MSK Flashcards
Features of carpal tunnel
arm pain and hand tingling
most commonly middle aged women
Tinel’s and Phalens tests
motor signs- weakness of thenar eminence
Causes of carpal tunnel
MEDIAN TRAP
Myxoedema (hyopthyroidism)
ETOH (alcohol)
Diabetes mellitus
Idiopathic
Amyloidosis
Neoplasia
Trauma
Rheumatoid arthritis
Acromegaly
Pregnancy
Management of carpal tunnel
The three S‘s
Splinting
Steroids – local injection
Surgery – decompression
Four signs or ulnar nerve palsy
- sensory loss over 5th finger and ulnar half of 4th
- weakness and wasting of the first dorsal interosseous
- weakness of pincer grip
- partial claw hand (weakness of medial lubricants)
T1 nerve lesion
Lower limb nerve roots
L2- hip flexion
L3- knee extension
L4- inversion and Dorsiflexion of foot
L5- dorsiflexion of big toe
S1- ever sign of foot
Movements of upper limb, with nerve root and peripheral nerve
How to test hand function?
- grip- squeeze my fingers- c8 root
- pincer grip
- prayer sign
- fine movement- pyramidal function
What conditions have a +ve prayer sign?
- RA
- scleroderma
- diabetes (cheiro-arthropathy)
- ulnar nerve palsy (partial claw hand)
- T1 palsy (complete claw hand)
- dupuytren’s Contracture
Causes of peripheral neuropathy
ABCDEP
Alcohol
B12
CKD
Diabetes and drugs
Every vasculitis
Plus:Cancer (para-neoplastic), Lyme disease, and Charcot Marie tooth
symptoms of acute hypercalcaemia
thirst and polyuria
constipation, vomiting
confusion
muscle weakness
bradycardia, heart block, cardiac arrest
tumours that typically metastasise to bone
Breast, bronchus, thyroid, kidney, prostate
acute managment of hypercalcaemia
rehydration- dilution
furosemide- inhibits tubular reabsorption of calcium
bisphosphonates- inhibits osteoclasts
dialysis
causes of hypercalcaemia
facticious: tourniquet, high serum albumin
hyperparathyroidism
bone secondaries
paraneoplastic e.g. carcinoma of the bronchus
others:myeloma, thyrotoxicosis, sarcoidosis, vitamin D toxicity, thiazides
symptoms of hyperparathyroidism
sones
bones
groans
moans
psychiactric overtones
what is dupuytren’s contracture?
fibroproliferative disease of palmar and digital fascia
thickening of palmar aponeurosis
doesn’t involve the tendons
prevents flexor tendons functioning
not painful- functional impairment
associations with dupuytren’s
white
FHx
alcohol
cigarette
diabetes
peyronie’s
phenytoin
trauma
dupuytrens contracture
prevent functional impairment
many don’t require treatment
zig-zag inscision to prevent volar contracture
post-op sling and splint
complications: haematoma, recurrence (significant), damage to neurovascualr bundle
