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Musculoskeletal > Elbow and arm orthopaedics, trauma and upper limb compessive neuropathies > Flashcards

Elbow and arm orthopaedics, trauma and upper limb compessive neuropathies Flashcards

1
Q

What is carpal tunnel syndrome?

A

Compression of the median nerve as it passes through the carpal tunnel

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2
Q

What forms the carpal tunnel?

A

The carpal bones and the flexor retinaculum at the wrist

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3
Q

What passes through the carpal tunnel?

A

Median nerve

9 flexor tendons

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4
Q

What can carpal tunnel syndrome be secondary to?

A

Rheumatoid arthritis (synovitis > less space)

Pregnancy

Diabetes

Chronic renal failure

Hypothyroidism

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5
Q

Which fracture in particular can predispose to carpal tunnel syndrome?

A

Colles fracture

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6
Q

How does carpal tunnel syndrome present?

A

Parathesiae in the median nerve innervated digits (thumb and radial 2½ fingers)

Worse at night

Loss of sensation

Weakness of thumb

Clumsiness in areas of hand supplied by median nerve

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7
Q

What signs on examination would indicate carpal tunnel syndrome?

A

In severe cases, thenar muscle wasting

Symptoms reproduced by Tinels test

Symptoms reproduced by Phalen’s test, holding the wrists hyper‐flexed (which decreases space in the carpal tunnel)

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8
Q

What test can confirm the diagnosis of carpal tunnel syndrome?

A

Nerve conduction testing
Shows slowed conduction across the wrist

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9
Q

What is the non-surgical treatment avaliable for carpal tunnel syndrome?

A

Wearing splints at night

Injection of corticosteroid

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10
Q

What is the surgical treatment of carpal tunnel syndrome?

A

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

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11
Q

What is cubital tunnel syndrome?

A

Compression of the ulnar nerve at the elbow behind the medial epicondyle

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12
Q

How does cubital tunnel syndrome usually present?

A

Paraesthesiae in the ulnar 1½ fingers

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13
Q

What is Osborne’s fascia?

A

A tight band of fascia forming the roof of the cubital tunnel

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14
Q

What can cause cubital tunnel syndrome?

A

Osborne’s fascia

Tightness at the intermuscular septum as the nerve passes through or between the two heads at the origin of flexor carpi ulnaris

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15
Q

What test on examination is indicative of cubital tunnel syndrome?

A

Froment’s

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16
Q

What does Froment’s test involve?

A

Ask the patient to grip an object e.g. a piece of paper between thumb and index finger to test strength of adductor pollicis

In a positive test, the weakness of adductor pollicis will mean the patient compensates by flexing flexor pollicus longus of the thumb to maintin grip strength

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17
Q

What is the repetitive strain injury in Tennis elbow/lateral epicondylitis?

A

Resisted extension at the wrist

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18
Q

What are the two ways that tennis elbow can occur?

A

Repetitive strain injury

Degenerative enthesopathy (inflammation of the origin or insertion of a tendon or ligament into bone)

19
Q

What is tennis elbow?

A

Lateral epicondylitis

20
Q

What is the pathology in tennis elbow?

A

Micro‐tears in the common extensor origin

21
Q

How does tennis elbow present?

A

Painful and tender lateral epicondyle and pain on resisted middle finger and wrist extension

22
Q

What is the conservative treatment of tennis elbow?

A

Rest from the activities that exacerbate the pain

Physiotherapy

NSAIDs

Steroid injections

Use of a brace (known as an elbow clasp)

23
Q

What is the surgical treatment for tennis elbow?

A

Division and/or excision of some fibres of the common extensor origin

24
Q

What is golfers elbow?

A

Medial epicondylitis - repetitve strain or degeneration of the common flexor origin

25
Q

Which is more common: tennis elbow or golfers elbow?

A

Tennis elbow - lateral epicondylitis

26
Q

What is the risk associated with steroid injection to treat golfers elbow?

A

Risk of ulnar nerve damage

27
Q

How can arthritic change at the radio-capitellar joint that has not responded to conservative management be treated?

A

Surgical excision of the radial head

28
Q

How can arthritic change at the humero-ulnar joint that has not responded to conservative management be treated?

A

Total elbow replacement

29
Q

How does radial nerve injury due to humeral shaft fracture present?

A

Wrist drop

Loss of sensation in 1st dorsal web space

30
Q

How are most cases of humeral shaft fracture treated?

A

Non-operatively with a functional humeral brace which compresses the fragments into acceptable alignment and provides some stability

31
Q

What is the treatment for intra-articular fractures of the distal humerus?

A

Ppen reduction, internal fixation (ORIF)

Anatomic reduction and rigid fixation to minimize loss of function

32
Q

How do olecranon fractures occur?

A

Usually occur with a fall onto the point of the elbow with contraction of the triceps muscle

33
Q

How are olecranon fractures usually managed?

A

ORIF to restore triceps function and restore the articular surface

34
Q

How can a simple transverse avulsion fracture of the olecranon be treated?

A

Tension band wiring which compresses the tension side of the fractures

35
Q

How do radial head and neck fractures usually occur?

A

Fall on an outstretched hand

36
Q

How might an undisplaced radial head or neck fracture present?

A

Lateral elbow pain on supination / pronation

‘Fat pad’ on lateral xray (a triangle like a sail anterior to the distal humerus)

37
Q

How are minimally or undisplaced radial head or neck fractures treated?

A

Sling

Early elbow exercises to minimise stiffness

38
Q

How can restricted range of movement following radial head/neck fracture be assisted, or differentiated from a mechanical block?

A

Aspiration of hemarthrosis

Injection of local anaesthetic

39
Q

When is ORIF performed in radial head/neck fractures?

A

If the fragment is large enough or excision if not amenable to fixation

40
Q

In what direction do most elbow dislocations occur and how?

A

In the posterior direction after a fall onto the outstretched hand

41
Q

What is the treatment for uncomplicated elbow dislocations?

A

Neurovascular assessment

Closed reduction under sedation

1-3 weeks in sling

Elbow exercises

42
Q

What fractures are associated with elbow dislocation?

A

Radial head

Humeral epicondyles

Coronoid process of the ulna

43
Q

How are epicondyle fractures fixed?

A

With a screw

Musculoskeletal (19 decks)

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