Upper Extremity II Flashcards
What is elbow epicondylitis usually due to?
Overuse
Why would you get imaging with elbow epicondylitis?
Concerns of lose bodies, fractures or exostosis (bone spur)
Tx for elbow epicondylitis
Acute: sling, wrist brace, ice, anti-inflammatory
Preventative: forearm strap, minimize activity
Recurrent: steroid injections, surgery for debridement
Causes of olecranon bursitis
Trauma, prolonged pressure, infection or rheumatologic conditions
Tx for olecranon bursitis
Ice, NSAIDs, aspiration if need culture, antibiotics and surgery if infected
Clinical presentation of cubital tunnel syndrome
Ulnar neuropathy (RF/LF tingling or numbness), decreased grip strength, chronic muscle wasting
Tx for cubital tunnel syndrome
NSAIDs, bracing, PT, surgery if need cubital tunnel release (maybe ulnar nerve transposition)
Pathogenesis of carpal tunnel
Swelling of synovium of thickening of transverse carpal ligament leading to compression of nerve
Females 2:1 (increased risk with smaller tunnel)
Other causes of carpal tunnel
Pressure or space occupying lesion, connective tissue disorders, trauma, pregnancy, renal failure, hypothyroidism
Early presentation of carpal tunnel
Pain intermittent and described as dull ache at wrist after use
Progresses to burning pain, numbness and tingling
Specialized test for carpal tunnel
Tinels, Phalens
Nerve conduction study
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
Electromyogram
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
Acute tx for carpal tunnel
Immediate decompression
Tx for chronic carpal tunnel
NSAIDs, local injection of corticosteroid, brace, PT
What are ganglion cysts?
Collection of synovial fluid within a joint or tendon sheath
Presentation of ganglion cysts
Commonly on dorsal radial and volar aspects of wrist
Soft mobile mass
Fluctuates in size, often with activity
Can be painful with repetitive activity
Tx of ganglion cysts
NSAIDs
May resolve spontaneously
Aspiration and steroid injection
Surgery for recurrence
What is De Quervain’s tenosynovitis?
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
Clinical presentation of de quervain’s tenosynovitis
Pain/swelling along dorsal radial wrist
Pain aggravated by thumb and wrist motion (grippin)
+Finkelstein test
Tx for de quervain’s tenosynovitis
Stop activity and thumb spica immobilization
NSAIDs, steroid injections, may have surgery to decompress 1st dorsal compartment
Boutonniere
Flexion of PIP and hyperextension at DIP
Ruptured central slip extensor tendon mechanism
Swan neck
Hyperextension of PIP and flexion of DIP
Volar plate attenuation of PIP joint
Who is most likely to get dupuytrens contracture?
Males, northern European descent, 40-50 YO
Presentation of dupuytrens contracture
Typically painless nodules develop into palpable cords along palmer surface (irreversible contractures)
Extension loss of fingers (RF and SF usually)
Test for dupuytrens contracture
Hueston table top test to assess ability to flatten hand on table
Tx for dupuytrens contracture
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
What causes trigger finger (stenosing flexor tenosynovitis)?
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)
Presentation of trigger finger
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
Tx for trigger finger
NSAIDs, local corticosteroid injection, surgery to release A1 pulley
What are the most important characteristics when determining a bone tumor/lesion?
Age and location!
Concerning features for bone tumors/lesions
Indistinct margins, abnormal periosteal rxn, soft tissue mass/invasion, rapid growth, pathologic fracture
What is the most common benign tumor?
Unicameral bone cyst
What is a unicameral bone cyst?
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
Tx for unicameral bone cyst
May resolve spontaneously
Consider surgery in recurrent pathologic fractures
Avoid tx if near physis until older because high recurrence rate
What is an aneurysmal bone cyst?
Blood filled cyst in the bone seen mostly in spine and extremities
Benign but aggressive
Dx of aneurysmal bone cyst
Radiographs
MRI that shows separation of 2 different fluid levels (definitive)
Biopsy
Refer to ortho for surgery!
What is a non-ossifying fibroma (NOF)/
Benign
MES: metaphyseal (end of metaphysis), eccentric (side of bone), sclerotic borders
When do you refer to ortho for non-ossifying fibroma?
If lesion is greater than 50% diameter of bone
What is a giant cell tumor?
Benign, aggressive tumor (has no boundaries because it goes where it wants)
Crosses metaphyseal to epiphyseal because may develop as growth plate closes
Imaging for giant cell tumor
Radiographs, MRI, bone scan that shows hot spot due to metabolic activity
Tx for giant cell tumor
Refer to ortho and may need radiation and surgery (limb resection)
High reoccurence rate
What is an osteoid osteoma?
Small benign bone tumor that has a nidus center (white spot) of growing cells surrounded by thickened bone
Eccentric (side of bone)
Clinical presentation of osteoid osteoma
Severe night pain and NSAIDs relieve the pain
Tx for osteoid osteoma
Refer to ortho or interventional radiology
CT guided radiofrequency ablation
What is the most common benign bone tumor?
Osteochondroma (pedunculated or sessile)
What is an osteochondroma?
Abnormal growth of bone and cartilage along surface of the bone
Presentation of osteochondroma
Fixed, non-mobile mass near joints (grow with pt)
May be painful, may have numbness and tingling
What is the most common bone tumor in kids?
Osteosarcoma
What is a chondrosarcoma?
Bone tumor composed of cartilage producing cells
Over 40 YO (most often males 60-80)
Hips, shoulder and pelvis (speckling appearance)
Presentation of chondrosarcoma
Pain, weakness
Pelvis masses radiate pain to hip/knee
What might look the same radiographically as a chondrosarcoma?
Chondroblastoma/enchondroma which are benign (must biopsy)
What is the most common primary bone tumor?
Multiple myeloma (malignant bone marrow) Over 40, male, African American
Diagnostics for multiple myeloma
Urine analysis shows Bence-Jones proteins
See punched out appearance on radiographs (hole punch)
Most likely cancers to be metastatic
PB-KTL (lead kettle)
Prostate (male), breast (female), kidney, thyroid, lung (male)
Diagnostics for metastatic bone cancer
Labs: anemia
Radiographs: pathologic fracture (osteolytic bone destruction (KTL), osteoblastic formation (P) or mixed (B)
Bone scan
