Tenosynovitis

Question 1

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

Answer 1

T

Question 2

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

Answer 2

T

Question 3

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

Answer 3

F all patients should be assessed
for possible ulnar neuropathy.

Question 4

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

Answer 4

T

Question 5

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

Answer 5

T

Question 6

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

Answer 6

T

Question 7

The causes of tendinopathy?

Answer 7

Degenerative, mechanical, inflammation,and infection

Question 8

Lateral epicondylitis occurs in male more than female

Answer 8

F It is equally common in men and women

Question 9

the
classic finding of lateral epicondylitis includes ECRB tendon pathology.

Answer 9

T

Question 10

lateral epicondylitis involve ECRP only

Answer 10

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

Question 11

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

Answer 11

T

Question 12

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

Answer 12

F historically was thought it was inflammation rather than degenerative

Question 13

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

Answer 13

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

Question 14

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

Answer 14

T

Question 15

provocative maneuver
that may elicit increased pain

Answer 15

resisted wrist extension with the
elbow extended and the wrist pronated

Question 16

Imaging studies add limited information in the diagnosis of lateralepicondylitis

Answer 16

T

Question 17

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

Answer 17

T

Question 18

Ultrasound has been found to have higher sensitivity than MRI

Answer 18

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

Question 19

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

Answer 19

T

Question 20

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

Answer 20

T

Question 21

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

Answer 21

T

Question 22

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

Answer 22

T

Question 23

the mainstay of treatment for
lateral epicondylitis

Answer 23

activity modification

Question 24

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

Answer 24

T

Question 25

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

Answer 25

T

Question 26

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

Answer 26

F short term only

Question 27

Injections into and around the lateral epicondyle remain highly controversial

Answer 27

T

Question 28

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

Answer 28

T

Question 29

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

Answer 29

T

Question 30

Indication of surgery

Answer 30

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

Question 31

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

Answer 31

T

Question 32

Disadvantages of arthroscopic approach

Answer 32

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

Question 33

the arthroscopic approach has similar results to the open approach

Answer 33

T

Question 34

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

Answer 34

T

Question 35

Medial epicondylitis occurs more than lateral epicondylitis

Answer 35

F medial elbow pain. Although less prevalent than lateral epicondylitis (

Question 36

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

Answer 36

T

Question 37

Muscle involved in the medial epicondyle

Answer 37

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

Question 38

the pathophysiology of the medial epicondylitis

Answer 38

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

Question 39

DDX of medial epicondylitis?

Answer 39

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

Question 40

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

Answer 40

T

Question 41

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

Answer 41

T

Question 42

Treatments

Answer 42

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 )

Question 43

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

Answer 43

T

Question 44

Structure at risk in medial epicondylitis surgery

Answer 44

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

Question 45

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

Answer 45

T

Question 46

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

Answer 46

T

Question 47

De Quervain mor common in male

Answer 47

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

Question 48

It is also more commonly seen in pregnant and lactating women

Answer 48

T

Question 49

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

Answer 49

T

Question 50

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

Answer 50

T

Question 51

DDX od deQuervian

Answer 51

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

Question 52

Non operative treatment

Answer 52

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

Question 53

80% had complete and lasting reliefofsymptoms after corticosteroid injection.

Answer 53

T

Question 54

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

Answer 54

T

Question 55

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

Answer 55

T

Question 56

The percentage of EPB sub sheath

Answer 56

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

Question 57

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)

Answer 57

T

Question 58

Erythema and crepitation may be present.

Answer 58

T

Question 59

intersection syndrome is an uncommon cause of wrist pain,

Answer 59

T

Question 60

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

Answer 60

T

Question 61

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

Answer 61

T

Question 62

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

Answer 62

T

Question 63

Trigger finger, also known as stenosing tenosynovitis

Answer 63

T

Question 64

lifetime risk percentage

Answer 64

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

Question 65

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

Answer 65

T

Question 66

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

Answer 66

T

Question 67

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

Answer 67

T

Question 68

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

Answer 68

T

Question 69

association with specific occupations has not been found

Answer 69

T

Question 70

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

Answer 70

T

Question 71

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

Answer 71

T

Question 72

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

Answer 72

T

Question 73

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

Answer 73

T

Question 74

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

Answer 74

T

Question 75

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

Answer 75

T

Question 76

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

Answer 76

T

Question 77

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

Answer 77

T

Question 78

a second injection increases the success rate

Answer 78

T

Question 79

The injections should be intrasheath

Answer 79

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

Question 80

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

Answer 80

T

Question 81

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

Answer 81

T

Question 82

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

Answer 82

F except for the diabetic patient sand hypothyroidism

Question 83

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

Answer 83

T

Question 84

complications of open release

Answer 84

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

Question 85

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

Answer 85

T

Question 86

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

Answer 86

T

Question 87

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

Answer 87

T

Question 88

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

Answer 88

T

Question 89

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

Answer 89

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

Question 90

Green classification of the trigger finger

Answer 90

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

Question 91

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

Answer 91

T

Question 92

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

Answer 92

T