1. 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 7LMS

2. 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 7LMS

3. 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 and use the code
Panteleimon Chan - Health and Medical Education in the Workplace Module 7LMS

4. Outline – Aims & Objectives
: Hand & Wrist Conditions & Framework
: Elbow Conditions & Framework
: Hand & Elbow Examination – OSCE / CSA
: Shoulder Conditions & Framework
: Shoulder Examination – OSCE / CSA
Summary & Close
Panteleimon Chan - Health and Medical Education in the Workplace Module 7LMS

5. 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 7LMS

6. 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 7LMS

7. 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 7LMS

8. 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 7LMS

9. 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 7LMS

10. 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 7LMS

11. 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 7LMS

12. 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, 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 7LMS

13. 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 7LMS

14. Thank You
Panteleimon Chan - Health and Medical Education in the Workplace Module 7LMS