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Orthopaedic Conditions > Elbow/wrist/hand > Flashcards

Elbow/wrist/hand Flashcards

1
Q

Elbow deformities- cubits varus

A

Aka gun-stock
Most obvious when elbows are ext + elevated
Most common cause is malunion of sypracondyl ar fracture (abnormal healing) s
Can be corrected by wedge osteopathy of lower humerus
Larger q-angle

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2
Q

Elbow deformities- cubits valgus

A

Most common cause is non-union of fractured lat epicondyle, may give gross deformity + bony knob on inner side of Jt
Increases liability of ulnar palsy development years after injury, Pt notices weakness of hand, numbness + tingling of ulnar fingers (ring + little)
Doesn’t need treatment, but for delayed ulnar palsy the nerve needs to be transposed to front of elbow (stops pinching)

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3
Q

Elbow deformities- stiff elbow

A

Can be severe impediment
Pt may be unable to reach out to, or bring back from, their environment
Cannot turn palm downwards to pick something up, or palm up to lift
Causes include congenital disorders, trauma, and arthritis
If physio doesn’t help, surgery is needed

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4
Q

Clinical presentation of TB

A

TB rarely seen until arthritis supervenes
Onset is insidious, long Hx of aching + stiffness
Marked wasting
While disease is active, Jt is held flexed, looks swollen, feels warm + tender
Limited ROM
P + spasm

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5
Q

Prognosis of TB

A

Anti-TB drugs
Rest in splint
Later treatment- collar + cuff
Surgery rarely needed

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6
Q

RA clinical presentation

A

Elbow involved in more than 50% of cases
Rheumatoid nodules can be detected over olecranon
P + tenderness, especially around head of radius
Eventually whole elbow becomes swollen + unstable
Often bilateral
X-ray shows bony erosion, gradual destruction of radial head + widening of trochlear notch of ulnar

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7
Q

Prognosis of RA

A

Splinted during periods of synovitis
If entire Jt is severely damaged, replacement should be considered

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8
Q

OA clinical presentation

A

Uncommon site for OA
P + stiffness
Jt may become unstable
Elbow looks + feels enlarged
Limited ROM
X-ray shows reduced Jt space with sub Honduran sclerosis + osteopahytes, one or more loose bodies may be seen

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9
Q

Prognosis of OA

A

Rarely requires more than symptomatic treatment
Loose bodies should be removed if they cause locking
If stiffness is disabling, removal of osteopahytes can improve ROM
If signs of ulnar neuritis the N can be transposed to front of elbow

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10
Q

Loose bodies epidemiology

A

Trauma
Osteochondritis dissects of capitulum
Multiple may occur with OA or synovial chondromatosis

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11
Q

Clinical presentation of loose bodies

A

Locking of elbow

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12
Q

Prognosis of loose bodies

A

Can be removed= reduction in symptoms

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13
Q

Olecranon bursitis epidemiology

A

Olecranon bursa can enlarge due to pressure or friction
When accompanied with P, cause is more likely to be from infection- gout (if Hx of previous attacks), RA

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14
Q

Clinical presentation of olecranon bursitis

A

Bilateral
X-ray shows calcification of bursa (gout)
Swelling + nodularity over olecranon, erosion of Jt may cause instability- RA

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15
Q

Prognosis of olecranon bursitis

A

Underlying disorders must be treated
Septic bursitis may need draining
Chronically large may need to be removed

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16
Q

Difference between tennis + golfers elbow

A

Tennis- lateral epicondylitis
Golfers- medial epicondylitis

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17
Q

Lateral epi Hx

A

Repetitive motion (gripping, hammering, lifting, tennis backhand)

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18
Q

Lat epi SSx

A

Tender to palpation over lateral epicondyle/common extensor tendon
Initiated/aggravated by movement

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19
Q

Risk factors of tennis/golfers

A

Resistive flex/ext
Certain jobs

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20
Q

Medial epi SSx

A

Tender to palpation over medial epicondyle/common flexor tendon

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21
Q

Prognosis of tennis/golfers elbow

A

Rest/avoiding precipitating activity
Splint + physio may help
If P severe area of max tenderness is injected with mixture of corticosteroid + local anaesthetic
Persistent P with no response to treatment may require surgery

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22
Q

Pronator teres syndrome Hx

A

Repetitive motions (gripping with pronation)
Tingling and weakness in hand

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23
Q

Pronator teres syndrome SSx

A

Tender to palpation over mid pronator teres
Weakness in wrist flexion

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24
Q

UCL rupture Hx

A

Prior elbow dislocation
Throwing injury or chronic overload

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25
Q

UCL rupture SSx

A

Tenderness to palpation of UCL
+ve valgus stress test

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26
Q

Wrist deformities- congenital variation

A

Embryonic abnormalities of upper limb, likely to affect more than one segment of limb
Anomalies occur together in forearm, wrist, hand
Other organs may be affected + may be associated congenital abnormalities
Overall incidence of upper limb abnormalities estimated to be 1/600 live births, only a fraction severe enough for surgery

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27
Q

Wrist deformities- radial dysplasia

A

Infant born with marked radial deviation
Aka club hand
1/2 Pt affected bilaterally
Absence of whole or part of radius, usually small thumbs

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28
Q

Treatment of radial dysplasia

A

Neonatal includes gentle stretching + splintage
Serious cases treated with distraction prior to tension free soft tissue correction
Has less effect on growth of carpus + distal ulnar
Prolonged splintage still required to avoid reoccurrence of deformity

If function deteriorates, centralisation over ulnar recommended, preferably before age 3

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29
Q

Wrist deformities- Madelung’s disease

A

Rare- effects growth plate of radius, with growth= misalignment of ulnar + radius on carpals
Present at birth, but rarely seen until around age 10
Despite deformity, function usually undisturbed

Treatment may not be necessary, if severe lower end of ulnar can be shortened

30
Q

Wrist deformity- acquired deformity

A

Physeal injuries result in malunited fractures or subluxation of distalradioulnar Jt
Osteotomy of radius or stabilisation of Jt may be needed

Non-traumatic deformities- seen typically in RA + cerebral palsy

31
Q

TB arthritis clinical presentation

A

Sometimes occurs at wrist
P + stiffness is gradual
Hand feels weak
Forearm looks wasted, wrist swollen + feels warm
Involvement of flexor tendon compartment may cause swelling across wrist into palm
Restricted + painful ROM
Unilateral

32
Q

Prognosis of TB arthritis

A

Anti-TB drugs
Splinted
Drain any abscesses

33
Q

OA epidemiology

A

Unusual except as sequel to intro-articulate injuries of distal radius or carpal bones, or a vascular necrosis of lunate
May forget about injury then later complain of P

34
Q

Keinbock disease

A

Blood supply to lunate interrupted

35
Q

Epidemiology of Keinbock disease

A

Exact cause unknown
Often associated with injury to wrist, such as fall
Repetitive microinjuries e.g., from jackhammer use

36
Q

Age groups affected by Keinbock disease

A

Usually young adult

37
Q

Risk factors of Keinbock disease

A

Trauma
Underlying medical conditions
Relative shortening of ulnar - excessive stress applied to lunate
Occupation (manual labour)

38
Q

Clinical presentation of Keinbock disease

A

Related dorsal wrist P with activity
Decreased wrist motion in flex/ext
Poor grip strength, swelling + tenderness over radiocarpal Jt

39
Q

Prognosis of Keinbock disease

A

No cure
Prompt treatment can preserve wrist function + relieve P
Later cases- Jt replacement considered

40
Q

Triangular fibrocartilage complex (TFCC)

A

Fans out from base of ulnar styloid process to medial adage of distal radius
Acts like meniscus of wrist

41
Q

Tears of TFCC epidemiology

A

May be due to old sprain being looked over, May actually be damage to TFCC
FOOSH

42
Q

TFCC degeneration risk factors

A

May be associated with long ulnar, impaction of ulnar head against ulnar side of lunate + ulnarcarpal arthritis

43
Q

Tear of TFCC clinical presentation

A

Loss of grip strength and ROM
Clicking on supination in forearm
Local P with ROM

44
Q

Prognosis of TFCC tear

A

Operative treatment may be needed
Peripheral tears can be reattached by arthroscopic techniques
Taping/bracing
NSAIDs

45
Q

DDX TFCC tear

A

Lunate dislocation
Ulnar styloid #
OA

46
Q

Prognosis of TFCC degeneration

A

Analgesics, splintage + steroid injections

47
Q

Chronic carpal instability epidemiology

A

Following trauma to carpus, may be partial collapse of scaphoid
May not be recognised at time of incident

48
Q

Clinical presentation of chronic carpal instability

A

Years after initially injuring, Pt complains of P + weakness of wrist

49
Q

Prognosis of chronic carpal instability

A

Prevention best method
Acute wrist sprains should be assessed for carpal displacement + instability
Can be treated with splintage, analgesics + specific physio

50
Q

Tenosynovitis epidemiology

A

Unaccustomed movement, sometimes occurs spontaneously
Resulting in synovial inflammation causing secondary thickening of sheath + stenosis of compartment, which further compromises tendon

51
Q

Clinical presentation of tenosynovitis

A

Swelling, localised to radial side of wrist
Tendon sheath feels thick + hard
Tenderness most acute at tip of radial styloid process
Finklestein’s test

52
Q

Prognosis of tenosynovitis

A

Early treatment includes rest, anti-inflam medication + injection of corticosteroid
Hopefully breaks cycle of inflammation

53
Q

Tenovaginitis

A

Women between 30-50
Hx of unaccustomed activity, such as cutting with scissors or wringing clothes
Quite common straight after child birth

54
Q

Ganglion cyst

A

Ubiquitous ganglion seen most on back of wrist
Soft, gel-like mass that changes size
Caused by fluid leaking out of Jt

55
Q

Epidemiology of ganglion

A

Arises from cystic degeneration in Jt capsule or tendon sheath
Jt/tendon leaking fluid

56
Q

Age groups affected by ganglion cysts

A

Young makes

57
Q

Clinical presentation of ganglion cyst

A

Painless or painful lump, usually on back of wrist, sometimes on front
Occasional slight ache
Lump well-defined, cystic, not tender, may be attached to tendon

58
Q

Prognosis of ganglion cyst

A

Often disappears after some months
If lesion continues to be troublesome, i can be aspirated
If it recurs, excision justified, 30% chance of recurrence post surgery

59
Q

Carpal tunnel syndrome

A

Most common nerve entrapment
In normal carpal tunnel there is limited movement, therefore any swelling is likely to cause compression + ischaemia of nerve

60
Q

Age groups affected by carpal tunnel syndrome

A

50-54
75-84

61
Q

Risk factors of carpal tunnel syndrome

A

During menopause
RA
Pregnancy
Myxoedema

62
Q

Clinical presentation of carpal tunnel syndrome

A

Insidious onset
P + paraesthesia occur in distribution of median nerve
Woken with burning P, tingling + numbness
Pt tends to seek relief by hanging arm over side of bed + shaking arm
Later cases- wasting of thenar muscles, weakness of thumb, abduction + sensory dulling in median nerve territory

63
Q

Prognosis of carpal tunnel syndrome

A

Light splint prevents wrist flexion
Steroid injection into carpal canal provides temporary relief

64
Q

DDX Carpal tunnel

A

Pronator teres syndrome
TOS
C6-7 radiculopathy

65
Q

Wrist sprain Hx

A

Traumatic extension or flexion of wrist (FOOSH)

66
Q

Wrist sprain SSx

A

Palpable tenderness over ligaments
Limited AROM and PROM

67
Q

Wrist sprain DDx

A

Scaphoid #
TFC tear

68
Q

Lunate dislocation Hx

A

FOOSH
Impact or trauma on hand

69
Q

Lunate dislocation SSx

A

Tenderness in wrist in line with 3rd metacarpal
Visible on X-ray

70
Q

Lunate dislocation DDx

A

Lunate or scaphoid #
OA

71
Q
A

Orthopaedic Conditions (11 decks)

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