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CORTEXT > CORTEXT 4 - Upper limb > Flashcards

CORTEXT 4 - Upper limb Flashcards

1
Q

Rotator cuff muscles

A

Supraspinatous
Infraspinatous
Subscapularis
Teres minor

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2
Q

Common shoulder problems relating to age

A 
Young = Instability 
Middle = Rotator cuff tears (grey hair, cuff tear)
Old = Glenohumeral OA
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3
Q

Impingement syndrome- what happens?

A

Tendons of the rotator cuff (predominantly supraspinatus) are compressed in the tight acromial space during movement, producing pain

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4
Q

During impingement, at what degrees does the pain hurt most?

A

60-120 degrees

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5
Q

3 cases associated with impingement

A
  1. Tendonitis subacromial bursitis
  2. Acromioclavicular OA with inferior osteophyte
  3. A hooked acromion rotator cuff tear
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6
Q

Mx of Impingement

A

NSAIDS, Analgesics, Physio, Subacromial injections (3 usually needed)
Pain still not away? - Subacromial decompression (creates more space for tendon to pass)

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7
Q

Rotator cuff tear affects which muscle most commonly?

A

Just supraspinatus = partial tear

A large tear can ALSO tear the infraspinatus and subscapularis

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8
Q

Ix & Mx Rotator cuff tear

A

Ix = US or MRI
Mx = (controversial)
Non operative = Physio + Subacromial injections
Operative = Rotator cuff repair with subacromial decompression (doesn’t work on big tears and 1/3 of surgeries fail!)

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9
Q

How is adhesive capsulitis/ ‘frozen shoulder’ characterized?

A

Progressive pain and stiffness of the shoulder in patients between 40 & 60, resolves after 18-24 months

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10
Q

What is the principle clinical sign of frozen shoulder?

A

Loss of external rotation

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11
Q

Mx frozen shoulder

A

Analgesics, physio, subacromial injections, MUA (manipulation under anaesthesia)

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12
Q

Instability: Traumatic

Mx

A

Shoulder may stabilize itself with rest & physio

If not, Bankhart repair needed (reattach the labrum and capsule to anterior glenoid)

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13
Q

Rate of re-dislocation in:

<20 and >30

A 
<20 = 80% re-dislocation 
>30 = 20% re-dislocation
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14
Q

Who are the patients vulnerable to atraumatic instability?

A

Patients with Ehlers-Danlos or Marfans syndrome

i.e. people with ligamentous laxity

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15
Q

Carpal tunnel syndrome causes

A 
Usually idiopathic but is secondary to many conditions including:
RA
Pregnancy 
Diabetes 
Chronic renal failure
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16
Q

Symptoms of carpal tunnel syndrome

A

Parenthesis (burning sensation) of the thumb and radial 2.5 fingers
Symptoms worse at night
Loss of sensation in affected fingers
Weakness of thumb

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17
Q

Carpal tunnel syndrome Mx

A 
Non-operative = wrist splints,  corticosteroid injection
Operative = Carpal tunnel decompression - division of the carpal ligament
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18
Q

Cubital tunnel syndrome - explain

A

Compression of the ulna nerve causing parenthesis (burning sensation) over the ulnar 1.5 fingers

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19
Q

What are the 2 joints within the elbow and what actions do they allow?

A

Humero-ulnar joint (responsible for flexion/extension)

Radio-capitellar joint (responsible for supination and pronation)

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20
Q

Where does the triceps muscle attach and what movement is it primarily used for?

A

Attaches to olecranon process

Powers elbow extension

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21
Q

Where does the brachialis muscle attach and what movement does it produce?

A

Coronoid process

Flexes the elbow

22
Q

Where does the biceps attach and what movement do they produce?

A

The bicipital tuberosity of the radius

Flexes the elbow

23
Q

What muscles are involved in supination?

A

Biceps & Supinator

24
Q

What muscles are involved in pronation?

A

Prorator teres muscle

Pronator quadratus muscle

25
Q

What arises from the medial and lateral epicondyle of the elbow

A

Medial epicondyle = Common flexor origin

Lateral epicondyle = Common extensor origin

26
Q

Is the elbow affected in RA and OA?

A

Affected in RA, rarely affected in OA

27
Q

Tennis elbow - Explain
How it happens
Pathology

A

Lateral Epicondylitis
Repetitive strain injury to those who always perform resisted extension at the wrist
Micro-tears in common extensor origin

28
Q

Tennis elbow symptoms

A

Tender lateral epicondyle

Pain on resisted middle finger and wrist

29
Q

Tennis elbow Mx

A 
Rest from activities that exacerbate the pain 
Physio 
NSAIDS
Steroid injection
Brace 
Surgical treatment = rare
30
Q

Golfer’s elbow- Explain:
How it happens
Mx

A

Medial epicondylitis. Repetitive strain of the common flexor origin
Less common than tennis elbow
Mx = Rest, physio, NSAIDS (injection = high risk of injury to ulnar nerve)

31
Q

If an elbow is really badly affected by RA/OA, what can you do?

A

A total elbow replacement (but they should limit the load they carry to 2.5kg)

32
Q

Pathology behind Dupuytren’s contracture

A

Proliferative connective tissue disorder when specialized palmar fascia undergoes hyperplasia
Proliferation of myofibroblasts & production of abnormal collagen (type 3) rather than type 1

33
Q

Clinical symptoms of Dupuytren’s contracture

A

Fingers are quite contracted

Nodules forming mostly at ring or little finger

34
Q

Who is commonly affected by Dupuytren’s?

A

MEN

Alcoholics (cirrhosis)

35
Q

Mx Dupuytren’s

A 
Fasciectomy = remove all diseased tissue 
Fasciotomy = division of cords 
Severe = amputation
36
Q

What is trigger finger

A

when a flexor tendon of a digit becomes inflamed and it results in a nodule - usually in the A1 pulley

37
Q

Clinical signs of trigger finger

A

Clicking noise when moving the finger and finger may get locked in flexed position

38
Q

Fingers most commonly affected in trigger finger?

A

Ring and middle

39
Q

Mx Trigger Finger

A

Steroid injection around the tendon

In persistent cases - do a surgical incision of the pulley

40
Q

What joint does OA most commonly affect in the hand

A

DIP

41
Q

Clinical signs of OA in the hands

A

Stiffness and bony thickening
Herberden’s nodes (DIP)
Bouchard’s nodes (PIP)
Mucous cyst

42
Q

Mild & Severe Mx for OA

A 
Mild = removal of osteophytes and excision of any mucous cyst 
Severe = arthrodesis
43
Q

Where else can OA affect in the hand?

And what can be done for treatment?

A

1st CMC joint (base of thumb)
Radiocarpal joint of wrist
Mx = Arthroplasty and Fusion

44
Q

RA of the hands:

Where is it found?

A

PIP, NOT DIP

45
Q

Natural history of RA in hands

A
  1. Synovitis and tenosynovitis - inflammation within joints & tendon sheath = pain + swelling
  2. Erosions of the joints
  3. Joint instability & tendon rupture
46
Q

Clinical signs of RA

A

Swan neck
Boutonniere
Z-shaped thumb

47
Q

Mx of RA

A 
DMARDS DMARDS DMARDS !!
Surgical: 
Tenosynovectomy (excision of synovial tendon sheath) 
Soft tissue releases 
MCP/PIP replacements = severe RA
48
Q

Ganglion cyst:
Where in the body are they found and what are they called?
What do they look like?
Mx

A

DIPJ = Mucous cyst
Popliteal fossa = Baker’s cyst
They are firm, smooth, rubbery and tranilluminable
Needle aspiration (but recurrence rate high)
Surgical excision

49
Q

What soft tissue swelling is usually found on the PIPJ

A

Giant cell tumour

50
Q

Symptoms of Giant cell tumour

Mx Giant cell tumour

A

May be painful/painless

Excision to prevent spread and to treat symptoms

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