upper limb Flashcards
what happens in rotator cuff impingement?
the tendons of the rotator cuff (mainly supraspinatous) are compressed in the tight subacromial space during movement
approximately, when in abduction does painful arc syndrome occur?
60-120 degrees
name some causes of rotator cuff impingement ?
hooked acromion rotator cuff tear
tendonitis subacromial bursitis
acromioclavicular OA
painting /overhead work
athelets-throwing, swimming
what is this?
shoulder pain (radiating to deltoid and upper arm)
tenderness on later edge of acromion
Hawkin’s _kennedy test positive
rotator cuff impingment
treatment for rotator cuff impingement?
- conservative- NSAIDS, analgesics, physio, steroid injection
- surgery- subacromial decompression to create for space for tendon to pass through
classic history of a sudden jerk in patient >40 with pain and weakness
rotator cuff tear
how do you confirm rotator cuff tears?
Ultrasound or MRI
treatment for rotator cuff tear?
non surgery-physio
surgery-subacromial decompression
what is adhesive capsulitis?
frozen shoulder
progressive pain and stiffness of shoulder in 40-60 year olds and loss of external rotation
frozen shoulder
how do you treat frozen shoulder/
physio and analgesics
steroids injections can help in the painful phase
what is acute calcific tendonitis?
acute onset of severe shoulder pain characterized by calcium deposition in supraspinatus tendon
where do you see calcific tendonitis?
proximal to greater tuberosity of humerus on XRAY
treatment for calcific tendonitis?
subacromial steroid injection and local anaesthetic gives great relief
what are the 2 types of shoulder instability?
traumatic
atraumatic
what is traumatic dislocation?
patients experience traumatic anterior shoulder dislocation.
most of these settle after reduction and physio
for recurrent dislocations, the Bankart repair can stabilize the shoulder
what is atraumatic dislocation?
patients tend to have generalised lax ligaments, dislocations can be multidirectional
what causes anterior shoulder pain with pain on resisted biceps contraction?
inflammation of long head of biceps (biceps tendonitis)
name things which can cause referred pain to the shoulder
neck
angina
diaphragmatic irritation-biliary colic, hepatic abscess
lateral epicondylitis?
tennis elbow
what causes tennis elbow
repetitive strain
lost of restricted extension of the wrist
painful and tender over lateral epicondyle
tennis elbow
treatment for tennis elbow?
rest from activity physio NSAIDs steroid injections use of a brace ultrasound therapy maybe surgery in rare cases/for athletes
medial epicondylitis
golfer elbow
cause of golfer elbow
repetitive strain or degeneration of the common flexor origin
which arthritis is more common in the elbow/
RA
what is Dupuytren’s contracture?
connective tissue disorder where the palmar fascia undergoes hyperplasia
normal fascia bands form nodules and cords progressing to contractures
Dupuytren’s contracture
who is more affected by Dupuytren’s contracture?
men people with diabetes people with liver cirrhosis Peyronie's disease Ledderhose disease
pathology of Dupuytren’s contracture?
proliferation of myofibroblast cells and production of abnormal collegen
what body part does Peyronie’s disease affect?
penis
what body part does Ledderhose disease affect?
feet
when do people with Dupuytren’s contracture get surgery?
when its affecting their function
what is trigger finger?
tendonitis of a flexor tendon to a digit
how to treat trigger finger?
steroid injection around tendon within the sheath
surgery offered inn recurrent cases
Heberden’s nodes
bony thickenings from OA in distal interphalangeal joints
Bouchard’s nodes
bony swellings from OA in proximal interphalangeral joints
Boutonniere deformity
swan neck deformity
Z shaped thumb
ulnar deviation
volar MCPJ subluxation
RA in hands
3 stages of RA in the hand?
- synovitis and tenosynovitis
- erosions of joint
- joint instability and tendon rupture
what are ganglion cysts?
mucinous filled cysts found adjacent to a tendon or synovial joint
firm, smooth, rubbery, should transilluminate
ganglion cyst
how to treat a ganglion cyst?
if swelling is causing localized discomfort, surgical excision
second most common soft tissue swelling of hand?
giant cell tumour of tendon sheath
where do you normally find giant cell tumour of tendon sheath?
palmar surface
what is the danger of a giant cell tumour of tendon sheath?
can envelope digital nerve or artery and erode bone.
