CORTEXT: upper limb Flashcards
Supraspinatus, infraspinatus and teres minor attach to the _____ _______ of the humerus.
greater tuberosity
Supraspinatus initiates ________, whilst infraspinatus and teres minor are _______ _______
supraspinatus - abduction
infraspinatus and teres minor - external rotation
In Impingement syndrome, the _____ ______ tendons are compressed in the __________ space during movement, causing pain.
rotator cuff tendons
subacromial
Where does impingement pain commonly radiate to?
The deltoid and upper arm
What tests are useful in confirming a diagnosis of impinged shoulder?
Hawkins’-Kennedy test
-internally rotate a flexed shoulder
Painful arc
What conservative treatment is used for impingement syndrome?
NSAIDs and analgesics
Physiotherapy
Subacromial steroid injections (x3)
What age group is most commonly affected by frozen shoulder - adhesive capsulitis?
40-60 year olds
What is a typical history of presenting complaint in frozen shoulder?
- Freezing: initial pain for 2-9 months which subsides
- Frozen: increasing stiffness (4-12 months)
- Thawing: stiffness alleviates shoulder motion is retained
What movement is predominantly lost in Frozen shoulder?
External rotation
The pathology of frozen shoulder is the inflammation, thickening and contraction of the _______ ______ and _________ ligaments, w
shoulder capsule
and
glenohumeral ligaments
Subacromial steroid injections may be used in treatment of frozen shoulder, especially during the painful phase (T/F).
False
-gleno-humeral injections are used
What treatment may relieve the stiffness in frozen shoulder?
- manipulation under anaesthesia
- surgical capsular release (divide the capsule)
A painful condition associated with calcium deposits in the supraspinatus tendon (seen on X-ray) describes….
How is the pain relieved?
Acute calcific tendonitis
Subacromial steroid and local anaesthetic injection
What surgical procedure may be carried out in a young patient with recurrent shoulder dislocation?
Bankart repair
-reattach labrum and capsule to the anterior glenoid (this was torn off during the first dislocation)
Inlfammation of what tendon can cause anterior shoulder pain?
biceps brachii tendon
What is the Popeye deformity?
A bunched biceps muscle due to the rupture of the proxmal biceps tendon
What is a SLAP lesion?
Tear in the glenoid at the attachment point of long biceps tendon.
‘superor labral tear from anterior to posterior’
The carpal tunnels is formed by the _____ bones and the ________ ________
carpal bones and
flexor retinaculum
What nerve passes within the carpal tunnel?
Median nerve
What is carpal tunnel syndrome associated with?
Rheumatoid arthritis
Fluid retention (pregnancy, chronic renal failure, diabetes, hypothyroidism)
Wrist fractures
What are the clinical signs of Carpal tunnel syndrome?
- pins and needles in thumb and raidal 2.5 fingers
- thenar muscle wasting and weakness
What tests can be perfored to aid diagnosis of carpal tunnel syndrome?
Tinel’s test
-percuss over median nerve
Phalen’s test
-hold wrist hyperflexed
What is divided in surgical Carpal tunnel decompression?
Transverse carpal ligament
What are the symptoms of Cubital tunnels syndrome?
Paraesthesia of the ulnar 1.5 fingers
Weakness of:
- 1st dorsal interosseous (abducts index finger)
- adductor pollicis
Tinel’s test may be performed to confirm the diagnosis of Cubital tunnel syndrome. Where should it be performed?
Percussion over the cubital tunnel, behind the medial epicondyle of the humerus
What articulations compose the Elbow joint? What are the movements at each one?
Ulno-humeral joint
-flexion/extension
Radio-capitellar
- supination/ pronation
- between radius and capitullum of humerus
What is the insertion point of triceps brachii?
Olechranon process of the ulna
What is the insertion of the brachialis?
Coronoid process of the ulna
What is the main supinator muscle?
Biceps brachii
_____ ______ proximally and ______ ______distally pronate the forearm.
Pronator teres proximally
Pronator quadratus distally
The common origin of the extensor muscles of the forearm is the _____ ______, whilst the common origin of the flexors of the forearm is the _____ _______
lateral epicodyle
medial epicondyle
Tennis elbow affects the _____ ______
lateral epicondyle
-micro-tears in the common extensor origin
Golfers elbow affects the….
medial epicondyle
What surgery may be performed to treat Rheumatoid Arthritis of the radio-capitellar joint?
Excision of the radial head
Dupuytrens’s contracture is most common in males (T/F)
True
10:1
What may be noted on examination of patient with Dupuytren’s contracture?
Palpable nodules
Puckered skin, adgerent to the disease fascia
Ring and little finger affected
What is Trigger finger?
Tendonitis of a flexor tendon resulting in nedule formation, which catches in the A1 pulley of the tendon sheath.
What treatments are available for trigger finger?
Steroid injection into tendon sheath
Surgical incision of the A1 pulley
What joints in the hands are most commonly affected in OA?
DIP joints
What are Heberden’s nodes?
Bony thickening of DIPJs
What joints are Bouchard nodes present at?
PIPJs
___ joints are spared by Rheumatoid Arthrits.
DIP joints
What is the progression of RA in the hands?
- Synovitis and tenosynovitis
- sweling and pain - Erosion of the joints
- articular cartilage is eroded off by inflammation - Joint instability and tendon rupture
- extensor tendons may rupture
DMARDs are…
disease modifying anti-rheumatoid drugs
What’s Boutonniere deformity?
Flexion at PIPJ with hyperextension at DIPJ
-RA sign
What is Swan neck deformity?
hyperextension at PIPJ with flexion at DIPJ
Mucinous cysts commonly occuring at the wrist describes…
Ganglion cyst
Well circumscirbed tumours, commonly occuring around the PIP joint, with multinucleate giant cells and haemosiderin on histology describes….
Giant cell tumour of the tendon sheath
