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Y4 Lecture Day II > Common MSK problems _ upper limb > Flashcards

Common MSK problems _ upper limb Flashcards

1
Q

Examination findings in subacromial pain/impingement syndrome

A
  • Painful arc of abduction between 60 and 120 degrees
  • Tenderness over the anterior acromion
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2
Q

Pathology in Impingement syndrome/painful arc

A

Entrapment of supraspinatus tendon and subacromial

bursa between acromion and grater tuberosity of

humerus.

• → subacromial bursitis and/or supraspinatous tendonitis

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3
Q

Presentation of impingement syndrome (shoulders)

A
  • Painful arc: 60-120O
  • Weakness and ↓ ROM
  • +ve Hawkin’s test
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4
Q

Ix for shoulder impingement syndrome

A
  • Plain radiographs: may see bony spurs
  • US
  • MRI arthrogram
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5
Q

Management of shoulder impingement syndrome

A

Conservative

  • Rest
  • Physiotherapy

Medical

  • NSAIDs
  • Subacromial bursa steroid ± LA injection

Surgical

  • Arthroscopic acromioplasty
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6
Q

Causes of anterior and posterior shoulder dislocations

A

Anterior

  • 95% of shoulder dislocations
  • Direct trauma or falling on hand
  • Humeral head dislocates antero-inferiorly

Posterior

  • Caused by direct trauma or muscle contraction (seen in epileptics and electric shocks).
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7
Q

Demographics in adhesive capsulitis

A

Adhesive capsulitis (frozen shoulder) is a common cause of shoulder pain

  • most common in middle-aged females
  • aetiology of frozen shoulder is not fully understood
  • diabetes mellitus: up to 20% of diabetics may have an episode of frozen shoulder
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8
Q

Features of adhesive capsulitis/frozen shoulder

A

Features typically develop over days

  • external rotation is affected more than internal rotation or abduction
  • both active and passive movement are affected
  • bilateral in up to 20% of patients
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9
Q

How long does adhesive capsulitis last?

A

the episode typically lasts between 6 months and 2 years

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10
Q

Examination findings/presentation of adhesive capsulitis

A
  • Progressive ↓ active and passive ROM
  • ↓ ext. rotation <30o
  • ↓ abduction <90o
  • Shoulder pain, esp. @ night (can’t lie on affected side)
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11
Q

Management of adhesive capsulitis

A

Conservative

  • rest
  • physio

Medical

  • NSAIDs
  • Subacromial bursa steroid ± LA injection
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12
Q

Spectrum of rotator cuff injury (4)

A

Rotator cuff injuries are the most common cause of shoulder problems.

A spectrum of disease is recognised:

  1. Subacromial impingement (also known as impingement syndrome, painful arc syndrome)
  2. Calcific tendonitis
  3. Rotator cuff tears
  4. Rotator cuff arthropathy
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13
Q

A symptom of rotator cuff injury

A

Symptom

  • shoulder pain worse on abduction
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14
Q

Signs on examination of (2) rotator cuff injuries

A

Painful arc of abduction:

  • subacromial impingement → between 60 and 120 degrees
  • rotator cuff tears → the pain may be in the first 60 degrees
  • tenderness over anterior acromion
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15
Q

Signs of the complete tear (complete rotator cuff injury)

A

Complete tear

  • Shoulder tip pain
  • Full range of passive movement
  • Inability to abduct the arm
  • Active abduction possible following passive abduction to 90O
  • lowering the arm beneath this → sudden drop

- “drop arm” sign

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16
Q

(2) types of rotator cuff tears

A
  • Partial tears → painful arc
  • Complete tear
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17
Q

Management of rotator cuff injuries

A

open or arthroscopic repair

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18
Q

Cause and demographics of lateral epicondylitis

A

Lateral epicondylitis

Cause: typically follows unaccustomed activity such as house painting or playing tennis (‘tennis elbow’).

  • most common in people aged 45-55 years
  • typically affects the dominant arm
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19
Q

Features of lateral epicondylitis

A
  • pain and tenderness localised to the lateral epicondyle
  • pain worse on wrist extension against resistance with the elbow extended or supination of the forearm with the elbow extended
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20
Q

How long does lateral epicondylitis last?

A
  • Episodes typically last between 6 months and 2 years
  • Patients tend to have acute pain for 6-12 weeks
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21
Q

Management of lateral epicondylitis

A
  • advice on avoiding muscle overload
  • simple analgesia
  • steroid injection
  • physiotherapy
22
Q

What’s Finkelstein test used for?

A

Finkelstein’s test is a test used to diagnose de Quervain’s tenosynovitis in people who have wrist pain

Finkelstein’s test:

when the examiner grasps the thumb and ulnar deviates the hand sharply. If sharp pain occurs along the distal radius de Quervain’s tenosynovitis is likely.

23
Q

What’s de Quervain tenosynovitis?

A

De Quervain’s tenosynovitis

  • common condition
  • the sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed
  • typically affects females aged 30 - 50 years old
24
Q

Features of de Quervian Tensinosis

A
  • pain on the radial side of the wrist
  • tenderness over the radial styloid process
  • abduction of the thumb against resistance is painful
  • Finkelstein’s test positive
25
Q

Management of de Quervain Tensynovitis

A
  • analgesia
  • steroid injection
  • immobilisation with a thumb splint (spica) may be effective
  • surgical treatment is sometimes required
26
Q

What happens in Carpal Tunnel syndrome?

A

Compression of median nerve in the carpal tunnel

27
Q

Symptoms that pt with carpal tunnel syndrome may complain of

A
  • pain/pins and needles in thumb, index, middle finger
  • unusually the symptoms may ‘ascend’ proximally
  • patient shakes his hand to obtain relief
  • classically at night
28
Q

Signs on examination of a patient with Carpal Tunnel Syndrome

A
  • weakness of thumb abduction (abductor pollicis brevis)
  • wasting of thenar eminence (NOT hypothenar)
  • Tinel’s sign: tapping causes paraesthesia
  • Phalen’s sign: flexion of wrist causes symptoms
29
Q

Causes of carpal tunnel syndrome

A
  • idiopathic
  • pregnancy
  • oedema e.g. heart failure
  • lunate fracture
  • rheumatoid arthritis
30
Q

What can be seen if electrophysiology is performed in a patient with Carpal Tunnel Syndrome?

A

motor + sensory: prolongation of the action potential

31
Q

Management of Carpal Tunnel Syndrome

A
  • corticosteroid injection
  • wrist splints at night
  • surgical decompression (flexor retinaculum division)
32
Q

Features of Carpometacarpal joint OA

A
  • functionally disabling
  • squaring of base of thumb
  • may be wasting of the muscles of the thenar eminence
  • ‘Grind test’ positive
  • ROM of thumb joint reduced
33
Q

Ix of carpometacarpal OA

A
  • X-rays will confirm the diagnosis → OA in 1st carpometacarpal joint
  • usually a clinical diagnosis
34
Q

Pathophysiology of Carpometacarpal OA

A
  • This joint is formed by the trapezium bone of the wrist and the first metacarpal bone of the thumb
  • Because of its relative instability, this joint is a frequent site for osteoarthritis
  • cushioning cartilage of the joint surfaces wears away, resulting in damage of the joint
35
Q

Symptoms of carpometacarpal OA

A
  • Pain at the base of the thumb occurs when moving the thumb and might eventually persist at rest
  • stiffness
  • swelling
  • loss of strength of the thumb
36
Q

Management of Carpometacarpal OA

A
  • doesn’t usually respond to oral analgesics although topical NSAIDsmay help
  • Splints can help
  • Steroid injection
  • Surgery if can’t be managed conservatively with trapeziectomy, fusion or joint replacement performed
37
Q

Risk factors for degenerative cervical myelopathy

A
  • smoking → due to its effects on the intervertebral discs
  • genetics
  • occupation - those exposing patients to high axial loading
38
Q

Symptoms of degenerative cervical myelopathy

A

DCM symptoms can include any combination of [1]:

  • Pain (affecting the neck, upper or lower limbs)
  • Loss of motor function (loss of digital dexterity, preventing simple tasks such as holding a fork or doing up their shirt buttons, arm or leg weakness/stiffness leading to impaired gait and imbalance
  • Loss of sensory function causing numbness
  • Loss of autonomic function (urinary or faecal incontinence and/or impotence) - these can occur and do not necessarily suggest cauda equina syndrome in the absence of other hallmarks of that condition
  • Hoffman’s sign: is a reflex test to assess for cervical myelopathy. It is performed by gently flicking one finger on a patient’s hand. A positive test results in reflex twitching of the other fingers on the same hand in response to the flick
39
Q

Investigations of degenerative cervical myelopathy

A

MRI of the cervical spine:

  • gold standard t
  • may reveal disc degeneration and ligament hypertrophy, with accompanying cord signal change
40
Q

Management of degenerative cervical myelopathy

A
  • urgent referral for assessment by specialist spinal services (neurosurgery or orthopaedic spinal surgery)

*early treatment (within 6 months of diagnosis) offers the best chance of a full recovery

  • decompressive surgery is the only effective treatment

*Physiotherapy should only be initiated by specialist services, as manipulation can cause more spinal cord damage.

41
Q

Causes of radial tunnel syndrome

A
  • compression of the posterior interosseous branch of the radial nerve
  • thought to be a result of overuse

increased pressure on the radial nerve as it travels from the upper arm (the brachial plexus) to the hand and wrist

  • radial nerve becomes irritated and/or inflamed from friction caused by compression by muscles in the forearm
42
Q

Features of radial tunnel syndrome

A
  • symptoms are similar to lateral epicondylitis making it difficult to diagnose
  • however, the pain tends to be around 4-5 cm distal to the lateral epicondyle
  • symptoms may be worsened by extending the elbow and pronating the forearm
43
Q

Features of medial epicondylitis

A
  • *Medial epicondylitis** (golfer’s elbow) Features
  • pain and tenderness localised to the medial epicondyle
  • pain is aggravated by wrist flexion and pronation
  • symptoms may be accompanied by numbness / tingling in the 4th and 5th finger due to ulnar nerve involvement
44
Q
A
45
Q

Diagnosis of radial tunnel syndrome

A

The diagnosis:

  • based on symptoms and signs alone
  • may be clinically tested by flexing the patients long finger while the patient extends the wrist and fingers. Pain is a positive finding.
46
Q

Treatment of radial tunnel syndrome

A
  • rest
  • NSAID
  • therapy with modalities
  • work modification
  • steroid injection if associated with lateral epicondylitis
  • decompressive surgery → if do not respond to prolonged conservative treatment
47
Q

Pathophysiology of cubital tunnel syndrome

A

Compression of ulnar nerve

48
Q

Features of cubital tunnel syndrome

A
  • initially intermittent tingling in the 4th and 5th finger
  • may be worse when the elbow is resting on a firm surface or flexed for extended periods
  • later numbness in the 4th and 5th finger with associated weakness
49
Q

Investigations and diagnosis of cubital tunnel syndrome

A
  • clinical diagnosis usually → follows pattern of ulnar n. damage e.g. ulnar nerve paralysis →ulnar claw position of the hand at rest
  • Clinical tests: such as the card test for Froment’s sign
  • ultrasound or MRI, may reveal anatomic abnormalities or masses responsible for the impingement
50
Q

Management of cubital tunnel syndrome

A
  • pain symptoms → NSAID, amitriptyline, or vitamin B6 supplementation
  • physiotherapy
  • identify positions and activities that aggravate symptoms and to find ways to avoid them

Y4 Lecture Day II (12 decks)

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