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
2
Q
What is a nightstick fracture?
A
Isolated fracture of the ulna shaft
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
4
Q
Describe the operative management of a humeral shaft fracture
A
IM nail, ORIF plate fixation
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
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
7
Q
Describe the surgical management of De Quervain’s tenosynovitis
A
Surgical decompression
8
Q
What is a Bennet’s fracture?
A
Fracture of the 1st metacarpal base
9
Q
Name the directions in which the elbow can dislocate
A
Posterior, anterior, lateral, medial, divergent
10
Q
Describe the clinical presentation of a proximal humerus fracture
A
Pain and swelling, decreased motion, extensive ecchymosis of chest, arm and forearm
11
Q
When would you use surgical release in lateral epicondylitis?
A
Refractory cases
12
Q
What investigations would you perform in a patient with suspected rotator cuff tear who has a good ROM?
A
X-ray, USS
13
Q
What are the surgical management options for adhesive capsulitis?
A
Manipulation under anaesthetic (tears capsule) or surgical capsular release (divides capsule)
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
15
Q
Describe the clinical presentation of extensor pollucis longus rupture
A
Substantial loss of function - can’t extend thumb at MCP/IPJ
16
Q
Name two potential complications of a Colles fracture
A
Median nerve compression from stretch of the nerve
Bleed into the carpal tunnel
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
18
Q
Which patient group is most likely to develop paronychnia?
A
Children/YAs, associated with nail biting
19
Q
Which artery is at risk of damage during an anterior shoulder dislocation?
A
Axillary artery
20
Q
What is biceps tendinopathy?
A
Inflammation of the long head of the biceps tendon
21
Q
Describe the management of a distal interphalangeal joint dislocation
A
Closed reduction +/- splinting
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
23
Q
Define an inferior shoulder dislocation
A
Humeral head inferior to glenoid
24
Q
Describe the clinical presentation of radius and ulna shaft fractures
A
Pain and swelling, loss of forearm and hand function, gross deformity
25
Describe the conservative management of a supracondylar fracture
Cast
26
Describe the clinical presentation of flexor tendon injuries
Loss of active flexion strength or motion of the involved digits
27
Which nerve is most commonly injured in a humeral shaft fracture?
Radial nerve
28
How can scapular musculature weakness lead to shoulder impingement?
A reduction in function of the scapular muscles may result in a reduction in the size of the subacromial space
29
Describe the post reduction management of a shoulder dislocation
Analgesia, stabilisation for 2-3 weeks, rehab with early mobilisation and physio
30
Describe the clinical presentation of adhesive capsulitis
Gradual severe anterior shoulder pain at night and at rest, stiffness
31
What special tests would you use in examining a patient with suspected impingement syndrome/rotator cuff tendonitis?
Hawkins-Kennedy, Jobe's, painful arc
32
Describe the management of a Boxer's fracture
'Buddy strap', early mobilisation
33
What is the usual mechanism of action for a supracondylar fracture
One of the most common traumatic fractures see in children, commonly due to a fall on outstretched hand
34
When might a Bennet's fracture require surgical repair?
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
35
Describe the examination findings in shoulder instability
Abnormal shoulder contour, muscle wasting, tenderness, muscle spasm, scapular winging
36
How would you manage a nailbed injury where the fingertip is not available?
Terminalise the finger or perform a V-Y flap
37
When may you consider nerve conduction studies in suspected lateral epicondylitis?
If there are any nerve symptoms
38
Which nerve is at risk of damage during an anterior shoulder dislocation and how would you assess for damage?
Regimental badge area sensory assessment to assess axillary nerve
39
Describe the pathophysiology of trigger finger
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
40
What causes lateral epicondylitis?
Most commonly due to repeated or excessive pronation/supination and extension of the wrist, which causes micro-tears in the common extensor origin
41
Name the three contributing factors for the development of Dupuytren's contracture
Genetic predisposition, environmental factors, local and global protein expression
42
Describe the surgical management of a scaphoid fracture
Percutanous screw fixation, ORIF
43
What special tests would you perform in suspected carpal tunnel syndrome?
Tinel's test, Phalen's test
44
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?
Scaphoid fractures can be invisible on initial x-ray
45
What is Dupuytren's diathesis?
Severe form of Dupuytrens involving little and ring fingers, Lederhosen's (superficial fibromatosis of the foot) and Peyronie's (superficial fibromatosis of the penis)
46
What special tests would you use in examining a patient with suspected rotator cuff tear?
Jobe's test, infraspinatus, subscapularis
47
What causes carpal tunnel syndrome?
Swelling of the carpal tunnel - mostly idiopathic, can occur secondary to many conditions
48
Describe the management of extensor pollucis longus synovitis
Synovectomy to help prevent rupture
49
Describe the surgical management for a distal radius fracture
ORIF or MUA and K-wires or external fixation
50
What investigations would you perform for a suspected scaphoid fracture?
X-ray - AP, lateral, two obliques
51
Outline the pathophysiology of adhesive capsulitis
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
52
What special test would you perform in suspected De Quervain's tenosynovitis?
Finklestein's test
53
What are Kanavel's cardinal signs used for?
Identifying flexor tendon sheath infection
54
Describe the conservative management of Dupuytren's contracture
Observation, stretches, activity modification
55
How would you manage an degenerative rotator cuff tear?
Physio (anterior deltoid strengthening), subacromial injections, wait and see approach
56
Describe the pathophysiology of Dupuytren's contracture
Excessive myofibroblast proliferation and altered collagen matrix composition leads to thickened and contracted palpar fascia
Avascular process involving O2 free radicals
57
What is the usual mechanism of action for a sole radial head dislocation in a child?
Pulled elbow
58
How do you manage a type 3 nailbed injury?
Repair nail bed and stabilise bone
59
Describe the histology of Dupuytren's contracture
Firm grey-white tissue, nodules and fascicles, bland fibroblasts, dense collagen
60
What is a flexor tendon sheath infection?
Infection within tendon sheath, tracking up palm and arm
61
Describe the conservative management of medial epicondylitis
Rest, NSAIDs, physio, injection of LA and steroids
62
What is a Galaezzi fracture?
Distal radial shaft fracture and dislocation of the radial head
63
Describe the immediate management of an anterior shoulder dislocation
Analgesia and sedation, O2
Reduction by manipulation
64
Which investigation would you perform in suspected cubital tunnel syndrome?
Nerve conduction studies
65
What special test would you perform in suspected Dupuytren's contracture?
Table-top test
66
When might you require fusion for an interphalangeal joint dislocation?
If presentation is delayed, the articular surface can degenerate making reduction impossible
67
Describe the examination findings in lateral epicondylitis
Flex elbow to 90° in pronation, pain on resisted middle finger and wrist extension
68
Describe the clinical presentation of a distal radius fracture
Wrist pain, swelling and deformity
69
Describe the examination findings in a Bennet's fracture
Swelling and ecchymosis, tenderness to palpation at CMC joint, pain with motion
70
Describe the operative management of a supracondylar fracture
Closed/open reduction and percutaneous pinning
71
What special tests would you use in examining a patient with suspected shoulder instability?
RC strength, apprehension, relocation, general laxity
72
Describe the conservative management of a radius/ulna shaft fracture
Cast
73
How can degenerative tendinopathy lead to shoulder impingement?
Degenerative changes of the acromion can lead to tearing of the rotator cuff, which allows for proximal migration of the humeral head
74
Which investigation would you perform in suspected humeral shaft fracture?
X-ray - AP and lateral
75
What is the usual mechanism of injury for proximal humerus fracture?
Typically low energy of osteoporotic bone from a fall
76
Which medication has been linked to the development of Dupuytren's contracture?
Epileptic medication
77
What causes a flexor tendon sheath infection?
Direct from penetrating trauma e.g. knife wound
Haematogenous spread e.g. from dental infection
78
Which region of the proximal humerus is usually involved in a fracture?
Surgical neck
79
What is De Quervain's tenosynovitis?
Inflammation of the tendon sheaths within the first compartment - contains APL and EPB
80
What is a type 3 nailbed injury?
Soft tissue and nail and bone
81
How can a rotator cuff tear lead to shoulder OA?
The torn rotator cuff will mean the deltoid pulls the head of humerus upwards, resulting in abnormal forces on glenoid
82
Describe the examination findings of a patient with Dupuytren's contracture
Palpate cords, reduced angle of MCP/PIP joints
83
What causes a degenerative rotator cuff tear?
Wearing down over time
84
List the structures which pass through the carpal tunnel
Median nerve, 9 flexor tendons (4 x FDS, 4 x FDP, 1 x FPL)
85
What is lateral epicondylitis commonly known as?
Tennis elbow
86
Describe the surgical management of Dupuytren's contracture
Needle fasioctomy (single band), limited fasciectomy (removal of the bands) dermofasciectomy + graft (removal of the band, adherent/contracted skin and covering graft)
87
Describe the examination findings in impingement syndrome/rotator cuff tendonitis
Tenderness below the lateral edge of the acromion (+ special tests)
88
What investigations would you perform in suspected flexor tendon sheath infection
X-rays, culture of drainage/surgical sample
89
How would you investigate carpal tunnel syndrome?
Questionnaire to stratify for nerve conduction study
Nerve conduction studies - slowing of conduction across the wrist
90
When would you perform an MRI for a distal radius fracture?
Indicated in evaluaton of soft tissue injury
91
Describe the clinical presentation of carpal tunnel syndrome
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
92
What is the mechanism of injury for an interphalangeal joint dislocation?
Hyperextension injury; direct axial blow
93
What is shoulder impingement?
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
94
What investigation would you perform in a suspected Boxer's fracture?
X-ray - AP, lateral, oblique
95
Describe the conservative management of trigger finger
Can resolve spontaneously, may require splint to prevent flexion, steriod + LA tendon sheath injection is often curative
96
Describe the examination findings in a supracondylar fracture
Gross deformity, swelling, ecchymosis, limited active elbow motion
97
Which patient group is most likely to develop shoulder impingement?
Patients under 25 years, typically in active/athletic individuals or in manual professions
98
What is the posterior fat pad sign?
Lucency on a lateral view along the posterior distal humerus and olecranon fossa is highly suggestive of occult fracture around the elbow
99
What is a Colles fracture?
Extra‐articular fracture of the distal radius within an inch of the articular surface and with dorsal displacement or angulation
100
Describe the clinical presentation of shoulder instability
Atraumatic laxity/subluxations, not painful
101
What special tests would you use in examination of a patient with suspected cubital tunnel syndrome?
Tinel's test, Froment's test (weakness of adductor pollicis), weakness in abduction of index finger (1st dorsal interosseous)
102
Which nerve is most commonly injured in a proximal humerus fracture?
Axillary nerve
103
Describe the conservative management of lateral epicondylitis
Rest, physio, injection of LA and steriods, brace (elbow clasp)
104
What is adhesive capsulitis (frozen shoulder)?
Inflammation and fibrosis of the joint capsule leading to contracture of the shoulder joint
105
Why are older patients more likely to sustain a rotator cuff tear?
The tendons of the rotator cuff can tear with minimal or no trauma as a consequence of degenerate changes in the tendons
106
Which patient group is most likely to develop De Quervain's tenosynovitis?
Females 30-50 years, associated with pregnancy and RA
107
Which patient group is most likely to develop trigger finger?
More common in females, typically age 50+, more common in diabetics
108
Describe the surgical management of trigger finger
Division of the A1 pulley under general or local anaethetic
109
Describe the conservative management for cubital tunnel syndrome
NSAIDs, activity modification, nighttime elbow extension splinting
110
Describe the clinical presentation of cubital tunnel syndrome
Paraesthesiae in the ulnar 1½ fingers, night symptoms (caused by sleeping with the arm in flexion)
111
Describe the management of a non-congruent mallet finger
Reduce the joint and fixate with K wires or screws
112
What is the most common mechanism of injury for scaphoid fractures?
Fall on outstretched hand - most frequently fractured carpal bone
113
Describe the surgical management of flexor tendon injuries
Flexor tendon repair/reconstruction/transfer
114
Describe the conservative management of flexor tendon injuries
Wound care, early ROM
115
Describe the management of extensor pollucis longus rupture
Tendon transfer (EIP)
116
What is a type 5 nailbed injury?
Proximal to DIP
117
Which investigation would you perform in a suspected supracondylar fracture
X-ray - AP and lateral
118
Describe the management of paronychnia
Elevate, antibiotics, incise and drain pus collection
119
What is a Monteggia fracture?
Proximal 1/3 of the ulna fracture and dislocation of the radial head
120
Which neurovascular structures are at risk of damage following a supracondylar fracture?
Brachial artery, median nerve
121
Why are commonly radius and ulnar fractures found together?
Radius and ulnar are connected by the proximal and distal radioulnar joints - form a ring
122
When would you perform a CT for a distal radius fracture?
To evaluate intra-articular involvement - indicated in surgical planning
123
What is the mechanism of injury for an anterior shoulder dislocation?
Fall with shoulder in external rotation - traumatic or sporting injury
124
What is the usual mechanism of injury for a Bennet's fracture?
Axial force applied to the thumb in flexion (forced hyperabduction)
125
Describe the clinical presentation of trigger finger
Pain over A1 pulley (MC head), sticking of finger usually in flexion
126
Which investigation would you perform for a suspected Bennet's fracture?
X-ray - AP and lateral
127
What investigation would you perform in suspected radius/ulna shaft fracture?
X-ray - AP and lateral
128
Describe the management of a congruent mallet finger
Mallet splint for 6 weeks (24/7)
129
What investigation would you perform in suspected biceps tendinopathy?
USS
130
Which patient group is most likely to sustain a rotator cuff tear?
Older patients (\> 40 years)
131
When may you consider USS or MRI in suspected lateral epicondylitis?
If diagnosis is uncertain
132
Describe the operative management of a proximal humerus fracture
ORIF, replacement
133
Describe the surgical management of lateral epicondylitis
Involves division and/or excision of some of the fibres of common extensor mechanism
134
Describe the clinical presentation of medial epicondylitis
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
What is a Smith fracture?
Volarly displaced or angulated extra‐articular fracture of the distal radius which usually occurs after falling onto the back of a flexed wrist
136
Why is management of atraumatic shoulder instability difficult?
Soft tissue procedures may not work
137
What is a risk of surgical repair in biceps tendinopathy?
High risk of neurovascular complications
138
Describe the management of a proximal interphalangeal joint dislocation
Closed reduction and buddy taping (or splinting)
139
When is surgical management for adhesive capsulitis indicated?
Once the pain has settled, if the patient cannot tolerate functional loss due to stiffness
140
Which is the most common joint dislocation?
Shoulder
141
What is subacromial bursitis?
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
What causes the painful arc in impingement syndrome/rotator cuff tendonitis?
Pain occurs between roughly 60 to 120 degrees of abduction as an inflamed area of supraspinatus tendon passes though the subacromial space
143
What is the mechanism of injury for an inferior shoulder dislocation?
Shoulder forced into hyperabduction
144
How can anatomical factors lead to shoulder impingement?
Congenital or acquired anatomical variations in the shape and gradient of the acromion
145
Define an anterior shoulder dislocation
Humeral head is anterior to glenoid
146
Describe the conservative management for a distal radius fracture
Cast
147
Describe the clinical presentation of a humeral shaft fracture
Pain, extremity weakness
148
In Neer's classification, what is type III shoulder impingement?
Partial/full thickness tears and degeneration of rotator cuff \>40 years
149
Name two features commonly observed in an x-ray of a supracondylar fracture
Humerocapitellar misalignment, posterior fat pad sign
150
What is the usual mechanism of action for an elbow dislocation?
Fall onto outstretched hand
151
Describe the conservative management of De Quervain's tenosynovitis
Splint, rest, physio, analgesics, steroid injection
152
What causes cubital tunnel syndrome?
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
Why does a scaphoid fracture predispose to non-union, AVN and early wrist OA?
Scaphoid has a retrograde blood supply - waist and proximal scaphoid fractures can severely disrupt the blood supply
154
Describe the clinical presentation of a rotator cuff tear
Pain in front of shoulder that radiates down arm, associated weakness
155
What is a type 4 nailbed injury?
Proximal 1/3 of phalynx
156
What is a subingual haematoma?
Localized bleeding outside of blood vessels underneath the nail plate
157
Describe the clinical presentation of a shoulder dislocation
Severe shoulder pain, inability to move shoulder, empty glenoid fossa may be visible
158
What is a type 2 nailbed injury?
Soft tissue and nail
159
Which patient group is most likely to develop Dupuytren's contracture?
Males 40-60, link to trauma (e.g. from manual labour) and ischaemic injury (e.g. smoking, diabetes)
160
When would you use surgical release in medial epicondylitis?
Refractory cases
161
Describe the clinical presentation of shoulder impingement/rotator cuff tendonitis
Progressive pain in the anterior superior shoulder that radiates to deltoid and upper arm
Difficulty sleeping on affected side, reaching overhead and lifting
162
How can overuse of the shoulder lead to shoulder impingement?
Repetitive microtrauma can result in soft tissue inflammation of the rotator cuff tendons and the subacromial bursa
163
Describe the conservative management of carpal tunnel syndrome
Wrist splints at night to prevent flexion, corticosteroid injections
164
Name a complication of carpal tunnel decompression
Damage to median nerve or one of its smaller branches
165
Describe the management of flexor tendon sheath infection
Elevation and high dose antibiotics
Emergency surgery - washout tendon sheath, opening up A1 and A5 pulleys
166
What is zone II with relevance to flexor tendon injuries?
Zone from FDS insertion (just distal to PIP joint) to the A1 pulley
Injuries in this region are very difficult to treat
167
How do you manage a type 1 and 2 nailbed injury?
Dressing only
168
What can cause biceps tendinopathy?
Overuse, instability, impingement or trauma
169
How do you manage a type 4 nailbed injury?
Repair nail bed and stabilise bone
If there is \<5mm of nail bed remaining - ablate
170
What percentage of over 60 year olds have asymptomatic rotator cuff tears due to tendon degeneration?
At least 20%
171
Which neurovascular structures are at risk in radius and ulna shaft fractures?
Radial and ulnar arteries
Median, radial and ulnar nerve function
172
Define shoulder instability
Painful abnormal translational movement or subluxation and/or recurrent dislocation
173
Describe the clinical presentation of Dupuytren's contracture
Usually starts as palmar pit/nodule
Flexion contracture of affected fingers, 4th and 5th fingers are the most commonly involved
174
How can muscular weakness lead to shoulder impingement?
Weakness in rotator cuff muscles can lead to the humerus shifting proximally towards the body
175
Describe the clinical presentation of a Bennet's fracture
Acute pain at base of thumb
176
Why might you perform a CT in a proximal humerus fracture?
If needed for pre-op planning
177
Why might you perform an MRI in a proximal humerus fracture?
Sometimes used to identify associated rotator cuff injury
178
Name the main risk factor for recurrent shoulder instability following a traumatic anterior dislocation
Age - risk of recurrence decreases with age
179
What is Dupuytren's Contracture?
Superficial fibromatosis that starts in the hand
180
Describe the surgical management of a radius/ulna shaft fracture
ORIF
181
What is mallet finger?
An avulsion of the extensor tendon from the distal phalynx resulting in inability to actively extend the DIPJ (flexion deformity)
182
Describe the clinical presentation of flexor tendon sheath infection
Extremely painful palm and arm, limited extension due to pain
183
Describe the operative management for cubital tunnel syndrome
Surgical release of tight structures
184
In Neer's classification, what is type I shoulder impingement?
Inflammation, oedema and haemorrhage \<25 years
185
What is the mechanism of injury for radius and ulnar shaft fractures?
Common fracture of the forearm caused by direct or indirect trauma
186
What investigations would you perform in suspected De Quervain's tenosynovitis?
USS and x-ray to rule out CMC joint OA which can mimic DQ
187
In Neer's classification, what is type II shoulder impingement?
Fibrosis and tendonitis bursa/cuff 25-40 years
188
Describe the surgical management of shoulder OA secondary to a rotator cuff tear
Reverse polarity shoulder replacement (anatomic shoulder replacement will fail)
189
Describe the examination findings in biceps tendinopathy
Tenderness to palpation of the long head of biceps tendon
Tendon tear - 'Pop-eye' sign, extensive bruising
190
What is a type 1 nailbed injury?
Soft tissue only
191
What is the mechanism of injury for a posterior shoulder dislocation?
Fall with shoulder in anterior location or direct blow to anterior shoulder - usually associated with seizures (epileptic fit, electrocution)
192
What is carpal tunnel syndrome?
Peripheral neuropathy caused by acute or chronic compression of the median nerve by the transverse carpal ligament
193
List the conditions which can cause carpal tunnel syndrome
RA, acromegaly, conditions involving fluid retention (pregnancy, diabetes, renal failure), fractures around the wrist
194
List Kanavel's cardinal signs
Affected finger held in fixed flexion
Fusiform swelling over finger
Painful to percuss over sheath
Painful on passive extension
195
Describe the conservative management of a proximal humerus fracture
Collar and cuff
196
Describe the clinical presentation of lateral epicondylitis
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
Describe the conservative management of a humeral shaft fracture
Humeral brace, U-slab cast
198
Describe the clinical presentation of a Boxer's fracture
Dorsal hand pain, swelling, possible deformity
199
What is the most common mechanism of injury for distal radius fractures?
Fall on outstretched hand
200
Describe the examination findings of a distal radius fracture
Ecchymosis and swelling, diffuse tenderness, motion limited by pain
201
Describe the surgical management of carpal tunnel syndrome
Carpal tunnel decompression - division of the transverse carpal ligament under local anaesthetic
202
What is cubital tunnel syndrome?
Involves compression of the ulnar nerve at the elbow behind the medial epicondyle ('funny bone' area)
203
What investigations would you perform in a patient with suspected rotator cuff tear who has reduced ROM?
X-ray, MRI
204
Describe the conservative management of biceps tendinopathy
Physio, consider corticosteriod injection
205
What is paronychnia?
Infection within the nail fold
206
What is trephine?
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
What is a Boxer's fracture?
Fracture of the 5th metacarpal neck
208
Which rotator cuff muscle is most commonly involved in a rotator cuff tear?
Supraspinatus
209
Describe the clinical presentation of an elbow dislocation
Pain and swelling over the elbow
210
What is atraumatic shoulder instability?
Patients with generalized ligamentous laxity (idiopathic, Ehlers‐Danlos, Marfan’s) can have pain from recurrent multidirectional subluxations or dislocations
211
What is a Barton's fracture?
Intra-articular fracture of the distal radius with dislocation of the radiocarpal joint
212
Name the structures which form the carpal tunnel
Carpal bones and the flexor retinaculum
213
Which is the most common type of shoulder dislocation?
Anterior dislocation (95%)
214
What is the usual mechanism of injury for an oblique or spiral humeral shaft fracture?
Fall (spiral indicates rotation)
215
Describe the examination findings in medial epicondylitis
Flex elbow to 90° in supination, pain produced when wrist flexed against resistance
216
What is medial epicondylitis commonly known as?
Golfer's elbow
217
Describe the clinical presentation of a supracondylar fracture
Pain, refusal to move elbow
218
Describe the examination findings in carpal tunnel syndrome
Demonstrable loss of sensation and/or muscle wasting of the thenar eminence (with chronic severe cases) - examine LOAF muscles especially APB
219
Describe the clinical presentation of interphalangeal joint dislocation
Pain and deformity of the affected digit
220
What is lateral epicondylitis?
Overuse injury of the hand, especially finger extensor tendons which originate in the lateral humeral epicondule
221
What investigations would you perform in a suspected distal radius fracture?
X-ray - AP, lateral, oblique
222
Describe the examination findings in a rotator cuff tear
Wasting of supraspinatus
Tenderness in subdeltoid region
223
Describe the examination findings of trigger finger
Demonstrate triggering, tenderness over A1 pulley, feel nodule pass beneath pulley
224
Describe the clinical presentation of biceps tendinopathy
Pain anterior shoulder radiating to elbow, pain aggrevated by shoulder flexion, forearm pronation and elbow flexion
Snapping with shoulder movements if subluxation
225
Describe the examination findings in adhesive capsulitis
Global restriction in ROM, especially in external rotation (\<50% of normal)
226
Which investigation would you perform in suspected proximal humerus fracture?
X-ray - AP and lateral
227
How can glenohumeral instability lead to shoulder impingement?
Can lead to superior subluxation of the humerus, causing an increased contact between the acromion and subacromial tissues
228
What investigations would you perform in suspected flexor tendon injuries?
X-ray to assess for associated fracture US to assess suspected lacerations
229
What causes shoulder impingement in the older population?
Secondary to degenerative changes or acromioclavicular bony changes
230
Why does an inferior shoulder dislocation require prompt neurovascular assessment and reduction?
Proximity to brachial plexus
231
How would you manage an acute rotator cuff tear?
Early physio, reassessment and surgical intervention (repair of rotator cuff)
232
Describe the conservative management of a scaphoid fracture
Cast
233
Describe the management of elbow dislocation
Reduction - traction in extension +/- pressure over olecranon (usually closed)
2 weeks in sling and rehab
234
Name two fractures which may occur due to an elbow dislocation
Radial head fractures and coronoid process fractures
235
Why should you always obtain an oblique view in an x-ray for suspected posterior shoulder dislocation?
When the humerus dislocates posteriorly, the lack of displacement makes it difficult to appreciate on an AP x-ray
236
What investigations would you perform in a suspected shoulder dislocation?
X-ray - AP shoulder and Garth views (apical oblique)
MRI angiogram
237
What is the usual mechanism of injury for a Boxer's fracture?
Usually caused by a clenched fist striking a hard object
238
What is trigger finger?
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
Describe the clinical presentation of paronychnia
Inflammation and redness around the fingertip, may result in pus collection
240
When might you require additional fixation for an interphalangeal joint dislocation?
If associated fracture renders the joint unstable
241
What causes the fixed flexion deformity in Dupuytren's contracture?
Thickening and contracture of subdermal fascia
242
What is a Bankart repair?
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
Describe the management of a chronic mallet finger (3 months +)
Dermatotenodesis
244
Describe the clinical presentation of a scaphoid fracture
Pain in the anatomical snuffbox
245
Which type of collagen primarily forms the bands in Dupuytren's contracture?
Type III collagen
246
Which patient group is most likely to develop carpal tunnel syndrome?
Women (8x more likely)
247
What is the usual mechanism of injury for a transverse or comminuted humeral shaft fracture?
Direct trauma to the arm (e.g. RTC)
248
What is rotator cuff tendontitis?
Repeated impingement of the rotator cuff results in inflammation or damage of the rotator cuff tendons
249
What causes medial epicondylitis?
Repetitive strain or degeneration of the common flexor origin
250
Describe the examination findings of a Boxer's fracture
Distal part of the fracture is displaced anteriorly, producing a shortening of the affected finger
251
Which direction do interphalangeal joints almost always dislocate in?
Posteriorly
252
Define a posterior shoulder dislocation
Humeral head posterior to glenoid
253
What causes an acute rotator cuff tear?
Fall on outstretched arm, sudden jerk (e.g. holding a rail on a bus which suddenly stops)
254
Describe the clinical presentation of mallet finger
Tenderness/bruising, no resisted finger extension on examination
255
Which age group is most likely to dislocate their shoulder?
Younger patients (teen - 30 years), sporty
256
Describe the surgical management of a Bennet's fracture
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
Name two common causes of extensor pollucis longus rupture
RA, Colles fracture
