The Elbow and Hands

Question 1

Where does tennis elbow affect

Answer 1

lateral epicondyle (lateral epidcondylitis)

Question 2

When can lateral epicondylitis occur

Answer 2

repetitive strain injury in tennis players
degenerative enthesopathy (inflammation of origin or insetion of a tendon or ligament into bone)

Question 3

What are the clinical features of lateral epicondylitis

Answer 3

Painful and tender lateral epicondyle

Pain on resisted middle finger and wrist extensions

Question 4

Where does golfers elbow effect

Answer 4

medial epicondyle (medial epicondylitis)

Question 5

What is dupytens contracture?

Answer 5

A proliferative connective tissue disorder where the specialised palmar ascia undergoes hyperplasia with normal fascial bands forming nodules and cords progressing to contractures at the MCP and PIP joints

Question 6

Where do contractures most commonly affect

Answer 6

the ring and little fingers

Question 7

What is the pathology of dupytrens

Answer 7

proliferation of myofibroblast cells and the production of abdnormal collagen (type 3 rather than type 1)

Question 8

Which gender is more commonly affected by dupytrens

Answer 8

males

also more common in scandanavians

Question 9

What conditions may dupytens be seen in

Answer 9

alcoholic cirrhosis
side effect of phenytoin therapy
more common in diabetics
Fibromatoses- Peyronie’s disease and plantar fibromatosis (ledderhose disease)

Question 10

What is a faciectomy

Answer 10

removal of all the diseased tissue

Question 11

what is a fasciotomy

Answer 11

division of cords

Question 12

What causes a trigger finger

Answer 12

tendonitis of a flexor tendon to a digit can result in nodular enlargement of the affected tendon (usually distal to a fascial pulley over the metacarpal neck)

Question 13

What happens in a trigger finger

Answer 13

movement of the finger produces a clicking sensation which may be painful and the finger may lock in a flexed position and must be forcibly extended

Question 14

What can relieve symptoms in a trigger finger

Answer 14

steroid injection around the tendons within the sheath will relieve symptoms

Question 15

What is a ganglion cyst?

Answer 15

Mucininous filled cysts found adjacent to a tendon or synovial joint

Question 16

What is a ganglion cyst in the knee called

Answer 16

baker’s cyst

Question 17

What are the cysts like

Answer 17

firm, smooth rubbery and should transilluminate

Question 18

How can ganglion cysts be treated

Answer 18

Needle aspiration (be careful volar ganglion may be near radial artery)
recurrence is common
usually cosmetic - will almost always recurr

surgical excision if localised discomfort - must remove entire cyst or will come back

Question 19

Give another cause for a swelling in the hand

Answer 19

giant cell tumour of tendon sheath

Question 20

Where are giant cell tumours of the tendon sheath usually

Answer 20

on the palmar surface around PIP joints or index and middle fingers

Question 21

What is the histology of the giant cell tumours

Answer 21

multinucleated giant cells

haemosiderin (hence their brown appearance)

Question 22

what is the common insertion point of the extensors at the elbow

Answer 22

lateral epicondyle

Question 23

what is the common insertion point of the flexors t the elbow

Answer 23

medial epicondyle

Question 24

management of tennis and golfers elbow

Answer 24

rest from activity causing the pain
physio 
NSAIDS
steroid injection - risk of ulner never damage in golfers elbow
use of brace (elbow claso)
rarely surgery

Question 25

in an elbow replacement what are patients resticted to

Answer 25

can only lift 2.5 kg in that arm post op

Question 26

what is fibromtoses of the penis called

Answer 26

peyronie’s disease

Question 27

what is planta fibromatorisi called

Answer 27

ledderhose disease

Question 28

indications for surgery in dupytrens

Answer 28

if interfering with function
more than 30 degrees contracture at MCP
any contracture at PIP as these are poorly tolerated

Question 29

what pulley is usually affected in trigger finger

Answer 29

A1

Question 30

what fingers are usually affected in trigger finger

Answer 30

middle or ring

Question 31

treatment of trigger finger

Answer 31

steroid injection
surgery if recurrent or persitant - division of pulley

NB division of A1 pully does not affect function

Question 32

treatment of giant cell tumour of tendon sheathq

Answer 32

excision to prevent local spread and to treat symptoms

can reoccur in around 10-20 percent

Question 33

what is de quervians tenosynovitis

Answer 33

sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed

Question 34

features of de quervians tenosynovitis

Answer 34

pain on the radial side of the wrist
tenderness over the radial styloid process
abduction of the thumb against resistance is painful
Finkelstein’s test: with the thumb is flexed across the palm of the hand, pain is reproduced by movement of the wrist into flexion and ulnar deviation