MSK pathology (UL) Flashcards
What is the typical presentation of overuse/strain injuries at presentation?
- exact time/mechanism of injury can be identified
- pain is non-progressive, and produced by one/few movements
- on examination there is local tenderness and pain reproduced on resisted active movement/stress testing
What are the most common places to get tendonitis?
Shoulder
Elbow
Achilles tendon
What is De Quervain’s tenovaginitis?
disease of unknown cause with painful inflammation of the abductor pollicis longs and extensor policies brevis tendons in the first dorsal compartment of the wrist
How does De Quervain’s tenovaginitis present?
acute pain over first dorsal compartment when using the thumb and swelling/tenderness over the area
most common after unaccustomed intensive activity
What is the special test for De Quervain’s tenovaginitis?
Finkles test positive
thumbs across palm, ulnar deviation causes pain over the tunnel
What is carpal tunnel syndrome?
compression neuropathy of the median nerve as it passes through the carpal tunnel
What is the cause of carpal tunnel syndrome?
95% are idiopathic
also seen in other conditions - DM, RA, hypothyroidism, acromegaly and trauma (Colle’s fracture)
3 times more common in women
How does carpal tunnel syndrome present?
- pain/paraesthesia in the hand, worst in the morning
due to wrist flexion when you sleep. may wake patient when they sleep and they shake hand for relief - thenar muscle weakness/wasting, first noticed as clumsiness
- sensory loss in the palm/radial 3.5 fingers
What is seen on examination of carpal tunnel?
- thenar wasting
- difficulty with thumb abduction and active thumb opposition
- positive tinsel’s (tapping leads to parathesia) and positive Phalen’s (pain for flexion for 60sec)
What investigations should be carried out to investigate cubital tunnel syndrome?
X-rays showing pathological osteophytes
nerve conduction studies can be used to show slowing at the elbow
What is the conservative management of cubital tunnel syndrome?
night time splints
NSAIDs
Activity modification
What is the surgical management of cubital tunnel syndrome?
simple cubital tunnel decompression
anterior transposition of the nerve
What is a ganglion cyst?
A soft tissue swelling filled with degenerative myoxoid fluid that stems from an underlying joint capsule, ligament or tendon sheath
How does a ganglion cyst present?
patient will complain of a lump in the hand or wrist with cosmetic concerns or associated pain
majority of patients are women aged 20-40, they can be idiopathic or follow trauma
What is seen on examination in a ganglion cyst?
Most common sites are on dorsal of the wrist, volar aspect of the wrist and at the base of the finger from the flexor sheath
they are not fixed to the skin and can become more obvious with some movements
they transilluminate
What is trigger finger?
Idiopathic fibrosis of the flexor tunnel leading to an intratendinous nodule that interrupts normal finger movement
usually involves the ring/middle finger
What is the presentation of trigger finger?
potential flexion at PIPJ/DIPJ
can feel triggering of the flexor tendons and a nodule can be felt at base of finger
jerky movement on flexion and full extension may be limited due to secondary joint problems
What is the management for trigger finger?
Spontaneous resolution is possible with activity modification, NSAIDS, tendon sheath corticosteroid injection
Surgical Mx: release of the A1 pulley, or tenosynovectomy in RA patients
What is Dupuytren’s contracture?
Progressive painless thickening of the palmar fascia causing flexion deformities of the fingers and functional difficulties
more common in males, FHx, also linked to trauma, liver cirrhosis, phenytoin, diabetes
What is the presentation of Dupuytren’s?
Nodules/cords in the palm or fingers, with flexion of MCP/PIP joints, classically affecting middle and ring fingers
thickened palmar fascia, ‘Garrod’s’ pads on the dorsal of the PIPJs
Loss of passive and active extension of joints
How is Dupuytren’s managed?
conservative - no specific treatment is required if the patient has no functional impairment
surgical - needle aponeurotomy, enzymatic fasciotomy, fasciotomy or dermfasciectomy
What is medial epicondylitis (golfers elbow)?
tendinopathy of the common flexor-pronator origin
it is caused by recurrent microtrauma to the elbow joint
How does media epicondylitis present?
pain develops sub acutely, exacerbated by use and settles with rest
pain can be severe and radiate up arm
What is seen on examination of golfers elbow?
tenderness around the medial epicondyle and pain triggered by resisted flexion of the hand
normal range of movement
no neuro symptoms (otherwise think about ulnar nerve entrapment)
What is the management of medial epicondylitis?
Simple analgesia (NSAIDS) and rest (activity modification)
Referral to physic for strengthening
Epicondylar clasp (provided by the splint department)
Steroid injection
X-ray of the joint if all the above are unsuccessful to rule out OA
Surgical management - golfers elbow release
What is lateral epicondylitis (tennis elbow)?
Tendinopathy of the common extensor tendon origin
more common than golfers elbow, peak in incidence at 40-60 years
caused by repetitious gripping/grasping movements
How does tennis elbow present?
pain develops subacutely
exacerbated by movement and relieved by rest
pain may radiate up/down arm
What is seen on examination of tennis elbow?
tenderness distal to the lateral epicondyle
pain reproduced by resisted extension of the wrist
passive range of movement is normal
What is the management of tennis elbow?
Conservative management same as for golfers elbow
Surgical intervention with tennis elbow release
What is olecranon bursitis?
the olecranon bursa becomes enlarged as a result of pressure or friction
it is not a painful condition, so if the pain is present consider differentials (gout/RA/infection)
