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CMT-dos > Upper extremity > Flashcards

Upper extremity Flashcards

1
Q
A
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2
Q

Wrist: Ganglion Cyst

general
Common causes

A

Pathophysiology: soft tissue lump or a “bleb” near a joint or tendon sheath; filled with synovial fluid

Common after trauma or result of OA

can resolve on its own

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3
Q

wrist: ganglion cyst

Sx/complaints

A

Common symptoms/complaints:
Tightness, soft and usually mobile
Can be painful
Minimal decrease in motion

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4
Q

wrist ganglion cyst

PE, testing

A

Physical Exam:
Soft/hard, mobile, sometimes painful, fluid filled lump

Tests: not necessary
US if needed:
NEAR RADIAL ARTERY

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5
Q

wrist: ganglion cyst

Tx

A

Treatment:
Depends on pain
NSAIDs/rest
Aspiration and/or injection
Surgical excision

Most common site is the wrist
Cysts can come and go

US if needed:
NEAR RADIAL ARTERY

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6
Q

Wrist: DeQuervain’s Tenosynovitis

general and causes

A

Pathophysiology: tenosynovitis of the tendons/tendon sheaths of the first dorsal compartment at the wrist

Causes: result of increase/repetitive wrist motion/activity

Can be caused by repetitive motion (factory work)

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7
Q

Wrist: DeQuervain’s Tenosynovitis

common Sx/complaints

A

Common symptoms/ complaints:
Wrist pain/swelling
Difficulty w/wrist motion

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8
Q
A
Tendons of the first dorsal compartment
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9
Q

Wrist: DeQuervain’s Tenosynovitis

PE/tests

A

Physical Exam:
TTP adjacent to snuffbox and proximal to the 1st CMC joint
Little to no swelling
+ Finkelstein

Tests: no testing needed but x-rays can help to r/o differentials

with ulnar deviation- finkelstein
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10
Q

Wrist: DeQuervain’s Tenosynovitis

Tx

A

Treatment:
Rest/thumb spica/ immobilization
Topicals/NSAIDs or Tylenol
Steroid injection
Surgical release of tendon sheath

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11
Q

Wrist: TFCC Tear

What the TFCC is: Triangular fibrocartilage complex

A

Ulnocarpal ligaments
Subsheath of extensor carpi ulnaris tendon
Radioulnar ligaments
Central fibrocartilaginous disk

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12
Q

Wrist: TFCC Tear

patho

A

Pathophysiology: Tear from a fall onto an outstretched hand or other high-force wrist loading trauma. Can also be the result of degeneration.

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13
Q

Wrist: TFCC Tear

Common symptoms/ complaints:

A

Mostly just c/o deep pain at ulnocarpal joint

trouble supinating/pronating/shaking hands

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14
Q

Wrist: TFCC Tear

Physical Exam:

A

Tender to palpation just distal to the ulnar head
Rotation of the wrist> painful catch or clunk
Testing the DRUJ in pronation/supination
One hand on radius/ulna-just proximal to wrist-
manip back/forth(Always compare to contralateral)
Passive ulnar deviation of the wrist may worsen their pain

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15
Q

Wrist: TFCC Tear

Imaging Tests:

A

MRI should confirm TFCC tear; might need arthrogram,
CT or MRI with contrast
Arthroscopy can also be performed

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16
Q

TFCC tear

Tx

A

Treatment:
Bracing/ immobilization for a couple of months
Physical therapy
Surgical repair

17
Q

TFCC

A

contrast should not be freely flowing, should be contained

18
Q

Wrist: Arthritis

general

A

Pathophysiology:
Mechanical/degenerative loss of articular cartilage of the wrist
Causes: trauma, RA, heredity

19
Q

wrist arthritis

Common symptoms/ complaints:

A

Joint pain
Pain with activity
Grinding/ crepitus
Swelling/Stiffness

20
Q

wrist arthritis

PE/Tests

A

Physical Exam:
TTP within the wrist joint at the distal radius
Limited motion
Crepitus

Tests:
X-rays (joint space narrowing, osteophytes, sclerosis, subchondral cysts, malalignment, etc)

21
Q

Wrist: Arthritis

Tx

A

Treatment:
Topical creams –Salonpas/CBD
NSAIDs/Tylenol
Bracing
Gentle exercise/PT
Steroid injection

Surgical repair has 2 options:
Arthrodesis
Joint replacement

22
Q

Carpal Tunnel Syndrome

general

A

Pathophysiology: compression of the median nerve within the carpal tunnel> the “roof” or transverse carpal ligament (AKA flexor retinaculum)

Causes-repetitive hand use, or hand/wrist motion, pregnancy, DM,RA

23
Q

carpal tunnel

common complaints

A

Common complaints from patients are numbness, tingling and weakness in the hand and fingers –not always specific

24
Q

Wrist: Carpal Tunnel Syndrome

PE/Tests

A

Numbness/tingling through the median nerve distribution
Pain
Weakness/thenar wasting (atrophy)
+ Tinel and Phalen signs

Tests:
EMG/ NCV
https://youtu.be/ztQPvUk-Z8E
US will sometimes show flattening of the nerve within the tunnel

25
Q

carpel tunnel

Tx

A

Treatment:
Rest
Bracing/ immobilization
NSAIDs/Tylenol
Steroid injection
Surgery (open or scope)

Misc:
If muscle wasting has started, prognosis is not as good

26
Q

Wrist: Ulnar Nerve Entrapment

general

A

Pathophysiology:
Ulnar nerve within Guyon canal is compressed
Often involves a small mass like a lipoma or ganglion

Causes are similar to CTS (repetitive hand/wrist activity)

27
Q

Ulnar Nerve Entrapment

Common symptoms/ complaints:

A

Pain
Numbness, burning, tingling in ulnar nerve distribution but only volar (not dorsal)

28
Q

Ulnar Nerve Entrapment

Tx

A

Treatment:
Splinting/ bracing is not usually helpful
Steroid injection is not a good option
(accuracy is difficult)
Straight to surgery usually

29
Q

Ulnar Nerve Entrapment

PE/Tests

A

Physical Exam:
Pain
Numbness, burning, tingling in ulnar nerve distribution but only volar (not dorsal)
+ Tinel over Guyon canal

Tests:
EMG/NCV
US or MRI to look for masses

30
Q

Wrist: Radial Neuropathy

General and causes

A

Pathophysiology: at the wrist- compression of the superficial radial nerve (dorsal-lateral hand)

Causes include: trauma, tight clothes/accessories (watch)

Can also occur due to compression at the axilla from crutches, someone sleeping on the arm, sleeping with arm over a chair (Saturday night palsy)

31
Q

radial neuropathy

common Sx

A

Common symptoms/ complaints:
Numbness and possibly weakness
Superficial radial nerve distribution

32
Q

radial neuropathy

PE/Tests

A

Physical Exam:
Numbness to dorsal-lateral hand (see pic)
Depending on location of compression, different areas of weakness may develop
+Tinel at area of compression

Tests: EMG/NCV only if symptoms don’t resolve within a few days of stopping the compression

33
Q

wrist:radial neuropathy

Tx

A

Treatment:
Splinting with thumb spica (immobilizes thumb)
Can try NSAIDS/PT

Treatment: a lot of times nothing

CMT-dos (95 decks)

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