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My2 MSK > orthopaedics: hands > Flashcards

orthopaedics: hands Flashcards

1
Q

what is cubital tunnel syndrome

A

compression of ulnar nerve at elbow: (medial epicondyle)

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2
Q

what are symptoms of cubital tunnel syndrome

A

parasthesia in ulnar fingers (medial 1+1/2), weakness in abduction of fingers (interossei muscles), positive tinel’s test, positive froment’s test

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3
Q

what is tinels test

A

percussion over affected nerve (ulnar or median) which then causes symptoms

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4
Q

what is froment’s test

A

when hold piece of paper inbetween thumb and finger looks weird

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5
Q

what causes cubital tunnel syndrome

A

tight fascia band on roof of tunnel (osborne’s fascia)

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6
Q

what investigations are done for cubital tunnel

A

exam and nerve conduction studies

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7
Q

how can you treat cubital tunnel

A

surgical release

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8
Q

what forms the carpal tunnel

A

carpal wrist bones and flexor retinaculum (carpal ligament)

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9
Q

what passes through the carpal tunnel

A

median nerve and 9 flexor tendons

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10
Q

what happens in carpal tunnel syndrome

A

increased pressure in the carpal tunnel compresses median nerve and flexor tendons (affects nerves more than flexors)

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11
Q

what can cause carpal tunnel syndrome

A

idiopathic women, RA, fluid retention, pregnancy, diabetes, renal failure, hypothyroidism, fractures at wrists

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12
Q

what symptoms are there of carpal tunnel syndrome

A

paraethesia in median nerve digits (thumb index, middle,) which is worse at night, loss of sensation/ function of thumb (themnar muscles)

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13
Q

what investigations are done for carpal tunnel syndrome

A

Tinel’s, Phalen’s, nerve conduction studies

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14
Q

what treatment can be done for carpal tunnel syndrome

A

non-operative: wrist splint and steroid injections.

surgical: decompression (division of ligament)

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15
Q

what is dupuytren’s contracture

A

palmar fascia is hypertrophic

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16
Q

where is palma fascia

A

separates muscles and skin

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17
Q

what digits are normally affected in dupuytren’s contracture

A

ring and pinkie finger

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18
Q

what cells proliferate in dupuytren’s contracture

A

myofibroblast cells: abnormal collagen type III

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19
Q

what can cause dupuytren’s contracture

A

white men, alcoholic cirrhosis, diabetes, phenytoin therapy, peyronies and ledderhose disease

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20
Q

how do you treat dupuytren’s contracture surgically

A

fasciotomy (removal of diseased tissue and division of cords), amputation if severe

21
Q

what is trigger finger

A

tendonitis of flexor tendon to a digit –> nodular enlargement catches in fascia pulley –> trapped in flexed position

22
Q

what are symptoms of trigger finger

A

clicking when moving, painful, finger locked in flexed position, middle and ring finger most common

23
Q

how do you treat trigger finger

A

steroid injection around tendon, surgery if recurrence (incision of fascial pulleY)

24
Q

what is dequervain’s tenosynovitis

A

spontaneous inflammation of tendons compartment of thumb

25
Q

what are symptoms of dequervain’s tenosynovitis

A

swollen, red, painful thumb esp on movement

26
Q

how do you manage dequervain’s tenosynovitis (mild –> severe)

A

NSAIDs, splint, steroid injection, surgical decompression

27
Q

what type of nodes present on DIP’s from OA

A

herberden’s nodes

28
Q

what can be associated with DIP OA

A

dorsal ganglion ycst

29
Q

how do you manage DIP OA

A

osteophyte excision and arthrodesis if severe pain

30
Q

what nodes are associated with PIP OA

A

Bouchard’s nodes

31
Q

how do you treat PIP OA

A

athrodesis or arthroplasty

32
Q

where do you rarely get OA in the hand

A

MCPs - usually from previous injury

33
Q

what joints does RA commonly affect in the hand

A

MCP’s - spares DIP

34
Q

what are the 3 stages of hand RA

A

1) synovitis and tenosynovitis 2) erosion 3) joint instability and tendon rupture

35
Q

describe synovitis and tenosynovitis in RA

A

inflamm within joints and tendon sheath causing swelling and pain

36
Q

describe erosion in RA

A

inflam pannus (synovium cartilage) which affects articular cartilage

37
Q

what deformites can occur with RA deformities

A

Volar MCPJ subluxation, ulnar deviation, swan neck deformity, boutonnière deformity, Z shaped fun

38
Q

what is a swan neck deformity

A

PIP drops in RA

39
Q

what is a boutonniere deformity

A

PIP raises in RA

40
Q

how do you treat RA of hands

A

DMARDs (first), tenosynovectomy (excision of tendon sheath), soft tissue release

41
Q

what are ganglion cysts

A

common mucinois filled cysts around tendons or synovial joints

42
Q

where do ganglion cysts commonly present

A

DIP, wrist, (knee baker’s cyst)

43
Q

what are symptoms of ganglion cysts

A

localised pain and irritation, firm, smooth, rubbery feel, transilluminate

44
Q

how do you treat ganglion cysts

A

needle aspiration (high recurrence, surgical excision (only if indicted)

45
Q

what is tendonitis

A

acute injury and inflam

46
Q

what is teninosis

A

chronic damage at cellular level (no inflamm)

47
Q

what is enthesopathy

A

inflam of tendon at insertion to bone

48
Q

what are tendons made of

A

fibroblasts producing collagen

My2 MSK (29 decks)

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