MSK week: Hand, Shoulder, Spine anatomy and pathology

Question 1

What occurs during trigger finger (stenosing tenosynovitis)

Answer 1

Tendon gets caught and inflammed. Eventually results in fixed flexion of digit.

Question 2

Which nerve is trapped in carpal tunnel syndrome

Answer 2

Median N

Question 3

Risk factors for carpal tunnel syndrome

Answer 3

• Female (smaller tunnel)
• Older age
• pregnancy
• hypothyroid
• diabetes
• acromegaly
• trauma
• RA
• ganglion cyst
• heavy work with hands and vibration machinery

Question 4

What causes dupuytren’s disease

Answer 4

Benign proliferation of fibroblasts and myofibroblasts. Leads to thickening of palmar cord, so fingers get stuck in flexion

Question 5

What is a ganglion cyst and where does it most commonly occur in the body

Answer 5

Mucin-filled synovial cyst. Attached by stalk to nearby joint capsule.

Most common:

1. back of wrist (70%)
2. wrist near radial artery (20%)
3. base of finger (10%)

Question 6

Symptoms of cubital tunnel syndrome

Answer 6

• Numbness/tingling around little and ring finger
• Hand clumsiness, weak grip
• Pain worse on elbow flexion

Question 7

Presentation of shoulder arthritis

Which movement is the first to be lost?

Answer 7

• pain

- restricted movement (rotation is the first to be lost)

Question 8

What causes subacromial impingement?

Presentation

Answer 8

Irritation of sub-acromial bursa or tendons of the rotator cuff, causing pain

Presentation:

• painful arc
• restriction of function

Question 9

Presentation of rotator cuff tear

Answer 9

• pain
• weakness
• pseudoparalysis (cannot move muscle as it is disconnected from bone, even though N is ok)

Question 10

Presentation of frozen shoulder

Answer 10

Pt has problem with external rotation

Question 11

Who has increased risk of developing frozen shoulder

Answer 11

• diabetics
• stroke, heart disease
• lung disease
• cancer
• hyper/hypothyroidism
• trauma
• surgery
• anti-retrovirals

Question 12

Most common site of shoulder dislocation

Answer 12

Anterior

posterior may occur after epileptic fit/ electric shock

Question 13

Presentation of shoulder dislocation

Answer 13

• odd looking shoulder
• pain
• loss of movement

Question 14

How to test for cuff impingement

Answer 14

Abduct arm midway + do internal rotation

If cannot do, test is positive

Question 15

Which vertebrae does the vertebral artery go through

Answer 15

Upper 6 cervical vertebrae

Question 16

Where is the pars interarticularis?

What is a defect in this portion called?

Answer 16

The part of the vertebrae between inferior and superior articular processes.

Defect: spondylosis

Question 17

Most common area for lumbar spine pathology

Answer 17

L4/L5 or L5/S1

Question 18

Most common cause of back pain in age 10-20

Answer 18

• 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)

Question 19

Most common cause of back pain in age 20-50

Answer 19

• Spondyloarthropathy

* Traumatic fracture

Question 20

Most common cause of back pain in age 35-70

Answer 20

Disc degeneration

Question 21

Most common cause of back pain in age 65-85

Answer 21

• Compression fracture
• Tumour
• Infection

Question 22

Symptoms of cauda equina

Answer 22

• BILATERAL leg pain

- bowel and bladder dysfunction

Question 23

Causes of cauda equina

Answer 23

o	Disc herniation
o	Spinal stenosis
o	Tumour
o	Trauma
o	Spinal epidural hematoma
o	Epidural abscess

Question 24

Treatment for acute mechanical low back pain

Answer 24

• NSAIDs
• minimal bed rest
• stay active

Question 25

Treatment for chronic mechanical low back pain

Answer 25

Intensive MDT treatment (including cognitive therapy)

Question 26

Red flags for back pain: TUNAFISH

Answer 26

• Trauma, thoracic pain
• Unexplained weight loss
• Night sweats, neuro deficits
• Age
• Fever
• Immunocompromised
• Steroid use, sphincter dysfunction
• History of cancer