - Health and Medical Education in the Workplace Module 7LMS0165-0901-2018

Outline – Aims & Objectives 0940-0950: Hand & Wrist Conditions & Framework 0950-1000: Elbow Conditions & Framework 1000-1030: Hand & Elbow Examination – OSCE / CSA 1100-1130: Shoulder Conditions & Framework 11100-1130: Shoulder Examination – OSCE / CSA Summary & Close Panteleimon Chan - Health and Medical Education in the Workplace Module 7LMS0165-0901-2018

Framework Anatomy & Pathology Panteleimon’s 1-Finger Technique – all you need ICE & BPS Patient Education - Key Investigations – Why? Imaging vs Proper Examination Negotiated Tailored Management Plan – Op vs Not Non-Op = NSAID & Physio (self vs refer) +/- Injection Red Flags Panteleimon Chan - Health and Medical Education in the Workplace Module 7LMS0165-0901-2018

Examination Technique – OSCE / CSA 5-Step Teaching Overview Demonstrate Detail Talk Through OSCE PGCMedEd Filming Panteleimon Chan - Health and Medical Education in the Workplace Module 7LMS0165-0901-2018

Hand Examination Technique – OSCE / CSA Inspect – deformity (Dupuytren’s, HB nodes, RA, Psoriatic nails), wasting, scars Tumour, Rubor, Calor, Dolor Palpate – joints, Notta’s nodules, tendons Move – ROM triggering, Finklestein’s (de Quervain’s) Grind test (CMCJ OA), Kirk-Watson (VISI/SLAC) Table-top (Dupuytren’s) NVD – 30sec Peripheral Nerves, Tinel’s Red Flags – Kanavel’s 4 Cardinal Signs Panteleimon Chan - Health and Medical Education in the Workplace Module 7LMS0165-0901-2018

Hand Examination Technique – OSCE / CSA Panteleimon’s 1-Finger Technique Hands Out, Turn Over, Elbows - Inspect Joints & Tendons – Palpation Spread wide, Clench Fist, Wrists Back & Forward & Queen Wave - Move Triggering / Finklestein’s / Table-Top– Special Tests 30 Sec NeuroVascularDefect & Tinel’s Summary & Close Panteleimon Chan - Health and Medical Education in the Workplace Module 7LMS0165-0901-2018

Elbow Examination Technique – OSCE / CSA Inspect – Deformity, wasting, scars, skin (plaques, bursa) Tumour, Rubor, Calor, Dolor Palpate – Bones (Epicondyles, Olecranon, Radial Head), tendons (common origins, Fish-hook), joints Move – ROM – 4 directions Hypermobility Laxity NVD – Tinel’s Panteleimon Chan - Health and Medical Education in the Workplace Module 7LMS0165-0901-2018

Elbow Examination Technique – OSCE / CSA Panteleimon’s 1-Finger Technique Elbows Straight, Bend Up, Supinate & Pronate - Inspect Joints & Tendons – Palpation Flex, Extend, Supinate, Pronate & vs Resistance - Move Collaterals, Fish-hook – Special Tests 30 Sec NeuroVascularDefect & Tinel’s Panteleimon Chan - Health and Medical Education in the Workplace Module 7LMS0165-0901-2018

Shoulder Examination Technique – OSCE / CSA Inspect – Deformity, wasting, scars, skin (plaques, bursa) Tumour, Rubor, Calor, Dolor Palpate – Bones (Epicondyles, Olecranon, Radial Head), tendons (common origins, Fish-hook), joints Move – ROM – 4 directions Hypermobility Laxity NVD – Axillary nerve Panteleimon Chan - Health and Medical Education in the Workplace Module 7LMS0165-0901-2018

Shoulder Examination Technique – OSCE / CSA Panteleimon’s 1-Finger Technique Expose & - Inspect Clavicle, ACJ, Post Corner, GHJ, Gr Tuberosity, Biceps Groove, Ls Tub – Palpation Mexican Wave, Hands Out & Above, “Stop”, Hawkin’s, Scarf, Elbow 90deg, Ext Rot, Int Rot, 20-20 Empty can – Move & Cuff Functional Bra & Hair, Jobe’s Instability– Special Tests 30 Sec NeuroVascularDefect Panteleimon Chan - Health and Medical Education in the Workplace Module 7LMS0165-0901-2018

Summary Aims & Objectives Review & revise the common conditions affecting the shoulder, elbow, wrist & hand; their assessment & their management Be able to examine each of the following in an OSCE / CSA – style format: shoulder, elbow, wrist & hand Framework Keep It Simple Diagnosis – Anatomy – 1 Finger Management – Op or Not – ICE & Education & Negotiated Plan Panteleimon Chan - Health and Medical Education in the Workplace Module 7LMS0165-0901-2018

Thank You Panteleimon Chan - Health and Medical Education in the Workplace Module 7LMS0165-0901-2018