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MB2 Rheumatology and Orthopaedics > Shoulder, elbow and hand > Flashcards

Shoulder, elbow and hand Flashcards

1
Q

intrinsic muscles of shoulder?

A

supraspinatus
infraspinatus
subscapularis
teres minor

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2
Q

extrinsic muscles of shoulder

A

deltoid
trapezium
pectoralis major
latissimus dorsi

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3
Q

range of movement of shoulder

A

abduction/adduction
flexion/extension
internal/external rotation

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4
Q

what type of shoulder problem is most likely in young people?

A

instability

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5
Q

what type of shoulder problem is most common in middle age

A

rotator cuff tear/frozen shoulder

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6
Q

what type of shoulder problem is more likely in older patients

A

rotator cuff tear/glenohumeral OA

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7
Q

what is impingement syndrome of the shoulder and causes?

A

compression of tendons of rotator cuff in subacromial space
tendonitis
subacromial bursitis
acromioclavicular OA with inferior osteophyte
hooked acromion
rotator cuff tear

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8
Q

clinical features of impingement syndrome?

A

painful arc of 60-120 degrees abduction
+ve hawkins kennedy test
pain to deltoid, upper arm, lateral edge of acromion

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9
Q

conservative management of impingement syndrome

A

NSAIDs
analgesia
physiotherapy
subacromial steroid injection

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10
Q

surgical management of impingement syndrome

A

decompression but you need to have had ineffective non operative management for 6 months

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11
Q

classical history of rotator cuff tear?

A

sudden jerk in patient >40 with subsequent pain/weakness

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12
Q

what rotator cuff muscle is most commonly affected

A

supraspinatus

if large infraspinatus and subscapularis may be affected

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13
Q

what may be seen on examination with rotator cuff tear

A

weaker initiation of abduction, internal rotation or external rotation
wasting of supraspinatus

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14
Q

non operative management of rotator cuff tears?

A

phyiotherapy to strengthen remaining muscles to compensate for loss of supraspinatus
subacromial injection

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15
Q

operative management of rotator cuff tears?

A

repair with subacromial decompression

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16
Q

what is acute calcific tendonitis and how is it managed

A

actue onset severe shoulder pain characterised by calcium hydroxapatite in supraspinatus tendon seen on x ray just prox to greater tuberosity
subacromial steroid injection and local anaesthetic
condition is self limiting

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17
Q

what is adhesive capsulitis and who is it more common in

A 
capsule/glenohumeral ligaments become inflamed and contract causing progressive pain/stiffness
women x2
middle aged 
diabetics 
hyperlipidaemia 
dupuytren's disease
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18
Q

presentation of adhesive capsulitis

A

pain 2-9 months progressing to sohulder stiffness 4-12 months
anterior pain at rest/night
stiffness
lost external rotation followed by globally reduced ROM

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19
Q

management of adhesive capsulitis?

A

physiotherapy, analgesia, steroid injection for pain

MUA or surgical release to divide capsule

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20
Q

what may cause referred shoulder pain?

A

angina
hepatic abscess
biliary colic

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21
Q

true/false - posterior shoulder dislocation is most common

A

false - anterior is

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22
Q

immediate shoulder dislocation management?

A

reduction by manipulation

analgesia

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23
Q

true/false - after dislocation the chance of a recurring dislocation increases with age

A

false

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24
Q

associated injuries with shoulder dislocation/instability

A

bankart labral lesion
fracture humeral head
fracture glenoid
rotator cuff tear

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25
Q

surgical option for recurrent dislocation

A

bankart surgery to reattach labrum to anterior glenoid

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26
Q

typical hx of shouler OA

A

gradual onset pain at night and rest
stiffness
intermittent exacerbation

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27
Q

typical examination findings shoulder OA

A 
asymmetry 
wasting 
limited external rotation 
globally reduced movement 
pain through ROM
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28
Q

non operative shoulder OA management

A

analgesia
physiotherapy
GH steroid injection

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29
Q

operative shoulder OA management

A

shoulder resurfacing
total arthroplasty
shoulder replacement
reverse polarity shoulder arthroplasty

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30
Q

movement of humero-ulnar joint?

A

flexion/extension

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31
Q

movement of radio-capitallar joint?

A

pronation/supination with radioulnar joints

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32
Q

___ inserts into ____ for extension of the forearm

A

triceps brachii

olecranon process

33
Q

what muscles supinate forerm

A

biceps brachii and supinator muscles

34
Q

what muscles pronate forearm

A

pronator teres proximally and pronator quadratus distally

35
Q

where does the common extensor origin come from

A

lateral epicondyle

36
Q

where does the common flexor origin come from

A

medial epicondyle

37
Q

in who is lateral epicondylitis more common

A

tennis players and those regularly performing resisted extension at the wrist

38
Q

clinical features of lateral epicondylitis

A

painful and tender lateral epicondyle

pain on resisted middle finger/wrist extension

39
Q

conservative management of lateral epicondylitis

A 
rest from activities exacerbating 
physiotherapy 
NSAIDs 
steroid injection 
analgesia 
use of a brace
40
Q

true/false - division of fibres of the common extensor origin is a curative surgery for lateral epicondylitis

A

false - it is a variable result surgery

41
Q

what is medial epicondylitis and how is it managed conservatively

A 
NSAIDs
analgesia 
physiotherapy
rest 
steroid injection
42
Q

what must you beware of when injecting for medial epicondylitis

A

damage to ulnar nerve

43
Q

true/false - OA is common in the elbow

A

false - primary OA isnt but secondary OA to trauma is

44
Q

true/false - RA In elbow is common

A

true

45
Q

OA in radio-capitellar joint with failed conservative management may be managed how?

A

surgical removal of the radial head with minimal functional impairment

46
Q

OA In humero-ulnar joint with failed conservative management may be managed how?

A

total elbow replacement, can only lift 2.5kg following the procedure

47
Q

what is cubital tunnel syndrome and what may cause it

A

compression of ulnar nerve behind medial epicondyle
tight band fascia forming roof
tightness at IM septum or between heads of flexor carpi ulnaris as nerve passes through

48
Q

what is froments test

A

adductor pollicis eakness cannot maintain thumb grip so flexor pollicis longus tries to maintain grip strength

49
Q

what is trigger finger

A

tendonitis of flexor tendon causing nodular enlargement that catches on the A1 pulley

50
Q

management options for trigger finger?

A

steroid injection

surgery to divide the A1 pulley

51
Q

where are ganglion cysts common

A

dorsal/volar wirst, foot, ankle, knee, DIPJ

52
Q

clinical signs and symptoms of a ganglion cyst?

A

firm, rubbery, transilluminate, lump

localised pain or irritation

53
Q

true/false - needle aspiration of a ganglion cyst is curative

A

false - it often recurs and so surgery is definitive, but can lead to scarring

54
Q

what is dupytrens contracture, describe the pathology

A

proliferative connective issue disorder involving myofibroblast and type 3 collagen proliferation and hyperplasia (instead of type 1)
leads to palpable nodules, skin puckering and contractures common to ring and little fingers

55
Q

in who is dupytrens contracture more common

A 
10x males 
north europe/scandanavia 
phenytoin 
diabetics 
alcoholic cirrhosis
56
Q

dupytrens contracture in penis is called?

A

peyronies disease

57
Q

dupytrens contracture in the feet is called

A

ledderhose disease

58
Q

up to ___ degrees contracture is tolerated in the MCPJ in dupytrens

A

30

59
Q

surgery for dupytrens involves what?

A

removing diseased tissue or division of cords

amputation in severe cases

60
Q

heberdens nodes are seen in PIPJ/DIPJ

A

DIPJ

61
Q

bouchards nodes are seen in PIPJ/DIPJ

A

PIPJ

62
Q

surgical intervention for DIPJ OA?

A

removal of ganglion cysts/osteophytes

Arthrodesis if severe

63
Q

surgical intervention for PIPJ OA?

A

Arthrodesis for index finger

arthrodesis may be done for other fingers but results vary

64
Q

how common is MCPJ OA and what causes it

A

quite rare

Gout, trauma, occupational stress, infection

65
Q

complications of MCPJ replacement

A

ulnar drift

extensor tendon subluxation

66
Q

management of 1st CMCJ OA

A

steroid injection for acute flare up

arthrodesis/arthroplasty for chronic pain

67
Q

causes of radiocarpal OA and management?

A

truama - scaphoid non-union/carpal dislocation

wrist arthroplasty/arthrodesis

68
Q

natural history of RA in the hands?

A

synovitis/tenosynovitis, inflammation in joints and tendon sheath
joint erosion due to inflammatory pannus
joint instability and tendon rupture extending to extensor tendon rupture/subluxation

69
Q

visible RA deformities in the hand on examination

A 
volar MCPJ subluxation 
ulnar deviation 
swan necking
boutonniere 
Z shaped thumb
70
Q

what is a swan neck deformity

A

hyperextended PIPJ and flexed DIPJ

71
Q

what is a boutonniere

A

flexed PIPJ with hyperextended DIPJ

72
Q

soft tissue management of hand RA

A

tenosynovectomy to prevent rupture
tendon transfer/fusion for extensor tendon rupture
soft tissue release for contractions

73
Q

bony joint surgical management for hand RA

A

MCP replacement
PIPJ replacement/fusion
wrist replacement/fusion

74
Q

what passes through carpal tunnel

A

FDS to 4 digits
FDP to 4 digits
FPL
median nerve

75
Q

causes of carpal tunnel

A 
idiopathic 
RA
Diabetes, hypothyroidism, chronic renal failure, pregnancy 
colles fracture or any 
women 8x
76
Q

clinical features carpal tunnel

A 
paraesthesiae in thumb and radial 2 1/2 fingers 
worse night 
lost sensation 
weak thumb 
clumsy 
muscle wasting thenar eminence 
\+ve tinels/phalens
77
Q

conservative/surgical management of carpal tunnel

A

wrist split at night + steroid injection

surgical division of transverse carpal ligament under local anaesthetic

78
Q

complication of division of transverse carpal ligament

A

median nerve damage or damage to one of its branches

MB2 Rheumatology and Orthopaedics (22 decks)

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