Compressive Neuropathies, Elbow and Hand

Question 1

What forms the carpal tunnel of the wrist?

Answer 1

carpal bones

flexor retinaculum

Question 2

Any swelling within the confines of the carpal tunnel may cause what?

Answer 2

medial nerve compression

Question 3

What can carpal tunnel syndrome occur secondary to?

Answer 3

RA (synovitis leads to less space)

Many conditions which involve fluid retention eg pregnancy, diabetes, CKD, hypothyroid

Question 4

Which fracture may cause carpal tunnel syndrome?

Answer 4

colles fracture

Question 5

Is carpal tunnel more common in men or women?

Answer 5

women (8 times more)

Question 6

How will patients present with carpal tunnel syndrome?

Answer 6

numbness in median nerve innervated digits (thumb and radial 2.5 fingers, worse at night
weakness of thumb
clumsiness

Question 7

What may be seen on examination in carpal tunnel syndrome?

Answer 7

muscle wasting of thenar eminence

Question 8

Which tests can be done in Carpal Tunnel?

Answer 8

Tinel’s test (decreases space in carpal tunnel)

Phalen’s test (holds wrists hyper flexed)

Question 9

What confirm diagnosis of carpal tunnel?

Answer 9

nerve conduction studies - see slowing of conduction across wrist

Question 10

Treatment of carpal tunnel syndrome?

Answer 10

wrist splints to prevent flexion

surgical carpal tunnel decompression (very commonly performed)

Question 11

Which nerve is compressed in cubital tunnel syndrome and where?

Answer 11

ulnar nerve

at albow behind medial epicondyle (funny bone area)

Question 12

Which muscles may be weak in cubital tunnel syndrome?

Answer 12

1st dorsal interosseus and adductor pollicis

Question 13

What test can assess muscle weakness in cubital tunnel syndrome?

Answer 13

Froment’s test

Question 14

What may be the cause of compression in cubital tunnel syndrome?

Answer 14

tight band of fascia forming the root of the tunnel (Osborne’s fascia)

Question 15

What confirm diagnosis of cubital tunnel syndrome?

Answer 15

nerve conduction studies

Question 16

What may give rise to either type of epicondylitis?

Answer 16

common extensor and flexor origins’ attachment (enthesis) can become painful (enthesopathy)

Question 17

Which is the elbow commonly affected by, OA or RA?

Answer 17

RA

Question 18

Is tennis elbow lateral or medial?

Answer 18

lateral

Question 19

Is golf elbow lateral or medial?

Answer 19

medial

Question 20

Injection for golfer’s elbow poses a risk of injury to which nerve?

Answer 20

ulnar

Question 21

What is Dupytrens contracture?

Answer 21

connective tissue disorder
specialized palmar fascia undergoes hyperplasia
Nodules/cords formed
Leads to contractures at MCP and PIP joints

Question 22

What is the pathology of Dupytrens?

Answer 22

proliferation of myofibroblast cells and production of abnormal collagen (type 3 instead of type 1)

Question 23

Contractures most commonly affect which fingers?

Answer 23

ring and pinky

Question 24

Who are more likely to have Dupytrens, men or women?

Answer 24

men (10:1)

Question 25

What can dupytrens be a features of?

Answer 25

alcoholic cirrhosis side effect of phenytoin therapy Peyronie's disease Ledderhose disease

Question 26

Is dupytrens less common in diabetics?

Answer 26

no, more common

Question 27

What is an indication for surgery in Dupytrens?

Answer 27

contracture at PIP joint

Question 28

What surgery is done in Dupytrens?

Answer 28

fasciectomy or fasciotomy

Question 29

What is trigger finger?

Answer 29

tendonitis of flexor tendon resulting in nodular enlargement of affected tendon

Question 30

Movement o finger in trigger finger produces what?

Answer 30

clicking sensation

Question 31

Which fingers are most commonly affected in trigger finger?

Answer 31

middle and ring

Question 32

In whom is DIP OA very common?

Answer 32

post menopausal women

Question 33

What are seen on examination of DIPs with OA?

Answer 33

Heberden's nodes

Question 34

What are seen on examination of PIPs with OA?

Answer 34

Bouchard's nodes

Question 35

Which joint is extremely commonly affected by OA in women over 40?

Answer 35

trapziometacarpal joint at base of thumb

Question 36

OA of the radio carpal join is normally due to what?

Answer 36

trauma

Question 37

Name the 3 stages of disease of the hand by RA.

Answer 37

1. synovitis and tenosynovitis 2. erosion of joint 3. joint instability and tendon rupture

Question 38

List the 5 hand deformities caused by RA.

Answer 38

Volar MCP joint xubluxation Ulnar deviation Swan neck deformity (hyperextension at PIP with flexion of DIP) Boutonnier deformity (flexion at PIP with hyperextension at DIP) Z thumb

Question 39

What are ganglion cysts?

Answer 39

common mucinous filled cysts adjacent to tendon or synovial joint

Question 40

What is a ganglion cyst in the knee?

Answer 40

Baker's cyst

Question 41

What do ganglion cysts feel like?

Answer 41

firm, smooth, rubbery, should transilluminate