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MBChB YR2 MSK > Disease Profiles: Upper Limb Conditions > Flashcards

Disease Profiles: Upper Limb Conditions Flashcards

1
Q

What is medial epicondylitis?

A

Overuse injury of the hand, especially finger flexor tendons which originate in the medial humoral epicondyle

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2
Q

What is a nightstick fracture?

A

Isolated fracture of the ulna shaft

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3
Q

Which patient group is most likely to develop adhesive capsulitis?

A

Age 40-50s, higher incidence in females

Association with diabetes, hypercholesterolaemia and endocrine disease and Dupuytren’s disease

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4
Q

Describe the operative management of a humeral shaft fracture

A

IM nail, ORIF plate fixation

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5
Q

Why may fractures of the distal radius that heal in a poor position (malunion) may result in impaired grip strength?

A

Loss of extension

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6
Q

Describe conservative management of adhesive capsulitis

A

Physio and analgesia

Intra-articular (glenohumeral) steriod injections can help in the painful phase

Fluroscopic distension

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7
Q

Describe the surgical management of De Quervain’s tenosynovitis

A

Surgical decompression

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8
Q

What is a Bennet’s fracture?

A

Fracture of the 1st metacarpal base

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9
Q

Name the directions in which the elbow can dislocate

A

Posterior, anterior, lateral, medial, divergent

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10
Q

Describe the clinical presentation of a proximal humerus fracture

A

Pain and swelling, decreased motion, extensive ecchymosis of chest, arm and forearm

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11
Q

When would you use surgical release in lateral epicondylitis?

A

Refractory cases

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12
Q

What investigations would you perform in a patient with suspected rotator cuff tear who has a good ROM?

A

X-ray, USS

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13
Q

What are the surgical management options for adhesive capsulitis?

A

Manipulation under anaesthetic (tears capsule) or surgical capsular release (divides capsule)

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14
Q

Describe the prognosis of adhesive capsulitis

A

Self limiting - resolves after 18-24 months

Nearly all patients have some residual stiffness and 15% have residual pain

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15
Q

Describe the clinical presentation of extensor pollucis longus rupture

A

Substantial loss of function - can’t extend thumb at MCP/IPJ

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16
Q

Name two potential complications of a Colles fracture

A

Median nerve compression from stretch of the nerve

Bleed into the carpal tunnel

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17
Q

When might you require an open reduction for an interphalangeal joint dislocation?

A

Head of phalynx can button-hole through volar plate, causing volar plate entrapment which blocks closed reduction

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18
Q

Which patient group is most likely to develop paronychnia?

A

Children/YAs, associated with nail biting

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19
Q

Which artery is at risk of damage during an anterior shoulder dislocation?

A

Axillary artery

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20
Q

What is biceps tendinopathy?

A

Inflammation of the long head of the biceps tendon

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21
Q

Describe the management of a distal interphalangeal joint dislocation

A

Closed reduction +/- splinting

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22
Q

Describe the clinical presentation of De Quervain’s tenosynovitis

A

Repetitive strain injury with pain over the radial styloid process at the wrist, pain often radiates proximally into the forearm, wrist usually swollen and can be red

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23
Q

Define an inferior shoulder dislocation

A

Humeral head inferior to glenoid

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24
Q

Describe the clinical presentation of radius and ulna shaft fractures

A

Pain and swelling, loss of forearm and hand function, gross deformity

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25
Q

Describe the conservative management of a supracondylar fracture

A

Cast

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26
Q

Describe the clinical presentation of flexor tendon injuries

A

Loss of active flexion strength or motion of the involved digits

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27
Q

Which nerve is most commonly injured in a humeral shaft fracture?

A

Radial nerve

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28
Q

How can scapular musculature weakness lead to shoulder impingement?

A

A reduction in function of the scapular muscles may result in a reduction in the size of the subacromial space

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29
Q

Describe the post reduction management of a shoulder dislocation

A

Analgesia, stabilisation for 2-3 weeks, rehab with early mobilisation and physio

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30
Q

Describe the clinical presentation of adhesive capsulitis

A

Gradual severe anterior shoulder pain at night and at rest, stiffness

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31
Q

What special tests would you use in examining a patient with suspected impingement syndrome/rotator cuff tendonitis?

A

Hawkins-Kennedy, Jobe’s, painful arc

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32
Q

Describe the management of a Boxer’s fracture

A

‘Buddy strap’, early mobilisation

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33
Q

What is the usual mechanism of action for a supracondylar fracture

A

One of the most common traumatic fractures see in children, commonly due to a fall on outstretched hand

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34
Q

When might a Bennet’s fracture require surgical repair?

A

Fracture can extend into the first carpometacarpal joint leading to instability and subluxation of the joint - if not resolved can cause arthritis of CMC joint

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35
Q

Describe the examination findings in shoulder instability

A

Abnormal shoulder contour, muscle wasting, tenderness, muscle spasm, scapular winging

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36
Q

How would you manage a nailbed injury where the fingertip is not available?

A

Terminalise the finger or perform a V-Y flap

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37
Q

When may you consider nerve conduction studies in suspected lateral epicondylitis?

A

If there are any nerve symptoms

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38
Q

Which nerve is at risk of damage during an anterior shoulder dislocation and how would you assess for damage?

A

Regimental badge area sensory assessment to assess axillary nerve

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39
Q

Describe the pathophysiology of trigger finger

A

Stenosing tenosynovitis (tendon swelling) → irritation → fibrocartilaginaginous metaplasia (more swelling) → nodule on FDS tendon

Nodule results in the loss of smooth gliding of the finger flexor tendons under the annular pully, so finger gets locked in flexed position

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40
Q

What causes lateral epicondylitis?

A

Most commonly due to repeated or excessive pronation/supination and extension of the wrist, which causes micro-tears in the common extensor origin

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41
Q

Name the three contributing factors for the development of Dupuytren’s contracture

A

Genetic predisposition, environmental factors, local and global protein expression

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42
Q

Describe the surgical management of a scaphoid fracture

A

Percutanous screw fixation, ORIF

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43
Q

What special tests would you perform in suspected carpal tunnel syndrome?

A

Tinel’s test, Phalen’s test

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44
Q

Why should you perform a repeat x-ray in 10 days, or an MRI scan, if you suspect a scaphoid fracture but initial x-ray is negative?

A

Scaphoid fractures can be invisible on initial x-ray

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45
Q

What is Dupuytren’s diathesis?

A

Severe form of Dupuytrens involving little and ring fingers, Lederhosen’s (superficial fibromatosis of the foot) and Peyronie’s (superficial fibromatosis of the penis)

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46
Q

What special tests would you use in examining a patient with suspected rotator cuff tear?

A

Jobe’s test, infraspinatus, subscapularis

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47
Q

What causes carpal tunnel syndrome?

A

Swelling of the carpal tunnel - mostly idiopathic, can occur secondary to many conditions

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48
Q

Describe the management of extensor pollucis longus synovitis

A

Synovectomy to help prevent rupture

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49
Q

Describe the surgical management for a distal radius fracture

A

ORIF or MUA and K-wires or external fixation

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50
Q

What investigations would you perform for a suspected scaphoid fracture?

A

X-ray - AP, lateral, two obliques

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51
Q

Outline the pathophysiology of adhesive capsulitis

A
  1. Freezing stage - minimal synovitis with pain, pain limits ROM
  2. Frozen stage - pain decreases, proliferative synovitis and contraction/adhesion of shoulder joint increases
  3. Thawing stage - inflammation decreases, movement slowly improves
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52
Q

What special test would you perform in suspected De Quervain’s tenosynovitis?

A

Finklestein’s test

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53
Q

What are Kanavel’s cardinal signs used for?

A

Identifying flexor tendon sheath infection

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54
Q

Describe the conservative management of Dupuytren’s contracture

A

Observation, stretches, activity modification

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55
Q

How would you manage an degenerative rotator cuff tear?

A

Physio (anterior deltoid strengthening), subacromial injections, wait and see approach

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56
Q

Describe the pathophysiology of Dupuytren’s contracture

A

Excessive myofibroblast proliferation and altered collagen matrix composition leads to thickened and contracted palpar fascia

Avascular process involving O2 free radicals

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57
Q

What is the usual mechanism of action for a sole radial head dislocation in a child?

A

Pulled elbow

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58
Q

How do you manage a type 3 nailbed injury?

A

Repair nail bed and stabilise bone

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59
Q

Describe the histology of Dupuytren’s contracture

A

Firm grey-white tissue, nodules and fascicles, bland fibroblasts, dense collagen

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60
Q

What is a flexor tendon sheath infection?

A

Infection within tendon sheath, tracking up palm and arm

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61
Q

Describe the conservative management of medial epicondylitis

A

Rest, NSAIDs, physio, injection of LA and steroids

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62
Q

What is a Galaezzi fracture?

A

Distal radial shaft fracture and dislocation of the radial head

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63
Q

Describe the immediate management of an anterior shoulder dislocation

A

Analgesia and sedation, O2

Reduction by manipulation

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64
Q

Which investigation would you perform in suspected cubital tunnel syndrome?

A

Nerve conduction studies

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65
Q

What special test would you perform in suspected Dupuytren’s contracture?

A

Table-top test

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66
Q

When might you require fusion for an interphalangeal joint dislocation?

A

If presentation is delayed, the articular surface can degenerate making reduction impossible

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67
Q

Describe the examination findings in lateral epicondylitis

A

Flex elbow to 90° in pronation, pain on resisted middle finger and wrist extension

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68
Q

Describe the clinical presentation of a distal radius fracture

A

Wrist pain, swelling and deformity

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69
Q

Describe the examination findings in a Bennet’s fracture

A

Swelling and ecchymosis, tenderness to palpation at CMC joint, pain with motion

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70
Q

Describe the operative management of a supracondylar fracture

A

Closed/open reduction and percutaneous pinning

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71
Q

What special tests would you use in examining a patient with suspected shoulder instability?

A

RC strength, apprehension, relocation, general laxity

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72
Q

Describe the conservative management of a radius/ulna shaft fracture

A

Cast

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73
Q

How can degenerative tendinopathy lead to shoulder impingement?

A

Degenerative changes of the acromion can lead to tearing of the rotator cuff, which allows for proximal migration of the humeral head

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74
Q

Which investigation would you perform in suspected humeral shaft fracture?

A

X-ray - AP and lateral

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75
Q

What is the usual mechanism of injury for proximal humerus fracture?

A

Typically low energy of osteoporotic bone from a fall

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76
Q

Which medication has been linked to the development of Dupuytren’s contracture?

A

Epileptic medication

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77
Q

What causes a flexor tendon sheath infection?

A

Direct from penetrating trauma e.g. knife wound

Haematogenous spread e.g. from dental infection

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78
Q

Which region of the proximal humerus is usually involved in a fracture?

A

Surgical neck

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79
Q

What is De Quervain’s tenosynovitis?

A

Inflammation of the tendon sheaths within the first compartment - contains APL and EPB

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80
Q

What is a type 3 nailbed injury?

A

Soft tissue and nail and bone

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81
Q

How can a rotator cuff tear lead to shoulder OA?

A

The torn rotator cuff will mean the deltoid pulls the head of humerus upwards, resulting in abnormal forces on glenoid

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82
Q

Describe the examination findings of a patient with Dupuytren’s contracture

A

Palpate cords, reduced angle of MCP/PIP joints

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83
Q

What causes a degenerative rotator cuff tear?

A

Wearing down over time

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84
Q

List the structures which pass through the carpal tunnel

A

Median nerve, 9 flexor tendons (4 x FDS, 4 x FDP, 1 x FPL)

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85
Q

What is lateral epicondylitis commonly known as?

A

Tennis elbow

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86
Q

Describe the surgical management of Dupuytren’s contracture

A

Needle fasioctomy (single band), limited fasciectomy (removal of the bands) dermofasciectomy + graft (removal of the band, adherent/contracted skin and covering graft)

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87
Q

Describe the examination findings in impingement syndrome/rotator cuff tendonitis

A

Tenderness below the lateral edge of the acromion (+ special tests)

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88
Q

What investigations would you perform in suspected flexor tendon sheath infection

A

X-rays, culture of drainage/surgical sample

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89
Q

How would you investigate carpal tunnel syndrome?

A

Questionnaire to stratify for nerve conduction study

Nerve conduction studies - slowing of conduction across the wrist

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90
Q

When would you perform an MRI for a distal radius fracture?

A

Indicated in evaluaton of soft tissue injury

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91
Q

Describe the clinical presentation of carpal tunnel syndrome

A

Parathesiae in the median nerve innervated digits (thumb and radial 3½ fingers) which is usually worse at night, loss of sensation and sometimes weakness of the thumb, pain relieved by shaking the hand, clumsiness in areas of hand supplied by median nerve

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92
Q

What is the mechanism of injury for an interphalangeal joint dislocation?

A

Hyperextension injury; direct axial blow

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93
Q

What is shoulder impingement?

A

Refers to the inflammation and irritation of the rotator cuff tendons as they pass through the subacromial space, resulting in pain, weakness, and reduced range of motion within the shoulder

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94
Q

What investigation would you perform in a suspected Boxer’s fracture?

A

X-ray - AP, lateral, oblique

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95
Q

Describe the conservative management of trigger finger

A

Can resolve spontaneously, may require splint to prevent flexion, steriod + LA tendon sheath injection is often curative

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96
Q

Describe the examination findings in a supracondylar fracture

A

Gross deformity, swelling, ecchymosis, limited active elbow motion

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97
Q

Which patient group is most likely to develop shoulder impingement?

A

Patients under 25 years, typically in active/athletic individuals or in manual professions

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98
Q

What is the posterior fat pad sign?

A

Lucency on a lateral view along the posterior distal humerus and olecranon fossa is highly suggestive of occult fracture around the elbow

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99
Q

What is a Colles fracture?

A

Extra‐articular fracture of the distal radius within an inch of the articular surface and with dorsal displacement or angulation

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100
Q

Describe the clinical presentation of shoulder instability

A

Atraumatic laxity/subluxations, not painful

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101
Q

What special tests would you use in examination of a patient with suspected cubital tunnel syndrome?

A

Tinel’s test, Froment’s test (weakness of adductor pollicis), weakness in abduction of index finger (1st dorsal interosseous)

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102
Q

Which nerve is most commonly injured in a proximal humerus fracture?

A

Axillary nerve

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103
Q

Describe the conservative management of lateral epicondylitis

A

Rest, physio, injection of LA and steriods, brace (elbow clasp)

104
Q

What is adhesive capsulitis (frozen shoulder)?

A

Inflammation and fibrosis of the joint capsule leading to contracture of the shoulder joint

105
Q

Why are older patients more likely to sustain a rotator cuff tear?

A

The tendons of the rotator cuff can tear with minimal or no trauma as a consequence of degenerate changes in the tendons

106
Q

Which patient group is most likely to develop De Quervain’s tenosynovitis?

A

Females 30-50 years, associated with pregnancy and RA

107
Q

Which patient group is most likely to develop trigger finger?

A

More common in females, typically age 50+, more common in diabetics

108
Q

Describe the surgical management of trigger finger

A

Division of the A1 pulley under general or local anaethetic

109
Q

Describe the conservative management for cubital tunnel syndrome

A

NSAIDs, activity modification, nighttime elbow extension splinting

110
Q

Describe the clinical presentation of cubital tunnel syndrome

A

Paraesthesiae in the ulnar 1½ fingers, night symptoms (caused by sleeping with the arm in flexion)

111
Q

Describe the management of a non-congruent mallet finger

A

Reduce the joint and fixate with K wires or screws

112
Q

What is the most common mechanism of injury for scaphoid fractures?

A

Fall on outstretched hand - most frequently fractured carpal bone

113
Q

Describe the surgical management of flexor tendon injuries

A

Flexor tendon repair/reconstruction/transfer

114
Q

Describe the conservative management of flexor tendon injuries

A

Wound care, early ROM

115
Q

Describe the management of extensor pollucis longus rupture

A

Tendon transfer (EIP)

116
Q

What is a type 5 nailbed injury?

A

Proximal to DIP

117
Q

Which investigation would you perform in a suspected supracondylar fracture

A

X-ray - AP and lateral

118
Q

Describe the management of paronychnia

A

Elevate, antibiotics, incise and drain pus collection

119
Q

What is a Monteggia fracture?

A

Proximal 1/3 of the ulna fracture and dislocation of the radial head

120
Q

Which neurovascular structures are at risk of damage following a supracondylar fracture?

A

Brachial artery, median nerve

121
Q

Why are commonly radius and ulnar fractures found together?

A

Radius and ulnar are connected by the proximal and distal radioulnar joints - form a ring

122
Q

When would you perform a CT for a distal radius fracture?

A

To evaluate intra-articular involvement - indicated in surgical planning

123
Q

What is the mechanism of injury for an anterior shoulder dislocation?

A

Fall with shoulder in external rotation - traumatic or sporting injury

124
Q

What is the usual mechanism of injury for a Bennet’s fracture?

A

Axial force applied to the thumb in flexion (forced hyperabduction)

125
Q

Describe the clinical presentation of trigger finger

A

Pain over A1 pulley (MC head), sticking of finger usually in flexion

126
Q

Which investigation would you perform for a suspected Bennet’s fracture?

A

X-ray - AP and lateral

127
Q

What investigation would you perform in suspected radius/ulna shaft fracture?

A

X-ray - AP and lateral

128
Q

Describe the management of a congruent mallet finger

A

Mallet splint for 6 weeks (24/7)

129
Q

What investigation would you perform in suspected biceps tendinopathy?

A

USS

130
Q

Which patient group is most likely to sustain a rotator cuff tear?

A

Older patients (> 40 years)

131
Q

When may you consider USS or MRI in suspected lateral epicondylitis?

A

If diagnosis is uncertain

132
Q

Describe the operative management of a proximal humerus fracture

A

ORIF, replacement

133
Q

Describe the surgical management of lateral epicondylitis

A

Involves division and/or excision of some of the fibres of common extensor mechanism

134
Q

Describe the clinical presentation of medial epicondylitis

A

Medial elbow pain with a tender point over the origin of the flexors at the medial epicondyle, pain aggravated by wrist flexion, pronation, and grasping (e.g. a opening a jar)

135
Q

What is a Smith fracture?

A

Volarly displaced or angulated extra‐articular fracture of the distal radius which usually occurs after falling onto the back of a flexed wrist

136
Q

Why is management of atraumatic shoulder instability difficult?

A

Soft tissue procedures may not work

137
Q

What is a risk of surgical repair in biceps tendinopathy?

A

High risk of neurovascular complications

138
Q

Describe the management of a proximal interphalangeal joint dislocation

A

Closed reduction and buddy taping (or splinting)

139
Q

When is surgical management for adhesive capsulitis indicated?

A

Once the pain has settled, if the patient cannot tolerate functional loss due to stiffness

140
Q

Which is the most common joint dislocation?

A

Shoulder

141
Q

What is subacromial bursitis?

A

In more severe cases of rotator cuff tendonitis, there may be calcification of the tendon, and associated subacromial bursitis → subacromial bursa also becomes inflamed

142
Q

What causes the painful arc in impingement syndrome/rotator cuff tendonitis?

A

Pain occurs between roughly 60 to 120 degrees of abduction as an inflamed area of supraspinatus tendon passes though the subacromial space

143
Q

What is the mechanism of injury for an inferior shoulder dislocation?

A

Shoulder forced into hyperabduction

144
Q

How can anatomical factors lead to shoulder impingement?

A

Congenital or acquired anatomical variations in the shape and gradient of the acromion

145
Q

Define an anterior shoulder dislocation

A

Humeral head is anterior to glenoid

146
Q

Describe the conservative management for a distal radius fracture

A

Cast

147
Q

Describe the clinical presentation of a humeral shaft fracture

A

Pain, extremity weakness

148
Q

In Neer’s classification, what is type III shoulder impingement?

A

Partial/full thickness tears and degeneration of rotator cuff >40 years

149
Q

Name two features commonly observed in an x-ray of a supracondylar fracture

A

Humerocapitellar misalignment, posterior fat pad sign

150
Q

What is the usual mechanism of action for an elbow dislocation?

A

Fall onto outstretched hand

151
Q

Describe the conservative management of De Quervain’s tenosynovitis

A

Splint, rest, physio, analgesics, steroid injection

152
Q

What causes cubital tunnel syndrome?

A

Compression can be due to a tight band of fascia forming the roof of the tunnel (Osborne’s fascia) or due to tightness at the intermuscular septum as the nerve passes through or between the two heads at the origin of flexor carpi ulnaris

153
Q

Why does a scaphoid fracture predispose to non-union, AVN and early wrist OA?

A

Scaphoid has a retrograde blood supply - waist and proximal scaphoid fractures can severely disrupt the blood supply

154
Q

Describe the clinical presentation of a rotator cuff tear

A

Pain in front of shoulder that radiates down arm, associated weakness

155
Q

What is a type 4 nailbed injury?

A

Proximal 1/3 of phalynx

156
Q

What is a subingual haematoma?

A

Localized bleeding outside of blood vessels underneath the nail plate

157
Q

Describe the clinical presentation of a shoulder dislocation

A

Severe shoulder pain, inability to move shoulder, empty glenoid fossa may be visible

158
Q

What is a type 2 nailbed injury?

A

Soft tissue and nail

159
Q

Which patient group is most likely to develop Dupuytren’s contracture?

A

Males 40-60, link to trauma (e.g. from manual labour) and ischaemic injury (e.g. smoking, diabetes)

160
Q

When would you use surgical release in medial epicondylitis?

A

Refractory cases

161
Q

Describe the clinical presentation of shoulder impingement/rotator cuff tendonitis

A

Progressive pain in the anterior superior shoulder that radiates to deltoid and upper arm

Difficulty sleeping on affected side, reaching overhead and lifting

162
Q

How can overuse of the shoulder lead to shoulder impingement?

A

Repetitive microtrauma can result in soft tissue inflammation of the rotator cuff tendons and the subacromial bursa

163
Q

Describe the conservative management of carpal tunnel syndrome

A

Wrist splints at night to prevent flexion, corticosteroid injections

164
Q

Name a complication of carpal tunnel decompression

A

Damage to median nerve or one of its smaller branches

165
Q

Describe the management of flexor tendon sheath infection

A

Elevation and high dose antibiotics

Emergency surgery - washout tendon sheath, opening up A1 and A5 pulleys

166
Q

What is zone II with relevance to flexor tendon injuries?

A

Zone from FDS insertion (just distal to PIP joint) to the A1 pulley

Injuries in this region are very difficult to treat

167
Q

How do you manage a type 1 and 2 nailbed injury?

A

Dressing only

168
Q

What can cause biceps tendinopathy?

A

Overuse, instability, impingement or trauma

169
Q

How do you manage a type 4 nailbed injury?

A

Repair nail bed and stabilise bone

If there is <5mm of nail bed remaining - ablate

170
Q

What percentage of over 60 year olds have asymptomatic rotator cuff tears due to tendon degeneration?

A

At least 20%

171
Q

Which neurovascular structures are at risk in radius and ulna shaft fractures?

A

Radial and ulnar arteries

Median, radial and ulnar nerve function

172
Q

Define shoulder instability

A

Painful abnormal translational movement or subluxation and/or recurrent dislocation

173
Q

Describe the clinical presentation of Dupuytren’s contracture

A

Usually starts as palmar pit/nodule

Flexion contracture of affected fingers, 4th and 5th fingers are the most commonly involved

174
Q

How can muscular weakness lead to shoulder impingement?

A

Weakness in rotator cuff muscles can lead to the humerus shifting proximally towards the body

175
Q

Describe the clinical presentation of a Bennet’s fracture

A

Acute pain at base of thumb

176
Q

Why might you perform a CT in a proximal humerus fracture?

A

If needed for pre-op planning

177
Q

Why might you perform an MRI in a proximal humerus fracture?

A

Sometimes used to identify associated rotator cuff injury

178
Q

Name the main risk factor for recurrent shoulder instability following a traumatic anterior dislocation

A

Age - risk of recurrence decreases with age

179
Q

What is Dupuytren’s Contracture?

A

Superficial fibromatosis that starts in the hand

180
Q

Describe the surgical management of a radius/ulna shaft fracture

A

ORIF

181
Q

What is mallet finger?

A

An avulsion of the extensor tendon from the distal phalynx resulting in inability to actively extend the DIPJ (flexion deformity)

182
Q

Describe the clinical presentation of flexor tendon sheath infection

A

Extremely painful palm and arm, limited extension due to pain

183
Q

Describe the operative management for cubital tunnel syndrome

A

Surgical release of tight structures

184
Q

In Neer’s classification, what is type I shoulder impingement?

A

Inflammation, oedema and haemorrhage <25 years

185
Q

What is the mechanism of injury for radius and ulnar shaft fractures?

A

Common fracture of the forearm caused by direct or indirect trauma

186
Q

What investigations would you perform in suspected De Quervain’s tenosynovitis?

A

USS and x-ray to rule out CMC joint OA which can mimic DQ

187
Q

In Neer’s classification, what is type II shoulder impingement?

A

Fibrosis and tendonitis bursa/cuff 25-40 years

188
Q

Describe the surgical management of shoulder OA secondary to a rotator cuff tear

A

Reverse polarity shoulder replacement (anatomic shoulder replacement will fail)

189
Q

Describe the examination findings in biceps tendinopathy

A

Tenderness to palpation of the long head of biceps tendon

Tendon tear - ‘Pop-eye’ sign, extensive bruising

190
Q

What is a type 1 nailbed injury?

A

Soft tissue only

191
Q

What is the mechanism of injury for a posterior shoulder dislocation?

A

Fall with shoulder in anterior location or direct blow to anterior shoulder - usually associated with seizures (epileptic fit, electrocution)

192
Q

What is carpal tunnel syndrome?

A

Peripheral neuropathy caused by acute or chronic compression of the median nerve by the transverse carpal ligament

193
Q

List the conditions which can cause carpal tunnel syndrome

A

RA, acromegaly, conditions involving fluid retention (pregnancy, diabetes, renal failure), fractures around the wrist

194
Q

List Kanavel’s cardinal signs

A

Affected finger held in fixed flexion

Fusiform swelling over finger

Painful to percuss over sheath

Painful on passive extension

195
Q

Describe the conservative management of a proximal humerus fracture

A

Collar and cuff

196
Q

Describe the clinical presentation of lateral epicondylitis

A

Pain and tenderness over the lateral epicondyle to the attachment of the forearm, pain is worse when stretching muscles e.g. opening a jar

197
Q

Describe the conservative management of a humeral shaft fracture

A

Humeral brace, U-slab cast

198
Q

Describe the clinical presentation of a Boxer’s fracture

A

Dorsal hand pain, swelling, possible deformity

199
Q

What is the most common mechanism of injury for distal radius fractures?

A

Fall on outstretched hand

200
Q

Describe the examination findings of a distal radius fracture

A

Ecchymosis and swelling, diffuse tenderness, motion limited by pain

201
Q

Describe the surgical management of carpal tunnel syndrome

A

Carpal tunnel decompression - division of the transverse carpal ligament under local anaesthetic

202
Q

What is cubital tunnel syndrome?

A

Involves compression of the ulnar nerve at the elbow behind the medial epicondyle (‘funny bone’ area)

203
Q

What investigations would you perform in a patient with suspected rotator cuff tear who has reduced ROM?

A

X-ray, MRI

204
Q

Describe the conservative management of biceps tendinopathy

A

Physio, consider corticosteriod injection

205
Q

What is paronychnia?

A

Infection within the nail fold

206
Q

What is trephine?

A

Used to treat painful subingual haematoma - small hole pierced in the thick collagen of the nail plate which allows the haematoma under pressure to drain

207
Q

What is a Boxer’s fracture?

A

Fracture of the 5th metacarpal neck

208
Q

Which rotator cuff muscle is most commonly involved in a rotator cuff tear?

A

Supraspinatus

209
Q

Describe the clinical presentation of an elbow dislocation

A

Pain and swelling over the elbow

210
Q

What is atraumatic shoulder instability?

A

Patients with generalized ligamentous laxity (idiopathic, Ehlers‐Danlos, Marfan’s) can have pain from recurrent multidirectional subluxations or dislocations

211
Q

What is a Barton’s fracture?

A

Intra-articular fracture of the distal radius with dislocation of the radiocarpal joint

212
Q

Name the structures which form the carpal tunnel

A

Carpal bones and the flexor retinaculum

213
Q

Which is the most common type of shoulder dislocation?

A

Anterior dislocation (95%)

214
Q

What is the usual mechanism of injury for an oblique or spiral humeral shaft fracture?

A

Fall (spiral indicates rotation)

215
Q

Describe the examination findings in medial epicondylitis

A

Flex elbow to 90° in supination, pain produced when wrist flexed against resistance

216
Q

What is medial epicondylitis commonly known as?

A

Golfer’s elbow

217
Q

Describe the clinical presentation of a supracondylar fracture

A

Pain, refusal to move elbow

218
Q

Describe the examination findings in carpal tunnel syndrome

A

Demonstrable loss of sensation and/or muscle wasting of the thenar eminence (with chronic severe cases) - examine LOAF muscles especially APB

219
Q

Describe the clinical presentation of interphalangeal joint dislocation

A

Pain and deformity of the affected digit

220
Q

What is lateral epicondylitis?

A

Overuse injury of the hand, especially finger extensor tendons which originate in the lateral humeral epicondule

221
Q

What investigations would you perform in a suspected distal radius fracture?

A

X-ray - AP, lateral, oblique

222
Q

Describe the examination findings in a rotator cuff tear

A

Wasting of supraspinatus

Tenderness in subdeltoid region

223
Q

Describe the examination findings of trigger finger

A

Demonstrate triggering, tenderness over A1 pulley, feel nodule pass beneath pulley

224
Q

Describe the clinical presentation of biceps tendinopathy

A

Pain anterior shoulder radiating to elbow, pain aggrevated by shoulder flexion, forearm pronation and elbow flexion

Snapping with shoulder movements if subluxation

225
Q

Describe the examination findings in adhesive capsulitis

A

Global restriction in ROM, especially in external rotation (<50% of normal)

226
Q

Which investigation would you perform in suspected proximal humerus fracture?

A

X-ray - AP and lateral

227
Q

How can glenohumeral instability lead to shoulder impingement?

A

Can lead to superior subluxation of the humerus, causing an increased contact between the acromion and subacromial tissues

228
Q

What investigations would you perform in suspected flexor tendon injuries?

A

X-ray to assess for associated fracture US to assess suspected lacerations

229
Q

What causes shoulder impingement in the older population?

A

Secondary to degenerative changes or acromioclavicular bony changes

230
Q

Why does an inferior shoulder dislocation require prompt neurovascular assessment and reduction?

A

Proximity to brachial plexus

231
Q

How would you manage an acute rotator cuff tear?

A

Early physio, reassessment and surgical intervention (repair of rotator cuff)

232
Q

Describe the conservative management of a scaphoid fracture

A

Cast

233
Q

Describe the management of elbow dislocation

A

Reduction - traction in extension +/- pressure over olecranon (usually closed)

2 weeks in sling and rehab

234
Q

Name two fractures which may occur due to an elbow dislocation

A

Radial head fractures and coronoid process fractures

235
Q

Why should you always obtain an oblique view in an x-ray for suspected posterior shoulder dislocation?

A

When the humerus dislocates posteriorly, the lack of displacement makes it difficult to appreciate on an AP x-ray

236
Q

What investigations would you perform in a suspected shoulder dislocation?

A

X-ray - AP shoulder and Garth views (apical oblique)

MRI angiogram

237
Q

What is the usual mechanism of injury for a Boxer’s fracture?

A

Usually caused by a clenched fist striking a hard object

238
Q

What is trigger finger?

A

Inhibition of smooth tendon gliding due to mechanical impingement at the level of the A1 pulley that causes progressive pain, clicking catching and locking of the affected finger

239
Q

Describe the clinical presentation of paronychnia

A

Inflammation and redness around the fingertip, may result in pus collection

240
Q

When might you require additional fixation for an interphalangeal joint dislocation?

A

If associated fracture renders the joint unstable

241
Q

What causes the fixed flexion deformity in Dupuytren’s contracture?

A

Thickening and contracture of subdermal fascia

242
Q

What is a Bankart repair?

A

Stabilises an unstable shoulder caused by traumatic anterior dislocation

Reattaches the labrum and capsule to the anterior gleniod which was torn off in the in the first dislocation

243
Q

Describe the management of a chronic mallet finger (3 months +)

A

Dermatotenodesis

244
Q

Describe the clinical presentation of a scaphoid fracture

A

Pain in the anatomical snuffbox

245
Q

Which type of collagen primarily forms the bands in Dupuytren’s contracture?

A

Type III collagen

246
Q

Which patient group is most likely to develop carpal tunnel syndrome?

A

Women (8x more likely)

247
Q

What is the usual mechanism of injury for a transverse or comminuted humeral shaft fracture?

A

Direct trauma to the arm (e.g. RTC)

248
Q

What is rotator cuff tendontitis?

A

Repeated impingement of the rotator cuff results in inflammation or damage of the rotator cuff tendons

249
Q

What causes medial epicondylitis?

A

Repetitive strain or degeneration of the common flexor origin

250
Q

Describe the examination findings of a Boxer’s fracture

A

Distal part of the fracture is displaced anteriorly, producing a shortening of the affected finger

251
Q

Which direction do interphalangeal joints almost always dislocate in?

A

Posteriorly

252
Q

Define a posterior shoulder dislocation

A

Humeral head posterior to glenoid

253
Q

What causes an acute rotator cuff tear?

A

Fall on outstretched arm, sudden jerk (e.g. holding a rail on a bus which suddenly stops)

254
Q

Describe the clinical presentation of mallet finger

A

Tenderness/bruising, no resisted finger extension on examination

255
Q

Which age group is most likely to dislocate their shoulder?

A

Younger patients (teen - 30 years), sporty

256
Q

Describe the surgical management of a Bennet’s fracture

A

The thumb is surgically reduced onto a bony fragment left behind on the volar beak ligament following fracture and fixed, commonly with K wires

257
Q

Name two common causes of extensor pollucis longus rupture

A

RA, Colles fracture

MBChB YR2 MSK (36 decks)

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