Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Msk > Session 10 Clinical Conditions > Flashcards

Session 10 Clinical Conditions Flashcards

1
Q

What fractures account for 70-80% of carpal bones

A

Scaphoid

Most common in adolescents and young adults following FOOSH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Patients with a scaphoid fracture usually complain of

A

Pain in Anatomical snuffbox
Exacerbated by moving the wrist
Passive ROM reduced
Swelling around radial and posterior aspects of wrist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Fractures most commonly affect what part of scaphoid

A

Waist

Also proximal pole an distal pole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

X-rays of scaphoid fracture

A

May not reveal fracture immediately
10-14 days may show as fracture line become more visible after some bone resorption

CT or MRI may be needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Complications of scaphoid fracture

A

Retrograde from distal to proximal pole

Blood supply to proximal pole is tenuous so fractures through waist of scaphoid can result in avascular necrosis

High risk of non-union, malunion or avascular necrosis (secondary OA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is colles’ fracture

A

Extra- articular fracture of the distal radial metaphysis, with dorsal angulation and impaction

Associated ulnar styloid fracture often present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Colles’ fracture features

A

Most common type of distal radial fracture

Common in patients with osteoporosis such as post-menopausal women

High impact trauma in young kids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Mechanism of fracture for colles’ fracture

A

FOOSH

Pronated forearm and wrist in dorsiflexion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Presentation of colles’ fracture

A

Painful, deformed swollen wrist

Fracture line, dorsal angulation and impaction visible on lateral view of X ray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Treatment of colles’ fracture

A

Reduction and immobilisation in a cast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Complications of colles’ fracture

A
  • Malunion resulting in dinner fork deformity
  • Median nerve palsy and post traumatic carpal tunnel syndrome
  • Secondary OA
  • Tear of extensor pollicis longus tendon
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is smith fracture

A

Fractures of distal radius with palmar angulation of distal fracture fragments

85% are extra-articular so reverse colles’ fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Smith fractures usually occur in

A

Young males or elderly females

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Mechanism of smith fracture

A

Fall onto dorsum of a flexed wrist or a direct blow to the back of the wrist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is garden spade deformity

A

Malunion of smith fracture, residual volar/palmar displacement of the distal radius

Cosmetic deformity

Narrows and distorts carpal tunnel and can result in carpal tunnel syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

RA particularly affects

A

MCPJ, PIPJ, cervical spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Presentation of RA

A
  • Often symmetrical
  • pain and swelling of PIPJs and MCPJs
  • erythema
  • stiffness worst in morning
  • Carpal tunnel syndrome due to synovial swelling
  • fatigue and flu-like symptoms
  • Rheumatoid nodules
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

X ray features of RA

A

Joint space narrowing
Periarticular osteopenia
Juxta-articular bony erosions (marginal)
Subluxation and gross deformity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Most common deformities of people with advanced RA

A

Swan neck deformity

Boutonnière deformity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is swan neck deformity

A

PIPJ hyperextends and MCPJ and DIPJ flex

Tissues on volar aspect of PIPJ become lax as a result of synovitis

Elongation or rupture of insertion of extensor digitorum onto base of distal phalanx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is boutonnière deformity

A

MCPJ and DIPJ are hyperextended and PIPJ is flexed

Inflammation in PIPJ leads to lengthening or rupture of extensor digitorum at insertion to base of middle phalanx on dorsal surface

Lateral bands slip down onto palmar surface and act as flexors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is psoriatic arthropathy

A

Asymmetrical

Sausage shaped (fusiform) swelling of digits known as dactylitis

Can progress to arthritis mutilans

Psoriatic arthritis most commonly affects DIPJs and causes nail lesions (pitting and onycholysis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Joint in the hand most commonly affected by OA

A

1st carpometacarpal joint (between trapezium and first metacarpal)

More common in women

24
Q

Presentation of OA of 1st CMC joint

A

Pain at base of thumb- worsened by movement relieved by rest

Stiffness in morning

Swelling

First metacarpal subluxes in ulnar direction

25
Q

What are Heberden’s nodes

A

Classic sign of osteoarthritis and affect DIPJ of fingers

Chronic swelling or sudden onset of pain swelling and loss of manual dexterity

Cystic swelling containing hyaluronic acid on dorsal aspect. Initial inflammation and pain subside and left with osteophyte

More women, genetic

26
Q

What are bouchard’s nodes

A

OA in PIPJS causing cystic swelling and an osteophyte

27
Q

What is carpal tunnel syndrome

A

Compression of median nerve

28
Q

Risk factors for carpal tunnel syndrome

A 
Obesity 
Repetitive wrist work 
Pregnancy 
RA
Hypothyroidism
29
Q

Consequences of nerve compression

A

Ischeamia, focal demyelination, decrease in axonal calibre, eventually axonal loss

30
Q

Complaints in carpal tunnel syndrome

A

Parasthesia in the distribution of the median nerve
Symptoms worse at night
Daily activities aggravate paraesthesia

31
Q

Sensation to the palm is spared in carpal tunnel syndrome why

A

Palmar cutaneous branch of median nerve branches proximal to carpal tunnel and passes superficial into it into the palm

32
Q

Long standing carpal tunnel syndrome can result in

A

Muscle weakness and atrophy of thenar muscles (flexor pollicis brevis superficial head, abductor pollicis brevis and opponens pollicis)

33
Q

Flexion and adduction of thumb in carpal tunnel syndrome

A

Can still flex thumb as flexor pollicis longus innervated by anterior interosseous branch of median nerve

Can still adduct as adductor pollicis is supplied by ulner nerve

34
Q

What is ulnar tunnel syndrome

A

Ulnar nerve compressed in Guyon’s canal

Passes lateral to pisiform bone over volar surface of the flexor retinaculum

35
Q

Presentation of ulnar nerve compression in Guyon’s canal

A

Paraesthesia in ring and little fingers

Weakness of intrinsic muscles of hand supplied by ulnar nerve

36
Q

What is Dupuytren’s contracture

A

Localised thickening and contracture of palmar aponeurosis leading to flexion deformity of adjacent fingers

37
Q

Dupuytren’s contracture presentation

A

Thickening or nodule on palm
Painful or painless

Myofibroblasts contract leading to formation of tight bands called cords

Fixed flexion

38
Q

Most common affected parts of hand in Dupuytren’s contracture

A

Ring and little finger

First we space and thumb May also be involved

39
Q

Conditions that increase risk of developing Dupuytren’s contracture

A
  • Type 1 diabetes
  • Frozen shoulder
  • Epilepsy
  • Liver disease/XS alcohol
  • Smoking
  • Hypercholesterolaemia
  • Heart disease
  • HIV
  • Hypo or hyperthyroidism
  • Trauma to the hand or fingers
  • Vibration-related hand injury
40
Q

Where does the radial nerve run

A

Radial (spiral) groove in posterior surface of shaft of humerus

Closely associated with the bone and may therefore be injured in a mid-shaft humeral fracture

41
Q

Will a patient still be able to actively extend their elbow during injury to the radial nerve

A

Yes

Normal or mildly compromised

Nerve supply to long and lateral heads of triceps are given off prior to the radial nerve entering spiral groove

Medial head supply given off in the spiral groove

Anconeus is paralysed but only has minor role in elbow extension

42
Q

In what position Will a patient’s wrist and fingers be when the wrist is pronated in radial nerve injury

A

Wrist and fingers flexed

Paralysis of brachioradialis and all extensor muscles of wrist and fingers

Wrist drop

43
Q

Likely distribution of sensory impairment in injury to radial nerve

A

Posterior cutaneous nerve branches from radial nerve above spiral groove so is unaffected

Lower lateral cutaneous nerve of the arm and posterior cutaneous nerve of forearm branch high in spiral groove so are also usually unaffected

Paraesthesia is therefore usually in the distribution of the superficial branch of the radial nerve

44
Q

Common mechanism of injury to median nerve

A

Injury to median nerve above level of elbow following supracondylar fracture of the humerus

45
Q

Injury to median nerve consequences

A

Paralyse muscles in anterior forearm so will be supinated, flexion weak and accompanied by adduction

Flexion of thumb weak or absent, opposition and palmar abduction absent

When making a fist the index and middle fingers wont flex- hand of benediction

IPJ and MCPJ will be extended and thumb adducted

Ape hand deformity

High lesion if absent flexion of IPJ of thumb 0

Rotation of thumb due to loss of opponens pollicis

Thenar wasting

46
Q

Injury to median nerve at wrist

A

Penetrating injury or compression at carpal tunnel

Differs to high as muscles at common flexor origin are intact

LOAF muscles paralysed

47
Q

What is LOAF

A

Lumbricals to index and middle fingers
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis

48
Q

What is ape hand deformity

A

Thenar eminence flattened, thumb adducted and laterally rotated

49
Q

Ulnar nerve injury at wrist damage

A

Supplies muscles of Hypothenar eminence, adductor pollicis, deep head of flexor pollicis brevis, interossei, lumbricals to ring and little finger, Palmaris brevis, ulnar 1.5 digits

50
Q

What is claw hand

A

Long standing damage to ulnar nerve

Affects little and ring fingers (hyperextended at MCP and flexed at proximal and distal IP)

51
Q

Why are MCPJs of ring and little fingers hyperextended and IPJs flexed in ulnar nerve injury at wrist

A

MCPJs: 3rd and 4th lumbricals are paralysed (usually flex)
Unopposed extension

IPJs: unopposed flexion from FDS and FDP,

52
Q

What can be seen in ulnar nerve at wrist injury as consequences

A

Wasting or interossei

Atrophy of adductor pollicis and first dorsal interosseous - loss of bulk of first web space of hand

Atrophy of Hypothenar muscles - loss of Hypothenar Eminence

Sensation lost in palmar aspect of ulnar 1.5 digits and the dosrum over the distal phalanges

53
Q

Ulnar nerve may be damaged at the elbow by a

A

Medial epicondylar fracture or compression of cubital tunnel

54
Q

Damage to ulnar nerve at elbow leads to

A

Paralysis of flexor carpi ulnaris, ulnar half of FDP and loss of sensation in dorsal and palmar cutaneous branches

55
Q

Presentation of ulnar nerve at elbow

A

Clawing seen is less pronounced - FDP paralysed so not any flexion in DIPJ of ring and little fingers

Only hyperextension at MCPJs and flexion at PIPJs

Intact FDS due to median nerve supply

Ulnar paradox- more proximal inquiry does not cause a more pronounced deformity

Msk (38 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions