ortho - shoulder/ elbow/ hand

Question 1

common non-traumatic disorder

Answer 1

• Rotator cuff syndrome
• Tennis elbow
• Golfers elbow
• Carpal tunnel syndrome
• Rheumatoid wrist and hand

Question 2

common traumatic disorder

Answer 2

• Montaggia & Galeazzi fracture dislocation
• Colles, Smith & Barton fracture
• Scaphoid fracture
• Bennetts fracture
• Gamekeepers thumb
• Boxers fracture
• Jerseyfinger

Question 3

rotator cuff syndrome

Answer 3

• Commonest cause of shoulder pain
• arise from repetitive compression or rubbing of the tendons (mainly supraspinatus) under the coracoacromial arch

Question 4

A spectrum - rotator cuff

Answer 4

• Impingement
• Tendinitis
• Partial tears
• Complete tears * Arthropathy

Question 5

impingement test

Answer 5

• The painful arc
• Neer’s impingement sign * Hawkins–Kennedy test

Question 6

cuff test

Answer 6

• Supraspinatus–the‘emptycan’
  test
• Infraspinatus – resisted external rotation
• Infraspinatus and posterior cuff – the ‘lag sign’
• Subscapularis – ‘the lift-off’ test

Question 7

conservative rx rotator cuff

Answer 7

• NSAIDs
• Physiotherapy - Active exercises in position of freedom
• Corticosteroid injection

Question 8

surgical rx rotator cuff

Answer 8

• Acromioplasty
• Rotator cuff repair
• Arthroplasty

Question 9

tennis elbow

Answer 9

• Lateral epicondylitis
• Tendinitis of extensor carpi radialis
  brevis
• Not limited to tennis players
• Pain & tenderness on the lateral aspect of the elbow
• Difficulty lifting weights away from the body

Question 10

conservative rx tennis elbow

Answer 10

• NSAIDS
• Cortisone injection
• Tennis elbow band
• Wrist extension splint

Question 11

surgical rx tennis elbow

Answer 11

• Surgical release

Question 12

carpal tunnel syndrome

Answer 12

• 9 tendons and the median nerve in the tunnel
• Most common nerve entrapment

Question 13

carpal tunnel syndrome risk factors

Answer 13

• Pregnancy – water retention
• Inflammatory synovitis – Rheumatoid arthritis
• Diabetes
• Hypothyroidism
• Gout
• Work related
• Idiopathic

Question 14

carpal tunnel. syndrome symptoms

Answer 14

• Pain -after midnight – after activity
• Tingling in median n. territory
• decreased sensation median n
• wasting of thenar muscles - advanced
• Phalen test +
• Tunnel sign +

Question 15

conservative rx carpal tunnel syndrome

Answer 15

• Anti-inflammatory medication – reduce inflammation
• Control systemic disease (diabetes, rheumatoid arthritis)
• Splinting
• Cortisone infiltration

Question 16

surgical rx carpal tunnel syndrome

Answer 16

carpal tunnel release
* Failure of conservative treatment
* Advanced stage

Question 17

rheumatoid wrist & hand typical deformities

Answer 17

• Radial deviation of the wrist
• Caput ulnae
• Ulnar deviation & volar sublaxation of fingers
• Boutonniere deformity
• Swan neck deformity
• Z-deformity of thumb

Question 18

rheumatoid wrist & hand deformity causes

Answer 18

• Ligament rupture
• Tendon ruptures
• Loss of supporting bone

Question 19

RA medical rx

Answer 19

• NSAIDS & DMARDS –mainstay of
  treatment
• Cortisone infiltration

Question 20

RA physical rx

Answer 20

• Splinting – prevent & correct deformities
• Modification of home & work setup
• Assistive devices

Question 21

RA surgical rx

Answer 21

• Synovectomy-tendons & joints
• Tendon repair, graft, or transfer
• Joint excision
• Joint fusion
• Joint arthroplasty

Question 22

traumatic disorder - montaggio #

Answer 22

• Fracture dislocation of radius and ulna
• Fracture of proximal ulna
• Dislocation of radial head
• Always fixed surgically

Question 23

traumatic disorder - galeazze #

Answer 23

• Fracture dislocation of radius &
  ulna
• Fracture of distal radius
• Dislocation of ulna head
• Always fixed surgically

Question 24

traumatic disorder - distal radius #

Answer 24

• Colles fracture is the most common ~ 90%
• Dinner fork deformity
• Smith fracture > Barton fracture
• Smith–reverse Colles
• Barton–fracture dislocation/ sublaxation of the wrist

Question 25

traumatic disorder - distal radius # rx

Answer 25

• Below elbow cast
• 6 weeks – undisplaced

Surgery
* Displaced fractures Colles & Smith
* Barton
* Poor results in intra-articular fractures

Question 26

traumatic disorder - scaphoid #

Answer 26

• Most common carpal fracture
• Poor blood supply-covered by cartilage
• Can be missed initially
• Repeat x-rays after 2 weeks
• Flawed with complications
  -Non-union
  -Avascular necrosis of scaphoid

Question 27

traumatic disorder - scaphoid # rx

Answer 27

• Scaphoid cast – 6 weeks (non-displaced fractures)
• Surgical fixation with a screw
• Displaced fractures
• Fractures with local associated injuries
• Vertical fractures
• Nonunion

Question 28

traumatic disorder - boxers #

Answer 28

• Fracture at the neck of 5th metarcapal
• Mechanism of injury consistent with boxing (punching)

Treatment
* POP slab if minimally angulated
* Surgical fixation if angulated >40

Question 29

traumatic disorder - Bennet’s #

Answer 29

• Affects the base of the thumb
• A fracture
  dislocation/ sublaxation
• Bigger fragment pulled by the long abductor of the thumb
• Always fixed surgically with a screw or wire

Question 30

traumatic disorder - game keepers thumb

Answer 30

• Rupture of ulna collateral ligament of the thumb at MCPJ
• Partial or complete rupture
• Complete – interposition of adductor pollicis aponeurosis
• Partial – splinting for 4-6 weeks
• Complete – repair and splint

Question 31

traumatic disorder - jersey finger

Answer 31

• Avulsion of flexor digitorum profundus at insertion site
• With or without bone fragment
• Rugby, fall, axial injury with the ball
Requires repair