Clinical Anatomy: Shoulder and Arm 2

Question 1

What is an avulsion fracture?

Answer 1

When the bony attachment of the muscle is torn away rather than the muscle or tendon tearing

Question 2

What happens if epiphyseal fractures are left untreated in children?

Answer 2

Uneven growth can result.

Question 3

What causes a pulled or wrenched elbow?

Answer 3

A pulled/wrenched elbow is common in children under 5 and is caused by pulling on child’s arm causing arm to be dislocated from annular ligament.

Question 4

How can a wrenched elbow be fixed?

Answer 4

By holding elbow in one hand, pronating then supinating the forearm. The radial head then pops back into the ligament.

Question 5

What causes valgus elbow?

Answer 5

Throwing athletes tend to rupture or damage their ulnar collateral ligament (UCL) leading to:

Strain injury to UCL

Cartilage damage at olecranon

Osteochondral lesions at capitulum

osteophyte formation (posteromedial humerus and olecranon

Loose bodies from fragmentation

Cubital tunnel syndrome

Question 6

How is pitcher’s elbow diagnosed?

Answer 6

Local pain and tenderness of the UCL and pain on valgus stress.

Radiographs can be used in severe cases to check for bone and cartilage damage.

This is particularly a problem for young atheletes as this negatively affects humeral and ulnar growth plates.

Question 7

How is valgus extension treated?

Answer 7

For less severe cases: RICE +/- NSAIDs

Severe cases with osteophytes: Arthroscopic surgery to remove ostoephytes and loose bodies as well as debridement of chondromalacia.

Arthroscopic surgery for full thickness UCL tears.

Question 8

What is carpal tunnel syndrome?

Answer 8

An overuse injury where compression occurs of median nerve in the carpal tunnel.

Question 9

What leads to compression of median nerve in carpal tunnel syndrome?

Answer 9

Inflammation of carpal joints

Restriction of flexor retinaculum

Tendonitis / Tenosynovitis

Question 10

What causes carpal tunnel syndrome?

Answer 10

Repatitive wrist movement

Prolonged static wrist postures

Direct pressure on the median nerve

Question 11

How is carpal tunnel syndrome treated?

Answer 11

Conservative treatment: rest and cessation of aggravating activity splinting and physiotherapy

Surgical removal of part of the flexor retinaculum may relieve pressure

Question 12

What is Raynaud’s disease?

Answer 12

Aka white hand it is a traumatic vasoplastic disease that results from a prolonged exposure to vibration which affects blood flow to extremities.

Question 13

What causes lateral epicondylitis (tennis elbow)?

Answer 13

Overuse syndrome related to excessive activity of wrist extensor muscles.

Question 14

What are the symptoms of lateral epicondylitis?

Answer 14

Pain on lateral aspect of elbow radiating into the forearm. This pain is aggravated with wrist extension and gripping.

Question 15

How is lateral epicondylitis treated?

Answer 15

Rest, physiotherapy, anti-inflammatory meds and strapping.

Question 16

What is tendonosis?

Answer 16

Tendon regeneration. This is due to damage to the fibers as opposed to just inflammation as seen in tendonitis.

Question 17

How can tendonosis be healed?

Answer 17

Unlike tendonitis, tendonosis requires matrix repair and mechanical support.

Surgery can be conducted but has a long recovery time, questionable efficacy, and is a last resort method.

2 new methods being investigated are PRP injections (2 injections), and Autologous Tenocyte Implantation (ATI)

Question 18

What does PRP stand for?

Answer 18

Platelet Rich Plasma. Evidence is questionable of their efficacy.

Question 19

How effective has autologous tenocyte implantation been?

Answer 19

Studies have shown 60.4% reduction in Damage to arms and shoulders (QuickDASH) and 63.7% reduction in pain (VAS), as well as increased grip strength of 86.3% in 12 months.

Question 20

What do antibodies attack in rheumatoid arthritis?

Answer 20

Synovial membranes of joints.

Question 21

What happens to joints that are attacked by antibodies in RA?

Answer 21

Fluid accumulates in capsule

Thickens and adheres to carilage

Capsule invaded by fibrous connective tissue

Joint begins to ossify

Question 22

What causes De quervain’s tenosynovitis?

Answer 22

Repetitive hand/wrist motions such as 10-pin bowling, racquet sports, and lifting babies.

Too much gaming or texting

Overuse in home and workplace (writing, drawing, CAD mousing, childcare, etc)

Inflammatory conditions

Direct injury following scarring.

Question 23

What is de quervain’s tenosynovitis?

Answer 23

Stenosing tenosynovitis affecting tendons of abductor pollicis longus and extensor pollicis brevis resulting in pain and swelling locally at base of thumb and increased pressure under flexor retinaculum.

Question 24

Who gets De quervain’s tenosynovitis?

Answer 24

Adults 30 - 50 years

Women 8 - 10x more likely than men

Young male gamers are catching up

Question 25

What makes De quervain’s tenosynovitis worse?

Answer 25

No rest, treatment, pinching, grasping, and other movements of the thumb and wrist.

Question 26

How is De quervain’s tenosynovitis treated?

Answer 26

RICE +/- NSAIDs

Splinting

Corticosteroid injection onto tendon sheath

Chronic recalcitrant may require surgical decompression of tendons.