MSK week: Hand, Shoulder, Spine anatomy and pathology Flashcards
What occurs during trigger finger (stenosing tenosynovitis)
Tendon gets caught and inflammed. Eventually results in fixed flexion of digit.
Which nerve is trapped in carpal tunnel syndrome
Median N
Risk factors for carpal tunnel syndrome
- Female (smaller tunnel)
- Older age
- pregnancy
- hypothyroid
- diabetes
- acromegaly
- trauma
- RA
- ganglion cyst
- heavy work with hands and vibration machinery
What causes dupuytren’s disease
Benign proliferation of fibroblasts and myofibroblasts. Leads to thickening of palmar cord, so fingers get stuck in flexion
What is a ganglion cyst and where does it most commonly occur in the body
Mucin-filled synovial cyst. Attached by stalk to nearby joint capsule.
Most common:
- back of wrist (70%)
- wrist near radial artery (20%)
- base of finger (10%)
Symptoms of cubital tunnel syndrome
- Numbness/tingling around little and ring finger
- Hand clumsiness, weak grip
- Pain worse on elbow flexion
Presentation of shoulder arthritis
Which movement is the first to be lost?
- pain
- restricted movement (rotation is the first to be lost)
What causes subacromial impingement?
Presentation
Irritation of sub-acromial bursa or tendons of the rotator cuff, causing pain
Presentation:
- painful arc
- restriction of function
Presentation of rotator cuff tear
- pain
- weakness
- pseudoparalysis (cannot move muscle as it is disconnected from bone, even though N is ok)
Presentation of frozen shoulder
Pt has problem with external rotation
Who has increased risk of developing frozen shoulder
- diabetics
- stroke, heart disease
- lung disease
- cancer
- hyper/hypothyroidism
- trauma
- surgery
- anti-retrovirals
Most common site of shoulder dislocation
Anterior
posterior may occur after epileptic fit/ electric shock
Presentation of shoulder dislocation
- odd looking shoulder
- pain
- loss of movement
How to test for cuff impingement
Abduct arm midway + do internal rotation
If cannot do, test is positive
Which vertebrae does the vertebral artery go through
Upper 6 cervical vertebrae
Where is the pars interarticularis?
What is a defect in this portion called?
The part of the vertebrae between inferior and superior articular processes.
Defect: spondylosis
Most common area for lumbar spine pathology
L4/L5 or L5/S1
Most common cause of back pain in age 10-20
- Infection
- Tumour
- Scheurmann’s disease (assymetry of growth plates. Posterior parts growing more quickly than anterior. Get exaggerated thoracic kyphosis)
- Spondylolysis (defect of pars interarticularis)
Most common cause of back pain in age 20-50
- Spondyloarthropathy
* Traumatic fracture
Most common cause of back pain in age 35-70
Disc degeneration
Most common cause of back pain in age 65-85
- Compression fracture
- Tumour
- Infection
Symptoms of cauda equina
- BILATERAL leg pain
- bowel and bladder dysfunction
Causes of cauda equina
o Disc herniation o Spinal stenosis o Tumour o Trauma o Spinal epidural hematoma o Epidural abscess
Treatment for acute mechanical low back pain
- NSAIDs
- minimal bed rest
- stay active
Treatment for chronic mechanical low back pain
Intensive MDT treatment (including cognitive therapy)
Red flags for back pain: TUNAFISH
- Trauma, thoracic pain
- Unexplained weight loss
- Night sweats, neuro deficits
- Age
- Fever
- Immunocompromised
- Steroid use, sphincter dysfunction
- History of cancer
