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Surgery finals > Shoulder, elbow, wrist + hand > Flashcards

Shoulder, elbow, wrist + hand Flashcards

1
Q

Describe the anatomy of the shoulder

A

Bones:
AC joint: acromion of scapula w clavicle
GH (shoulder) joint: glenoid cavity of scapula w humerus
-Deepened by glenoid labrum (increase contact)

Bursae
Ligaments eg. GH, CA, CH 
Muscles: rotator muscles + tendons
-Supraspinatus
-Suprascapularis
-Subscapularis
-Teres minor
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2
Q

Describe the types of shoulder dislocation

A

Described based on location of humeral head relative to glenoid cavity
Anterior: most common. Extension + lateral flexion injury
Posterior
Inferior

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3
Q

What nerve injury may result from shoulder dislocation?

A

Axillary nerve injury -> parasthesia/anaesthesia over ‘regimental badge’ area

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4
Q

Describe the aetiology of shoulder dislocation

A

2 peaks: young M and older F
Young: high-impact eg sports
Old: falls, blows

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5
Q

Describe the movements of the shoulder in relation to the muscles of the shoulder

A 
Abduction: 
-First 15˚: supraspinatus
->15˚: deltoid
Flexion: biceps 
Extension: triceps
Internal rotation: subscapularis
External rotation: infraspinatus + teres minor
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6
Q

Describe the presentation of shoulder dislocation

A
  • Pain following traumatic incident
  • Characteristic posturing
  • Anterior: externally rotated + abducted
  • Posterior: internally rotated + adducted
  • Decreased movement + pain with movement
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7
Q

Describe the common shoulder fractures and mechanism of injury

A

Clavicle fracture: common. Fall on shoulder/ outstretched hand
Scapular: uncommon. High speed RTA
Humeral: eg surgical neck. Blow/fall on hand.

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8
Q

Describe the management of shoulder fractures

A

Clavicle:
-Sling immobilisation or surgical

Scapula:
-Conservative: rest, analgesia, physio

Humeral:
-Surgical

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9
Q

Describe the complications of humeral fractures depending on their location

A

Surgical neck:

  • Damage to axillary N and posterior circumflex A
  • > numbness over regimental badge, difficulty with abduction

Mid-shaft:

  • Damage to radial N + profunda brachii A
  • > wrist drop, numbness over dorsum of hand

Supracondylar (above epicondyles)

  • Damage to brachial A + median/radial/ulnar N
  • > ischaemia -> Volkmann’s ischaemic contracture (hand)
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10
Q

Describe the different types of rotator cuff pathology

A
  • Tears: traumatic (eg w dislocation)
  • Tendonitis: chronic
  • Subacromial bursitis
  • Impingement: occurs w age
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11
Q

Describe the presentation of rotator cuff pathology

A

-Shoulder pain: worse with overhead activity
+/- traumatic event
-Decreased movement/weakness

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12
Q

Describe the signs of rotator cuff pathology on examination

A
  • Pain on movement esp abduction, int + ext rotation
  • Weakness (full thickness tears)
  • Specific tests for individual muscles:
    1. Empty can test: supraspinatus
    2. Ext rotation test: infraspinatus
    3. Lift off test: subscapularis
    4. Belly press test: subscapularis
  • Impingement tests: Neer + Hawkins- pain elicited
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13
Q

Describe the management of rotator cuff pathology

A

Conservative: acute not suitable for surgery, chronic

  • Rest, ice, stretching + physio
  • NSAIDs

Surgical: acute + fit for surgery, chronic non-responsive

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14
Q

Describe the management of shoulder dislocation

A
  • Assess for neurovascular compromise
  • Analgesia
  • Reduction under sedation eg. propofol
  • Sling for 3-4 weeks
  • Physio
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15
Q

Define adhesive capsulitis

A

Adhesive capsulitis AKA frozen shoulder is a condition characterised by pain + reduced ROM in the shoulder

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16
Q

Describe the epidemiology + RFs of adhesive capsulitis

A
  • Not very common
  • Affects middle aged
  • RFs: DM, thyroid disease, previous trauma, surgery
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17
Q

Describe the presentation of adhesive capsulitis

A

-Insidious onset shoulder pain
-Stiffness + difficulty w ADLs
4 classic stages: takes about 1-3 years overall
1. Pain predominates, not much movement reduction
2. Pain v bad, movement reduced
3. Pain improved, movement reduced
4. Pain resolved
Stiffness resolves slowly

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18
Q

Describe the investigations for adhesive capsulitis

A

Normal investigations- Dx of exclusion (fractures, rotator cuff pathology etc)

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19
Q

Describe the management of adhesive capsulitis

A

Conservative: mainstay

  • Rest
  • PHYSIO
  • Analgesia

Medical:

  • Steroid injection if unresponsive
  • Hydrodilatation

Surgical:

  • Manipulation under anaesthetic
  • Arthroscopic capsular release
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20
Q

Give some differential diagnoses for shoulder pain

A

Trauma-related:

  • Fracture
  • Dislocation
  • Rotator cuff pathology eg tear

Non-traumatic:

  • Impingement
  • Sub-acromial bursitis
  • Adhesive capsulitis
  • Arthritis: OA, inflammatory, septic
  • Malignancy
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21
Q

Describe the presentation of epicondylitis

A
  • Pain over the medial/lateral side of the posterior elbow

- Hx of overuse of muscles in forearm

22
Q

What are the types of epicondylitis and how are they different?

A

Medial + lateral
Medial: overuse of forearm flexors- ‘golfer’s elbow’
Lateral: overuse of forearm extensors- ‘tennis elbow’

23
Q

Describe the investigations and management of epicondylitis

A

Ix: none needed unless unclear
Management is conservative for 6-12 weeks
-Rest, ice, +/- brace
-NSAIDs
-> physio
Referral + surgical treatments considered after

24
Q

Describe the presentation of olecranon bursitis

A
  • Red, hot, tender lump on posterior elbow

- Golf-ball like

25
Describe the common fractures of the forearm and mechanism of injury
Radial: - Colle's: most common. Distal radius # causing posterior displacement of hand. FOOSH. - Smith's: opposite of Colle's. Distal radius # causing anterior displacement of hand. Fall on back of hand - Galeazzi's: radial shaft fracture + ulnar dislocation Ulnar: usually shaft, frequently occurs w radial. Direct blow -Monteggia's: ulnar fracture + radial dislocation
26
Describe the management of forearm fractures
- Analgesia - Assess neurovascular compromise - Imaging Conservative: - Closed reduction + backslab -> POP - Remove after 6 weeks + physio Surgical: - MUA + Kirschner wires - ORIF
27
What are the commonly fractured bones in the hand?
Scaphoid: FOOSH Metacarpals: -Boxer's: 5th metacarpal -Bennett's: base of 1st metacarpal
28
Name the carpal bones
Proximal, from thumb to little finger: -Scaphoid, lunate, triquetrum, pisiform Distal, from little finger to thumb: -Hamate, capitate, trapezoid, trapezium
29
Describe the presentation of scaphoid fracture
- FOOSH | - Pain + tenderness in anatomical snuffbox, worse on pinching/grasping
30
Describe the implications of scaphoid anatomy on management/prognosis
Scaphoid receives retrograde blood supply - Distal fractures heal well, conservative Mx - Proximal/waist fractures risk avascular necrosis/poor healing. Conservative or surgical Mx.
31
What is trigger finger?
Aka stenosing tenosynovitis | -Inflammation of the sheath of the tendon, causing it to catch in flexed position + requires manual extension
32
Describe the epidemiology + RFs for trigger finger
Middle aged F | RFs: RA, DM, carpal tunnel syndrome
33
Describe the management of trigger finger
Conservative: -Rest, splinting, stretching Medical: -Steroid injection Surgical: -Tenolysis for intractable
34
What is Dupuytren's contracture?
Progressive, painless fibrotic thickening of the palmar fascia
35
Describe the epidemiology + RFs for Dupuytren's contracture
M, middle aged - Idiopathic - Alcoholic liver disease - DM - Fibrotic conditions eg. thyroiditis
36
Describe the presentation of Dupuytren's
- Skin thickening, puckering, tethering, etc - Loss of mobility of overlying skin - Nodules -> thickened cord - Contractures
37
Describe the management of Dupuytren's
Identify + treat underlying cause if any | Surgical referral if contractures develop: fasciectomy/-otomy
38
What is de Quervain's tenosynovitis?
A condition characterised by swelling + inflammation of the tendon sheaths in the wrist -Typically affects abductor pollicis lungus/ extensor pollicis brevis
39
Describe the epidemiology + RFs for de Quervain's tenosynovitis
Middle aged F | RFs: RA, pregnancy
40
Describe the presentation of de Quervain's tenosynovitis
- Pain and stiffness around thumb base - Exacerbated by gripping/forming fist - Catching/snapping sensation
41
Describe the classic sign/test to diagnose de Quervain's tenosynovitis
Finkelstein's test -Make a fist with thumb tucked in -Ulnar deviation 'bend wrist towards pinky' +: painful
42
Describe the management of de Quervain's tenosynovitis
Conservative: - Splinting, rest - NSAIDs Medical: -Steroid injection Surgical: -Tenolysis
43
What is a ganglion cyst?
Sac of synovial fluid that originates from the tendon sheaths/joints
44
Describe the presentation of ganglion cyst
- Rapidly growing lump on the dorsum of the hand | - Firm, non-tender, transilluminates
45
Describe the management of a ganglion cyst
Conservative: -Wait (50% resolve spontaneously) Medical: -Aspiration. Likely to recur Surgical: -Excision. Risk of complications
46
Describe the anatomy of the carpal tunnel
Formed by flexor retinaculum and carpal bones | Contains flexor tendons (flexor digitorum + pollicis longus) and median nerve
47
Describe the epidemiology and RFs for carpal tunnel syndrome
``` Classically middle aged F RFs: -Obese -Pregnancy -Frequent keyboard use/wrist movements -Radial fracture -Acromegaly ```
48
Describe the presentation of carpal tunnel syndrome
- Gradual onset, intermittent tingling/numbness in the hand + pain - Pain: in wrist, worse with activity + at night, radiates to forearm. Relieved by shaking/flicking wrist - Clumsiness of hand
49
Describe the signs of carpal tunnel syndrome on examination
-Reduced sensation in 1+2+3rd finger, spares thenar eminence +/- wasting/weakness of the thenar muscles -Tinel's sign: tap the flexor retinaculum -Phalen's sign: press backs of hands together
50
Describe the investigations for carpal tunnel syndrome
- History and examination - EMG - Bloods for underlying eg. FBC, TFTs, antibodies
51
Describe the management of carpal tunnel syndrome
Conservative: - Rest, stretching - Splint (1 month trial) Medical: -Steroid injections Surgical: -Surgical release

Surgery finals (16 decks)

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