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Plastic Surgery( Grabb)Ali jasim > Tenosynovitis > Flashcards

Tenosynovitis Flashcards

1
Q

Lateral epicondylitis results from microtears at the origin of the common extensor tendon mass, specifically
the extensor carpi radialis brevis tendon

A

T

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2
Q

Medial epicondylitis affects the common flexor tendon
mass, most often the pronator teres and flexor carpi raclialis.

A

T

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3
Q

Conservative management is the mainstay of medial
epicondylitis treatment and some of the patients need to be assessed
for possible ulnar neuropathy.

A

F all patients should be assessed
for possible ulnar neuropathy.

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4
Q

Intersection syndrom approximately 4 cm proximal to the radiocarpal joint. It often resolves with nonoperative treatment
such as therapy and splinting.

A

T

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5
Q

Trigger fingers in Diabetics are less likely to
respond to nonoperative treatment

A

T

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6
Q

disorders involving the tendons of
the upper extremity are the result of degenerative or mechanical
stresses, rather than an inflammatory process

A

T

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7
Q

The causes of tendinopathy?

A

Degenerative, mechanical, inflammation,and infection

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8
Q

Lateral epicondylitis occurs in male more than female

A

F It is equally common in men and women

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9
Q

the
classic finding of lateral epicondylitis includes ECRB tendon pathology.

A

T

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10
Q

lateral epicondylitis involve ECRP only

A

F the extensor digitorum communis (EDC), and the ECU.
Although each of these tendons may be involved in the process

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11
Q

s within the ECRB tendon
substance represent the sine qua non for lateral epicondylitis.

A

T

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12
Q

Historically tendinosis rather than tenosynovitis was thought to occur in the lateral epicondylitis

A

F historically was thought it was inflammation rather than degenerative

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13
Q

Inflammatory cell are present in the histopathological study of lateral epicondylitis mainly macrophage

A

F Inflammatory cells, such as macrophages and neutrophils,
are lacking

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14
Q

repetitive contact between
the capitellum and the ECRB tendon may be the causative problem.

A

T

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15
Q

provocative maneuver
that may elicit increased pain

A

resisted wrist extension with the
elbow extended and the wrist pronated

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16
Q

Imaging studies add limited information in the diagnosis of lateralepicondylitis

A

T

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17
Q

Ultrasound (US) and magnetic resonance imaging (MRI) have both
been utilized for diagnosis, to assess disease severity and for purposes ofpreoperative planning

A

T

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18
Q

Ultrasound has been found to have higher sensitivity than MRI

A

F MRI is often the modality of choice, with
a higher sensitivity of 90% to 100%

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19
Q

However, the severity ofdisease
present on MRI does not necessarily correlate with symptoms

A

T

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20
Q

patients with resolved pain may continue to have pathologic findings
present on MRI

A

T

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21
Q

MRI is often reserved for recalcitrant cases in which
the patient fails to improve with 6 months of conservative treatment
or when the diagnosis in unclear

A

T

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22
Q

the condition usually clears up in eight to twelve months without any treatment except
perhaps avoidance of the painful movements

A

T

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23
Q

the mainstay of treatment for
lateral epicondylitis

A

activity modification

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24
Q

up to 40% of people continue to have discomfort after 1 to 5 years of
nonoperative treatment

A

T

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25
Q

Despite numerous randomized controlled
studies, none of these interventions has been definitively proven to
work better than rest and therapy alone.

A

T

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26
Q

Physical and occupational therapy for lateral Epicondylitis patients improved in the short term and in the long term

A

F short term only

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27
Q

Injections into and around the lateral epicondyle remain highly
controversial

A

T

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28
Q

Some studies have shown an
improvement in pain at 4 to 6 weeks after steroid injection , but this advantage usually is not
present at 12 months

A

T

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29
Q

Transient loss of
finger extension is a potential side effect of botox injection

A

T

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30
Q

Indication of surgery

A

patients who fail 6 to 12 months of conservative management and who remain significantly affected by pain

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31
Q

release of the ECRB from the lateral epicondyle, open,
or arthroscopic debridement of the ECRB tendinosis, denervation of
the lateral epicondyle, and anconeus rotation

A

T

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32
Q

Disadvantages of arthroscopic approach

A

include decreased visualization of the ECRB tendon, resulting in potential
incomplete debridement of diseased tissues, and greater possibility of radial nerve injury

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33
Q

the arthroscopic
approach has similar results to the open approach

A

T

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34
Q

Medial epicondylitis, also known as golfer’s elbow, is a common cause
of medial elbow pain

A

T

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35
Q

Medial epicondylitis occurs more than lateral epicondylitis

A

F medial elbow pain. Although less prevalent than lateral epicondylitis (<l% versus 3.4%)

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36
Q

medial epicondylitis is associated with repetitive movements and is
often found in patients 40 to 50 years old

A

T

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37
Q

Muscle involved in the medial epicondyle

A

The common flexor tendon is composed of five muscles including
the pronator teres (PT), FCR, flexor carpi ulnaris, palmaris longus,
and flexor digitorum superficialis

38
Q

the pathophysiology of the medial epicondylitis

A

Microtrauma from repetitive motion, specifically repetitive valgus loads, may result in mucoid degeneration of the tendons resulting in
the histopathologic findings of angiofibroblastic hyperplasia, fibrosis, and calcification

39
Q

DDX of medial epicondylitis?

A

elbow arthritis, osteochondral defects, medial collateral
ligament instability, cervical radiculopathy, pronator syndrome, and
ulnar neuritis/cubital tunnel syndrome

40
Q

Ulnar neuritis is especially
important as 23% to 61% of patients with medial epicondylitis also
have concurrent ulnar neuropathy

A

T

41
Q

Ultrasound can be used to assist in the diagnosis of medial epicondylitis, as it has been shown to be both specific and sensitive

A

T

42
Q

Treatments

A

Activity modification
Physical therapy, with common flexor mass stretching and strengthening
Counterforce bracing has shown some success
Elbow extension bracing
Corticosteroid injections for short term relieve( 6 week )

43
Q

Overall, in 88% to 96%
ofcases, nonoperative management and the passage oftime has been
shown to result in resolution ofsymptoms.

A

T

44
Q

Structure at risk in medial epicondylitis surgery

A

the ulnar nerve, the MCL and the medial antebrachial
cutaneous nerves

45
Q

De Quervain disease is a stenosing tendiopathy involving the first
dorsal extensor compartment

A

T

46
Q

radial-sided
wrist pain exacerbated by ulnar deviation of the wrist and thumb
abduction.

A

T

47
Q

De Quervain mor common in male

A

It is most common in the fifth and sixth decade of life
and is up to six times more common in women than men

48
Q

It is also more commonly seen in pregnant and
lactating women

A

T

49
Q

(APL) and extensor pollicis brevis (EPB)
travel together within the first dorsal compartment, which overlies
the radial styloid.

A

T

50
Q

the EPB can travel through its own
separate subsheath within the first compartment

A

T

51
Q

DDX od deQuervian

A

CMC joint arthritis of the
thumb, scaphotrapezial-trapezoid arthritis, intersection syndrome,
scaphoid fracture, and radial sensory nerve pathology

52
Q

Non operative treatment

A

nonsteroidal antiinflammatory medications along with splint immobilization with or without corticosteroid injection

53
Q

80% had complete and lasting
reliefofsymptoms after corticosteroid injection.

A

T

54
Q

patients who fail to improve
with corticosteroid injections have been found to have a higher rate
ofEPB subsheath than the general population

A

T

55
Q

The EPB should be
clearly identified and passively tested to ensure thumb metacarpal
extension before the surgical release is complete

A

T

56
Q

The percentage of EPB sub sheath

A

44% in the normal population and 62% in de Quervain disease patients.

57
Q

Intersection syndrome involves the contents of the second dorsal
compartment, the ECRL and ECRB as they cross beneath the first
compartment muscles (APL and EPB)

A

T

58
Q

Erythema and crepitation may be present.

A

T

59
Q

intersection syndrome is
an uncommon cause of wrist pain,

A

T

60
Q

MRI and ultrasound can be useful modalities for distinguishing between intersection syndrome and other
pathologies, such as de Quervain disease.

A

T

61
Q

Controversy exists as to whether stenosis of the second compartment
sheath alone versus friction between the first and second compartments is the underlying etiology

A

T

62
Q

Nonsteroidal antiinflammatory drugs (NSAIDs) combined with
splinting of the wrist in 20° ofextension for 2 to 3 weeks resolves most
cases. Refractory cases can be treated with a corticosteroid injection

A

T

63
Q

Trigger finger, also known as stenosing tenosynovitis

A

T

64
Q

lifetime risk percentage

A

of 2.6% in the general population and up to 10% in those with diabetes

65
Q

The Al pulley, located at the level of the metacarpal head is the site
of mechanical impingement seen in trigger finger

A

T

66
Q

The thumb’s Al
pulley is located near the MCP joint crease and is the site of flexor
pollicis longus triggering.

A

T

67
Q

repetitive motion of the flexor tendons
through the Al pulley leads to friction within the flexor sheath,
causing both thickening of the pulley and nodule formation within
the flexor tendon

A

T

68
Q

it
is not uncommon for patients to localize the problem to the proximal
interphalangeal (PIP) joint rather than the Al pulley

A

T

69
Q

association with specific
occupations has not been found

A

T

70
Q

patients with diabetes,
hypothyroidism, rheumatoid arthritis, gout, and renal failure develop
trigger fingers at higher rates

A

T

71
Q

there
is no evidence ofinflammation but there is evidence of fibrocartilage
metaplasia and upregulation of type 3 collagen

A

T

72
Q

Splinting of the MCP joint has been
shown to be successful in up to 66% of cases

A

T

73
Q

Splinting of the MCP joint has been
shown to be successful in up to 66% of cases

A

T

74
Q

with a higher success
rate (70%) in digits versus thumbs (50%) with splining

A

T

75
Q

The PIP joint can also be
splinted, instead of the MCP joint, with similar effect.

A

T

76
Q

Splinting is
recommended for 6 to 10 weeks both during the day and night, to
which some patients can find difficult to adhere

A

T

77
Q

Corticosteroid has proven effective in treating trigger fingers and
can be the first line intervention

A

T

78
Q

a second injection
increases the success rate

A

T

79
Q

The injections should be intrasheath

A

F Intrasheath injections are not required for effect,
and intratendinous injections should be avoided to reduce the risk of
tendon rupture

80
Q

Patients with diabetes do not respond as well to steroid injections;
some studies advocated for immediate surgical release or only one
attempt at injection before surgical intervention is considered

A

T

81
Q

number of injections
that should be attempted before proceeding to surgical release has
not been established

A

T

82
Q

Percutaneous
techniques have been shown to be successful with up to 95% resolution of symptoms in all patients

A

F except for the diabetic patient sand hypothyroidism

83
Q

statistically
significant increase in digital nerve injury with percutaneous release
versus open release

A

T

84
Q

complications of open release

A

chronic pain, infection, iatrogenic digital
nerve injury, incomplete release, and bowstringing

85
Q

trigger finger and de Quervain disease are the most common tendinopathies of the hand and wrist

A

T

86
Q

treatment of EPL tendinitis is often surgical
with complete release of the third dorsal compartment, to prevent
rupture of the EPL

A

T

87
Q

The floor of the ECU tendon sheath is an important contributor
to the triangular fibrocartilage complex

A

T

88
Q

Injecting local anesthesia into the ECU subsheath can be a helpful
diagnostic tool

A

T

89
Q

Almost every
tendon in the hand and wrist can cause pain if irritated through
mechanical stresses or stenosing forces

A

T but Atypical conditions has been recorded
include tendinopathy of the extensor carpi ulnaris (ECU), flexor
carpi radialis (FCR), and extensor pollicis longus (EPL

90
Q

Green classification of the trigger finger

A

Grade one pain only at the A1 LEVEL
Grade 2 catching finger
Grade 3 Looked digit passively corrected
Grade 4 fixed flexion

91
Q

Percutaneous
techniques have been shown to be successful with up to 95% resolution of symptoms

A

T

92
Q

statistically
significant increase in digital nerve injury with percutaneous release
versus open release,44 which may be most germane to the thumb

A

T

Plastic Surgery( Grabb)Ali jasim (92 decks)

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