Shoulder, Upper Limb & Hand - Conditions Flashcards
contents of carpal tunnel
9 flexor tendons + flexor tendon synovial sheath, median nerve
what joints make up the elbow
humeroulnar & radio-capitellar joint
what is a bankart lesion
anterior shoulder dislocation, labrum lesion
movement most affected by glenohumeral instability
external rotation
is anterior or posterior shoulder dislocation more common
anterior
what sign on examination is positive in anterior shoulder dislocation
sulcus sign
what nerve is at risk in anterior shoulder dislocations and how would this present
axillary nerve regimental area numb
how to diagnose a posterior shoulder dislocation
light bulb sign, oblique x-ray
what increases the likeliness of repeat shoulder dislocation
under 20 yrs
management of shoulder dislocation
closed reduction, XR, slight 2-3weeks +- PT
what shoulder movements are hardest on a biceps tendon tear
flexion & pronation
how diagnose biceps tendon tear
US
deformity seen in a biceps tendon tear
popeye
management of a biceps tendon tear
conservative
management options of shoulder pain
NSAID, depo medrone CCS + lignocaine injection, PT
age most commonly affected by impingement syndrome
30-40
other name of impingement syndrome
painful arc
pathology of impingement syndrome
supraspinatus compressed in subacromial space on movement, AC OA/RC tear
presentation of impingement syndrome
pain 60-120° abduction, +ve Hawkins-Kennedy
what is seen on x ray in impingement syndrome
eye brows sign
Mx of impingement synd
NSAID/analgesia/early PT/subacromial CCS
last line Mx of impingement synd
subacromial decompression
age and gender affected by frozen shoulder
40-60 female
other name for frozen shoulder
adhesive capsulitis
presentation of frozen shoulder
progressive pain/stiff, loss of external rotation
what is seen on xr in frozen shoulder
normal
risk factors for frozen shoulder
diabetes, Dupuytren
management of frozen shoulder
PT/analgesia, intraarticular CCS, self-limiting 3-4yr
pathology of frozen shoulder
decreased joint volume
age most likely affected by rotator cuff tear
50-60 years
presentation of rotator cuff tear
painful and weak abduction, external and internal rotation. +- sudden jerk
tendon affected by RC tear
supraspinatus
investigations for RC tear
1st line US
also MRI/SR
management of rotator cuff tear
subacromial injection, repair + subacromial decompression
what is lateral epicondylitis
tennis elbow
what is medial epicondylitis
golder’s elbow
what is the pathology of tennis elbow
degenerative micro-tear
presentation of tennis elbow
tender/pain on wrist/ finger extension
management of tennis elbow
PT, NSAID, CCS injection, elbow brace
what is the posterior fat pad sign and when is it seen
elbow effusion, severe trauma
injury mechanism of surgical neck of humerus fracture
foosh
complications of surgical neck of humerus fracture
axillary nerve/artery/ brachial plexus injury
management of surgical neck of humerus fracture in a young PTx
orif
management of surgical neck of humerus fracture in an old PTx
conservative/ORIF/TSR
complication of humeral shaft fracture and how does it present
radial nerve injury presents with wrist drop
what is a monteggia fracture
high energy ulnar # + radial head dislocation
management of monteggia fracture
ORIF
age affected by monteggia fractures
adults & child
what is a galeazzi fracture
isolated distal 1/3 radius # + DRUJ dislocation
management and investigations of galeazzi fracture
lateral wrist XR, ORIF
ages affected by galeazzi fracture
adults & child
what is a nightstick fracture
isolated ulna
management of nightstick fractures
conservative
injury mechanism of a colles fracture
FOOSH
what is a colles fracture
extra-articular distal radial #
risk factor for colles fracture
OP
management of a stable colles fracture
POP
management of displaced simple colles fracture
MUA
management of displaced comminuted colles fractur e
MUA+K-wires/screw, ORIF
complications of a colles fracture
median nerve compression, EPLT rupture, CRPS, < grip strength
where do giant cell tumours of tendon sheath occur
flexor tendon palmar surface near PIP
histology of giant cell tumour of tendon sheath
haemosiderin deposit
management of giant cell tumour of tendon sheath
if pain excise
what is trigger finger also called
flexor tendon tenosynovitis
presentation of trigger finger
palmar pain/ nodule; middle/ring finger clicks in flexion
management of trigger finger
resolve/splint/ CCS
what nerve is affected by cubital tunnel synd
ulnar nerve
what nerve is affected by carpal tunnel synd
median nerve
presentation of carpal tunnel synd
thumb+2.5 paraesthesia, worse at night,
risk factors for carpal tunnel synd
women, RA, pregnancy, diabetes, CKD, Colles #
management of carpal tunnel synd
splint, PT, IJ CCS
last line Mx of carpal tunnel synd
decompression surgery
risk factors for dupuytren’s contracture
phenytoin, diabetic, male, smoke, alcoholic, FH
pathology of dupuytren’s contracture
palmar fascia hyperplasia/scarring, type 3 collagen
presentation of dupuytren’s contracture
ring/pinky fixed flexion, nodule /puckered
is dupuytren’s contracture bilateral
50 percent of the time
examination technique for duputren’s contracture
table top test
name of dupuyten’s contracture of the penis
peyronie’s disease
name of dupuytren’s contracture of the feed
lederhosen
management of dupuytren’s contraction
fasciectomy/fasciotomy if it interferes w/ function
what is a boxer’s fracture
5th MC neck fracture
pathology of acute calcific tendonitis
Ca deposit in supraspinatus tendon
acute calcific tendonitis Mx
subacromial CCS then self limiting
acute calcific tendonitis presentation
acute onset severe shoulder pain
what is a smiths fracture
distal radius extra-artiuclar displaced + angulated
injury mechanism of a smiths fracture
elderly person falls on hyperflexed wrist
management of smith’s fracture
all unstable; ORIF
what is a barton fracture
intra-articular radial #
barton fracture mx
ORIF, comminuted ex fix +- k-wire
injury mechanism of scaphoid fracure
foosh
presentation of scaphoid fracture
young male snuffbox pain or when pressing on thumb metacarpal
investigations for scaphoid fracture
xr: wait 10 day, 4 views
complications of scaphoid fracture
OA, nonunion, AVN
management of scaphoid fracture
splint before xr, confirmed: POP 6-12wk, ORIF if displaced
pathology of ganglion
synovial fluid outpouching, firm smooth mucous filled
location of ganglion
adjacent to tendon/synovial joint
management of ganglion
self limiting, pain; aspirate/excise
pathology of dequervain’s tenosynvoitis
EPB & APL thumb tendon inflam
dequervain’s tenosynovitis presentation
pain/swollen/red at styloid process, Finklestein’s test
what is paronychia and who gets it
nail fold infection, nail biting child
paronychia mx
elevate/ABx/drain/resolve
cause of boutonniere deformity
ra
what is boutonniere deformity
central slip extensor tendon rupture
boutonniere deformity mx
tendon transfer
presentation of cubital tunnel synd
pinky paraesthesiae, weak ulnar nerve muscles
what is mallet finger
avulsion finger# on extensor tendon from forced extension, can’t extend DIPJ
mallet finger mx
mallet splint 6wk
management of pipj dislocation
buddy strap 3wk
