2.3.3 Upper Extremity Injuries Flashcards
What test does Dr. Fox use to ellicit the pain from tennis elbow in the office?
Laptop test
-have patients act like they are grabbing their chart out of a bag
What is the treatment sequence for trigger finger?
splints, steriod injections, surgery (cutting of A1 pulley/sparing the A2 pulley)
What are some of the risk factors for carpal tunnel syndrome?
female, pregnancy, diabetes, obesity
What is the scientific name for trigger finger?
stenosing flexor tenosynovitis
What is the typical presentation of rotator cuff tears?
Age > 40 y/o
anterolateral shoulder pain worsened by reaching and overhead activity (like taking a jug of milk out of the fridge)
Night pain
Weakness with attempted overhead activity
What two tests can be used to identify cubital tunnel?
Tinel’s over cubital tunnel
2-point discrimination
Which is normal? which is abnormal?
Which pulleys in the finger are used to keep the flexors from fish poling?
A4 and A2 pulley
How does the position of the nodule in trigger finger change in response to the change in positon of the finger?
What are two tests (used to stimulate symptoms) that can be used to diagnose carpal tunnel?
Tinel’s sign (tapping on tranverse carpal ligament)
Phalen’s test (hold for up to 30 seconds)
What is the standard presentation of cubital tunnel syndrome?
Numbness and tingling in the ring finger and little finger
Nocturnal paresthesias
Worsening symptoms while driving or resting medial elbow on hard surfaces
Why is an x-ray taken in a patient with tennis elbow symptoms?
Rule out other causes of pain
May see some bony changes on x-ray
What are the treatment steps for carpal tunnel?
Night splints -> steriod injections -> surgery (endoscopic or open)
What is the scientific name for tennis elbow?
Lateral epicondylitis
Describe the tract of the ulnar nerve.
Note the branch heading towards the thumb (helps explains the atrophy seen with cubital tunnel)
What are the two signs seen on exam with ulnar pathology?
Wartenburg sign: ask come to ADductor fingers (bring them together), little finger stays abducted - shows dyfunction of palmar interossei, other fingers come together because of the extensor tendon
Fromment’s Sign: Person is trying to compensate for the first palmar interosseus muscle and thumb adductor (positive shown on right)
Which tendon is most commonly torn in the rotator cuff?
Supraspinatus tendon
What are two ways to identify the neuropathy and structure changes as a result of carpal tunnel syndrome?
Sensory testing (2-point discrimination)
Thenar atrophy (severe atrophy can be irreversible)
From which bones does the transverse carpal ligament arise?
The hook of the hamate and the trapezium
What is the standard presentation of tennis elbow?
Middle aged
lateral elbow pain
worsed by repetitive gripping/forearm rotation activities
(cannot grip without flexing extensor tendons)
What is the treatment sequence for tennis elbow?
steriod injections -> PT -> surgery (Dr. Fox not keen on)
There also is a brace that is supposed to help
What ligament is incised during cubital tunnel surgery?
Osborn’s ligament
What three things must be elicted during an exam?
reproduction of locking and release that is pathogenic
Tenderness over A1 pulley
Look for other potential causes of contracture (dupuytren’s and arthritis
What are some elements of the presentation that could lead to the diagnosis of carpal tunnel syndrome?
Nocturnal paresthesias (night tingling)
Parasthesias worsened by gripping activities - holding phone, steering wheel, writing
Weakness of grip
Name a risk factor for trigger finger
Diabetes
What is cubital tunnel syndrome?
Peripheral compression neuropathy of the ulnar nerve as it passes through the cubital tunnel (tightness from osborn’s ligament)
What muscle is typically affected most by lateral epicondylitis?
Extensor carpi radialis brevis (ECRB)
What two hand deformities can be seen on physical examination of a patient with an ulnar nerve injury?
Claw hand (not normally seen with cubital tunnel) and intrinsic atrophy (lose thickness of first interosseus muscle
compression of the median nerve within the carpal tunnel?
Carpal tunnel syndrome
What is the test used to measure/quantify neuropathy in a patient?
EMG/NCS - nerve conduction study
ID
Which is normal RCT, small RCT, and massive RCT
Just a little more imaging review. A normal MRI on the left, An MRI showing a small supraspinatus tear in the middle. You can see the small area of detachment of the tendon insertion to the greater tuberosity without much in the way of retraction. Now contrast that to the MRI on the right where the supraspinatus is detached entirely and the tendon isnt really even appreciable anymore. You couldnt say it just from one cut, but this patient likely has a massive rotator cuff tear. The humeral head is also no longer centered on the glenoid and sits in a superiorly migrated position to rest against the undersurface of the acromion.
What is the standard presentation of trigger finger?
Locking/catching sensation w/ finger flexion (worst in AM)
Pain in palm at the entrance of flexor tendon sheath
What is the origin of the extensor carpi radialis brevis?
