MSK Small Group 1 Flashcards

1
Q

The brachialis connects the _______________.

A

humerus to the ulna

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2
Q

The brachioradialis connects the _____________.

A

humerus to the radius.

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3
Q

The _____________ is just medial to the biceps tendon at the elbow.

A

median nerve

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4
Q

True or false: the finger and wrist extensors attach to the lateral epicondyle.

A

False. The finger extensors attach more distally along the radius.

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5
Q

A great way to visualize the brachioradialis is ____________.

A

to have the elbow flexed to 90ºwith the hand midway between pronation and supination; have the patient flex

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6
Q

What three physical exam tests can you do to evaluate for tendonitis?

A
  • Pain with active movement
  • Pain with passive movement
  • Focal tenderness
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7
Q

To do passive stretching, you need to move the joint _____________.

A

in the opposite way that the tendon contracts; for instance, to stretch the wrist extensors, you flex the patient’s wrist while they are relaxed

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8
Q

Remember, when you are testing for pain on activation of a tendon, it’s best to ______________.

A

have the patient flex against resistance

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9
Q

What does the term volar mean?

A

It is synonymous with anterior when used for the hand (also synonymous with palmar).

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10
Q

There are two kinds of rest that MSK doctors recommend: ____________.

A

immobilization (with splints/braces) and activity modification

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11
Q

Why do some doctors use the term tendinopathy as opposed to tendonitis?

A

The suffix -itis implies an inflammatory process, but in most cases of “tendonitis” there are no inflammatory cells found in or near the tendon. As such, tendinopathy better describes the pathology.

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12
Q

What are three ways to reconnect tendon to bone at the end of a surgery?

A
  • They now commonly insert screws into the bone that have little hooks to suture the tendon to.
  • You can also use a drill to make a small hole in bone that can be used to anchor tendon to.
  • Lastly, if you cut the tendon prior to surgery and leave a little hanging stub, then you can reattach the tendon to it.
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13
Q

What are risks of steroid injections?

A

Clinically relevant:
• Tendon thinning (with possible rupture)
•Skin thinning
• Vascular thinning
(The above three result from decreased collagen deposition.)
•Local immune suppression
•High glucose (particularly important for diabetics)

Non-clinically relevant:
•Hair loss
•Sweat gland
• Decreased production of melanin (with discoloration)

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14
Q

Other than the wrist flexors, what else attaches to the medial epicondyle?

A

The pronator teres

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15
Q

What causes medial epicondylitis?

A

Golfing (“golfer’s elbow”)

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16
Q

What can tear the medial collateral ligament?

A

Pitching in baseball

17
Q

What is the most common source of medial epicondyle pain?

A

Ulnar entrapment

18
Q

What is the definition of “ intrinsic muscles of the hand”?

A

Muscles that have their insertion and origin in the hand

These muscles abduct and adduct the fingers as well as flex the MCP joint.

19
Q

The overall motor function of the median nerve is ____________.

A

flexion of the wrist, thumb, index finger, and long finger (and the lateral half of the ring finger)

20
Q

What are the two clinically relevant aspects of autonomic innervation of the extremities?

A
  • Sweating

* Vasomotor

21
Q

What connections mediate bicipital flexion of the shoulder?

A

Coracoid to radius

The humerus to radius mediates elbow flexion.

22
Q

It’s good to check temperature using ________________.

A

the back of your hand (which is more temperature sensitive)

23
Q

With disruption of autonomic function, you lose what functions?

A

Vasoconstriction (with subsequent vasodilation) as well as loss of sweating

24
Q

What is a good way to test for denervation of the skin?

A

Submerge the area in question into water. Denervated skin will not wrinkle.

25
Q

Why does the “claw hand” result from disruption of the ulnar nerve?

A

The ulnar nerve normally mediates flexion of the MCP, so without that, the fingers are stuck in partial extension.

26
Q

The normal resting state of the hand is _____________.

A

progressively more flexion from the index finger to the pinky

27
Q

What symptoms are common in carpal tunnel syndrome?

A
  • Burning pain in the wrist in hand
  • Nocturnal pain
  • Typing can often alleviate the pain, strangely enough
28
Q

What are risks for carpal tunnel?

A

Obesity and being sedentary

29
Q

What do people often do to relieve carpal tunnel symptoms?

A

Shake their hands below their waist (to increase the hydrostatic pressure and move fluid around)

30
Q

What is the best way to evaluate for carpal tunnel?

A

Arms extended, at the level of the heart, with wrists flexed

31
Q

What counts as a positive Tinnel’s test?

A

Paresthesia

32
Q

Carpal tunnel of pregnancy results from ____________.

A

edematous synovium of pregnancy

33
Q

_________________ is useful in carpal tunnel. Why?

A

Steroids

Steroids work to shrink the synovium of the tendon sheaths in the carpal tunnel, so this decreases volume and leads to symptomatic relief.

In other areas of tendinopathy, there is no synovium so steroids won’t work (e.g., cubital fossa).