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X Clin Med Exam 3 > Upper Extremity II > Flashcards

Upper Extremity II Flashcards

1
Q

What is elbow epicondylitis usually due to?

A

Overuse

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2
Q

Why would you get imaging with elbow epicondylitis?

A

Concerns of lose bodies, fractures or exostosis (bone spur)

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3
Q

Tx for elbow epicondylitis

A

Acute: sling, wrist brace, ice, anti-inflammatory
Preventative: forearm strap, minimize activity
Recurrent: steroid injections, surgery for debridement

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4
Q

Causes of olecranon bursitis

A

Trauma, prolonged pressure, infection or rheumatologic conditions

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5
Q

Tx for olecranon bursitis

A

Ice, NSAIDs, aspiration if need culture, antibiotics and surgery if infected

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6
Q

Clinical presentation of cubital tunnel syndrome

A

Ulnar neuropathy (RF/LF tingling or numbness), decreased grip strength, chronic muscle wasting

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7
Q

Tx for cubital tunnel syndrome

A

NSAIDs, bracing, PT, surgery if need cubital tunnel release (maybe ulnar nerve transposition)

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8
Q

Pathogenesis of carpal tunnel

A

Swelling of synovium of thickening of transverse carpal ligament leading to compression of nerve
Females 2:1 (increased risk with smaller tunnel)

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9
Q

Other causes of carpal tunnel

A

Pressure or space occupying lesion, connective tissue disorders, trauma, pregnancy, renal failure, hypothyroidism

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10
Q

Early presentation of carpal tunnel

A

Pain intermittent and described as dull ache at wrist after use
Progresses to burning pain, numbness and tingling

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11
Q

Specialized test for carpal tunnel

A

Tinels, Phalens

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12
Q

Nerve conduction study

A

Used for carpal tunnel because can be used to test sensory and motor nerves
Records time from stimulus to response
Will be delayed in CTS because of demyelination of median nerve fibers

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13
Q

Electromyogram

A

Used in carpal tunnel diagnosis
Needle inserted into muscle to measure electrical activity with muscle relaxed and fully contracted
Denervated muscle spontaneously fires during relaxation and produces fibrillation

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14
Q

Acute tx for carpal tunnel

A

Immediate decompression

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15
Q

Tx for chronic carpal tunnel

A

NSAIDs, local injection of corticosteroid, brace, PT

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16
Q

What are ganglion cysts?

A

Collection of synovial fluid within a joint or tendon sheath

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17
Q

Presentation of ganglion cysts

A

Commonly on dorsal radial and volar aspects of wrist
Soft mobile mass
Fluctuates in size, often with activity
Can be painful with repetitive activity

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18
Q

Tx of ganglion cysts

A

NSAIDs
May resolve spontaneously
Aspiration and steroid injection
Surgery for recurrence

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19
Q

What is De Quervain’s tenosynovitis?

A

Inflammation of the 1st dorsal compartment involving the sheath of the abductor pollicis longus and extensor pollicis brevis
Cause of overuse and repetitive gripping (increased risk with hormonal changes so post partum)
30-50 YO Woman

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20
Q

Clinical presentation of de quervain’s tenosynovitis

A

Pain/swelling along dorsal radial wrist
Pain aggravated by thumb and wrist motion (grippin)
+Finkelstein test

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21
Q

Tx for de quervain’s tenosynovitis

A

Stop activity and thumb spica immobilization

NSAIDs, steroid injections, may have surgery to decompress 1st dorsal compartment

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22
Q

Boutonniere

A

Flexion of PIP and hyperextension at DIP

Ruptured central slip extensor tendon mechanism

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23
Q

Swan neck

A

Hyperextension of PIP and flexion of DIP

Volar plate attenuation of PIP joint

24
Q

Who is most likely to get dupuytrens contracture?

A

Males, northern European descent, 40-50 YO

25
Q

Presentation of dupuytrens contracture

A

Typically painless nodules develop into palpable cords along palmer surface (irreversible contractures)
Extension loss of fingers (RF and SF usually)

26
Q

Test for dupuytrens contracture

A

Hueston table top test to assess ability to flatten hand on table

27
Q

Tx for dupuytrens contracture

A

Steroid injection if painful (tenosynovitis) or rapid growth of nodules
Surgery is progressive presentation (flexion contracture over 30 degrees at MCP or and PIP flexion noted or cannot perform table top test)
Collagenese injections

28
Q

What causes trigger finger (stenosing flexor tenosynovitis)?

A

Nodule forms at volar aspect of MCP in the tendon and it can no longer run through the sheath (mechanical impingement causing irritation and inflammation)

29
Q

Presentation of trigger finger

A

Digit snaps, catches or locks with passive/active ROM at IP/PIP (nodule cannot glide through A1 pulley)
Progressively becomes painful
Concern for contracture if not treated because leave soft tissue locked in place

30
Q

Tx for trigger finger

A

NSAIDs, local corticosteroid injection, surgery to release A1 pulley

31
Q

What are the most important characteristics when determining a bone tumor/lesion?

A

Age and location!

32
Q

Concerning features for bone tumors/lesions

A

Indistinct margins, abnormal periosteal rxn, soft tissue mass/invasion, rapid growth, pathologic fracture

33
Q

What is the most common benign tumor?

A

Unicameral bone cyst

34
Q

What is a unicameral bone cyst?

A

Fluid filled cavity in the bone, usually in long bones
View with radiographs and MRI or CT if needed
Bone scan can evaluate for more cysts

35
Q

Tx for unicameral bone cyst

A

May resolve spontaneously
Consider surgery in recurrent pathologic fractures
Avoid tx if near physis until older because high recurrence rate

36
Q

What is an aneurysmal bone cyst?

A

Blood filled cyst in the bone seen mostly in spine and extremities
Benign but aggressive

37
Q

Dx of aneurysmal bone cyst

A

Radiographs
MRI that shows separation of 2 different fluid levels (definitive)
Biopsy
Refer to ortho for surgery!

38
Q

What is a non-ossifying fibroma (NOF)/

A

Benign

MES: metaphyseal (end of metaphysis), eccentric (side of bone), sclerotic borders

39
Q

When do you refer to ortho for non-ossifying fibroma?

A

If lesion is greater than 50% diameter of bone

40
Q

What is a giant cell tumor?

A

Benign, aggressive tumor (has no boundaries because it goes where it wants)
Crosses metaphyseal to epiphyseal because may develop as growth plate closes

41
Q

Imaging for giant cell tumor

A

Radiographs, MRI, bone scan that shows hot spot due to metabolic activity

42
Q

Tx for giant cell tumor

A

Refer to ortho and may need radiation and surgery (limb resection)
High reoccurence rate

43
Q

What is an osteoid osteoma?

A

Small benign bone tumor that has a nidus center (white spot) of growing cells surrounded by thickened bone
Eccentric (side of bone)

44
Q

Clinical presentation of osteoid osteoma

A

Severe night pain and NSAIDs relieve the pain

45
Q

Tx for osteoid osteoma

A

Refer to ortho or interventional radiology

CT guided radiofrequency ablation

46
Q

What is the most common benign bone tumor?

A

Osteochondroma (pedunculated or sessile)

47
Q

What is an osteochondroma?

A

Abnormal growth of bone and cartilage along surface of the bone

48
Q

Presentation of osteochondroma

A

Fixed, non-mobile mass near joints (grow with pt)

May be painful, may have numbness and tingling

49
Q

What is the most common bone tumor in kids?

A

Osteosarcoma

50
Q

What is a chondrosarcoma?

A

Bone tumor composed of cartilage producing cells
Over 40 YO (most often males 60-80)
Hips, shoulder and pelvis (speckling appearance)

51
Q

Presentation of chondrosarcoma

A

Pain, weakness

Pelvis masses radiate pain to hip/knee

52
Q

What might look the same radiographically as a chondrosarcoma?

A

Chondroblastoma/enchondroma which are benign (must biopsy)

53
Q

What is the most common primary bone tumor?

A 
Multiple myeloma (malignant bone marrow)
Over 40, male, African American
54
Q

Diagnostics for multiple myeloma

A

Urine analysis shows Bence-Jones proteins

See punched out appearance on radiographs (hole punch)

55
Q

Most likely cancers to be metastatic

A

PB-KTL (lead kettle)

Prostate (male), breast (female), kidney, thyroid, lung (male)

56
Q

Diagnostics for metastatic bone cancer

A

Labs: anemia
Radiographs: pathologic fracture (osteolytic bone destruction (KTL), osteoblastic formation (P) or mixed (B)
Bone scan

X Clin Med Exam 3 (8 decks)

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