MSK conditions

Question 1

nocturnal hand or arm numbness
(paresthesias), dropping objects, inability to twist lids off jars, aching at the
wrist or even the forearm, and numbness of the first three digits

These are signs of what?

Answer 1

Carpal tunnel syndrome

Question 2

Risk factors for carpal tunnel syndrome?

Answer 2

prolonged wrist extension
(such as keyboarding) and mail sorting, vibration, cold exposure,
wrist anatomy, pregnancy, RA, diabetes, and hypothyroidism

Question 3

What test do we do for De Quervains?

Answer 3

Finkelstein
Ask the patient to grasp the thumb against the palm and
then move the wrist toward the midline in ulnar deviation

Question 4

Grip weakness plus wrist pain are often present in what condition?

Answer 4

de Quervain tenosynovitis.

Question 5

Do you see decreased grip strength in carpal tunnel?

Answer 5

Yes
Decreased grip strength is a positive test for weakness of the
finger flexors and/or intrinsic muscles of the hand. It can also
result from inflammatory or degenerative arthritis, carpal tunnel
syndrome, epicondylitis, cervical radiculopathy and other nerve
disorders of the arm and hand

Question 6

Carpal tunnel affects what nerve?

Answer 6

Median

Question 7

What fingers are affected by carpal tunnel?

Answer 7

1-3 and lateral side of 4th
***But patients often complain of numbness to whole hand

Question 8

What tests do we do to test for carpal tunnel?

Answer 8

Thumb Abduction and Opposition, Tinel Sign,
Phalen Sign

Question 9

Describe the tinel sign. What is considered a positive test?

Answer 9

repeatedly tapping over the course of the median nerve in the carpal tunnel

Shooting pain, aching, or worsening numbness in the median
nerve distribution is a positive test (

Question 10

Describe the phalen test. What is a positive test?

Answer 10

ask the patient to hold the wrists in full flexion and juxtaposing the dorsum of each hand against each other for 60 seconds with
the elbows fully extended (Fig. 23-51). Alternatively, ask the patient to press
the backs of both hands together to form right angles. These maneuvers
compress the median nerve

Numbness and tingling in the median nerve distribution within 60
seconds is a positive test

Question 11

S&S of de quervains

Answer 11

• Pain near the base of the thumb
• Swelling near the base of the thumb
• Difficulty moving the thumb and wrist when doing something that involves grasping or pinching
• A “sticking” or “stop-and-go” sensation in the thumb when moving it