Upper Extremity Conditions

Question 1

What is thoracic outlet syndrome?

Answer 1

Compression of the neurovascular bundle in the thoracic outlet between bony and soft tissue structures.

Question 2

List 4 areas that are commonly compressed in cases of thoracic outlet syndrome.

Answer 2

Superior thoracic outlet
Scalene triangle
Between clavicle and first rib
Between pec minor and thoracic wall

Question 3

List 4 special tests used to assess for the presence of thoracic outlet syndrome.

Answer 3

Adson’s test
Roos test
Wright test
Costoclavicular test

Question 4

What are the clinical signs of median, ulnar and radial nerve entrapment?

Answer 4

Median = aching pain and weakness of forearm muscles and positive Tinel’s sign with paresthesia in median nerve distribution

Ulnar = Medial elbow pain, paresthesia in ulnar distribution and positive Tinel’s sign

Radial = lateral elbow pain, pain over the supinator muscle, paresthesia in a radial distribution, may have positive Tinel’s sign

Question 5

What is carpal tunnel syndrome?

Answer 5

Compression of the median nerve at the carpal tunnel of the wrist due to inflammation of the flexor tendons and/or median nerve

Question 6

What conditions must be ruled out to confirm the presence of carpal tunnel syndrome?

Answer 6

Cervical spine dysfunction
TOS
Peripheral nerve entrapment

Question 7

What is the most commonly fractured carpal bone?

Answer 7

Scaphoid

Question 8

There is a high incidence of _____ with scaphoid fractures.

Answer 8

Avascular necrosis

Question 9

What is a Dupuytren’s contracture?

Answer 9

Banding on palm and digit flexion contractures, resulting from contracture of palmar fascia that adheres to skin

Question 10

What structures are most commonly affected in diabetic versus non-diabetic patients with Dupuytren’s contracture?

Answer 10

Diabetic = MCP and PIP of 3rd-4th digits 
Non-diabetic = MCP and PIP of 4th-5th digits

Question 11

What is a Boutonniere’s deformity?

Answer 11

Results from rupture of central tendinous slip of extensor hood

Deformity = extension of MCP and DIP with flexion of PIP

Question 12

What is a Swan neck deformity?

Answer 12

Results from contracture of intrinsic muscles with dorsal subluxation of lateral extensor tendons

Deformity = flexion of MCP and DIP with extension of PIP

Question 13

What is a Ape hand deformity?

Answer 13

Observed thenar muscle wasting, with first digits moving dorsally until it is inline with second digit

Results from median nerve dysfunction

Question 14

What is the cause and deformity seen with mallet finger?

Answer 14

Rupture or avulsion of extensor tendon at its insertion into distal phalanx of digit

Deformity = flexion of DIP joint