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MSKJaz > Upper limb > Flashcards

Upper limb Flashcards

1
Q

signs of shoulder impingement

A

painful arc
Hawkins sign
decreased ROM
pain on movement, not usually at night

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2
Q

Bigliani grade 3 acromion = ____

can cause shoulder ___

A

slopes closer to humerus

impingement

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3
Q

management of shoulder arthritis is ___

A

conservative

Sx is risky and not as reliable as lower limb Sx

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4
Q

Hill-Sachs lesion =

A

dent in back of humerus head as impacts on front of glenoid

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5
Q

TUBS (shoulder instability) =

Rx =

A

Traumatic Unilateral dislocation with Bankart/Hill-Sachs lesions
Bankart repair - anchor and suture labrum back to bone

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6
Q

AMBRI (shoulder instability) =

A 
Atraumatic
Multidirectional
Bilateral
Rehab
Inferior capsular shift
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7
Q

carpal tunnel syndrome is compression of ____
Ix =
Rx =

A

median nerve
nerve conduction
night splints, Sx decompression

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8
Q

cubital tunnel syndrome is compression of ___

A

ulnar nerve

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9
Q

3 sites where ulnar nerve can be compressed =

A

FCU tendon heads
cubital tunnel
intermscular fibrous bands above elbow

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10
Q

in upper limb trauma get at least __ views on xray

A

2

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11
Q

where >2 views are needed in upper limb trauma = (2)

A 
C1-2 = AP, lateral and odontoid peg (teeth parted)
Scaphoid = AP, lateral and 2 obliques
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12
Q

appearance of haematoma in # on xray =

A

lucency crossing bone

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13
Q

avulsion fractures mechanism =

A

tendons pull bone off

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14
Q

appearance of avulsion fractures on xray

mimic =__+__+__ = all ___

A 
incompletely corticated fragment
sesamoid bones
accessory ossification centres
old non-united #s 
all completely corticated
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15
Q

normal alignment of acromioclavicular joint on imaging

A

inferior border of clavicle has a straight line to inferior border acromium

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16
Q

alignment of humero-capitellar joint on imaging

used to spot __

A

anterior border of humerus should go through middle of capitellum
supracondylar #

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17
Q

in lateral wrist ___ should look like a cup

A

lunate

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18
Q

if there is an elbow effusion a displaced ___ can be seen posterior to ____ = ___ sign
is always abnormal if present

A

fat pad
distal humerus
posterior fat pad

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19
Q

in children: fracture that causes usually smoothly curved metaphyses to be bumpy on imaging =

A

buckle

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20
Q

3 types of # seen in kids

A

buckle
plastic bowing
greenstick

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21
Q

Little leaguers elbow =

A

medial epicondyle of humerus avulsed due to flexor tendons

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22
Q

bony rings where you would expect to fin >1 fracture

A

spinal canal
pelvis
forearm
lower leg

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23
Q

extra articular fracture of the distal radius with dorsal angulation and impaction =
mechanism of injury =

A

Colles #

FOOSH

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24
Q

50% of Colles # also have a ___ #

A

ulnar styloid

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25
Q

hand is displaced ___ in a Colles #

A

backwards

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26
Q

pain in anatomical snuff box after FOOSH =

A

scaphoid #

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27
Q

best view on imaging for posterior shoulder dislocation =

A

oblique view

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28
Q

involving articular surface of 1st MC base - tendons pull thumb distal to # = displacement =

A

Bennett’s #

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29
Q

age commonly affected by supraspinatus tendonitis

A

35-65 yo

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30
Q

age typically affected by frozen shoulder

more common in ___

A

40-60yo

diabetics

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31
Q

if shoulder pain can be localised with one finger it is ___ and is likely to be ___ pathology

A

superficial

ACJ OA/pathology

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32
Q

if shoulder pain is generalised it is likely to be from ___ structures eg __/__

A

deeper
subacromial
GHJ

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33
Q

Scarf test puts P on

A

ACJ

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34
Q

Hawkins is for __ pain - impingement as rotate ___ upwrds

A

subacromial

greater tuberosity

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35
Q

sternoclavicular joint arthritis is ___

Rx =

A

rare

physio, injection (rarely excision)

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36
Q

ACJ arthritis is __ and often overlaps with ___

Rx =

A

common
impingement
injection / excision

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37
Q

causes of GHJ arthitis

A

idiopathic (most common)
previous Sx
instability
cuff tear

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38
Q

distinctive candle drip osteophyte of ___ =

A

humerus

GHJ OA

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39
Q

OA of GHJ causes decrease of ROM esp __

A

external rotation

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40
Q

if rotator cuff is torn ___ pulls humeral head __

A

deltoid

superiorly

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41
Q

new Rx for cuff tear

A

reverse geometry replacement

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42
Q

fossa olecrani is a feature of

A

elbow OA

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43
Q

if elbow replaced wt limit is

A

5kg / 1kg repeatedly

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44
Q

Sx options for RA

A

synovectomy
tendon realign
replace
fuse

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45
Q

SLAC =

A

scapholunate advanced collapse (=> wrist instability)

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46
Q

SNAC

A

scaphoid non-union advanced collapse

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47
Q

total wrist arthrodesis stops __ movement but preserves ___

A

flexion/extension

sup+pronation

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48
Q

base of thumb OA is usually the __ joint affected in OA => ___ subluxation and pain esp in __

A

2nd
CMCJ
pinch

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49
Q

volar plate of PIPJ becomes attenuated, small ligs and lumbrical tendons move dorsally =

A

swan neck deformity

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50
Q

PIPJ flexion and DIPJ hyperextension = ___ deformity

A

Boutonniere

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51
Q

outpouching of synovial fluid from DIPJ OA

A

mucous cyst

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52
Q

Rx of mucous cyst

A

usually leave alone

rarely = Sx

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53
Q

possible complications of mucous cyst

A

pain
fluctuate/ discharge
deform nail = a ridge

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54
Q

outpouchings of synovial cavity, filled with synovial fluid, fluctuate, usually painless/”tight” and resolve with time
affect the hand

A

ganglion cyst

55
Q

in trigger finger tendon swells and catches on __ pulley so there is pain over the ___ and finger is stuck in ___

A

A1
MC head
flexion

56
Q

Rx for trigger finger

A

spontaneous resolution >
splint >
steroid and LA injection (can repeat up to 3x - usually curative)
Sx to divide A1 pulley

57
Q

spontaneous, very painful, swollen and red

+ve Finklesteins test - thumb in fist and ulnar deviate => v painful =

A

Dequervains tenosynovitis

58
Q

Rx for Dequervains tenosynovitis =

A

NSAIDs, splint, rest, steroid injection, decompression Sx

59
Q

thickening and contracture of subdermal fascia => fixed flexion =

A

Dupuytrens contracture

60
Q

high incidence of Dupuytrens contracture in which population

A

N Europeans

61
Q

dupuytrens contracture usually starts as __/___ and starts ___+__

A

palmar pit/nodule

painless and gradual

62
Q

Dupuytrens diathesis is ass with __+__

A

Lederhosen’s

Peyronies

63
Q

risk factors for development of Dupuytrens contractures

A 
northern european
DM
alcohol/cirrhosis
smoking
epilepsy
trauma
knuckle pads; Ledderhose; Peyronie’s; frozen shoulder
64
Q

Dupuytrens affecting __ joint is likely to do well

___ is unlikely to ever fully flex as capsule thickens

A

MCPJ = good

PIPJ

65
Q

Rx for Dupuytrens contracture

A 
activity modification >
fasciectomy
dermofasciectomy
collagenase injection (stretch next day and itll snap easily)
percutaneous needle fasciotomy
66
Q

paronychia =

A

nail fold infection

67
Q

Rx of paronychia

A

elevate
abx
incise and drain

68
Q 
flexor tendon sheath infection:
occurence rate?
is a Sx \_\_\_\_\_
can\_\_\_\_ the palm and arm
very \_\_\_
limited passive and active \_\_\_
may cause \_\_\_\_\_
A 
rare
Sx emergency
track up
painful
extension
tracking lymphangitis
69
Q

Rx for flexor tendon sheath infection

A

incision above and below and wash out sheath

70
Q

If pressure from a subungual haematoma is causing pain then Rx =

A

trephine (bore a hole in nail)

71
Q

if the tip of the finger/ nail has been severed Rx =

A

dressing

72
Q

if the finger has been severed halfway through the length of the nail Rx =

A

repair nail bed and stabilise bone

73
Q

if there is less than 5mm of nail bed left after finger has been severed then Rx =

A

ablate

74
Q

If MCPJ needs immobilised then do in ___ because this is when the capsule is ___ so don’t lose ROM

A

flexion

tight

75
Q

If PIPJ needs immobilised then do in ___ because this is when the capsule is ___ so don’t lose ROM

A

extension

tight

76
Q

is easier to see rotational of the fingers if you ask the ptnt to ___

A

flex them

77
Q

Boxer’s # =

A

fracture of one of the MC in the hand usually after a drunken swipe
minimally displaced and no rotation

78
Q

Rx for Boxer’s (MC) #

A

buddy strap and mobilise early

79
Q

Mallet finger is caused by

A

extensor digitorum tendon of the fingers becoming unattached or having an avulsion fracture that causes the DIPJ to become flexed permanently

80
Q

s+s of Mallet finger

A

can’t extend DIPJ

tender and bruised

81
Q

Rx of mallet finger

A

splint 24/7 for 6 wks
fix if large avulsion #
is chronic/ present late = dermatotenodesis

82
Q

Rx of early and late presentation of PIPJ dislocation

A 
early = pull to reduce and buddy strap
late = fusion
83
Q

Bennett’s # causes the fragment of thumb base attached to hand lig.s to ___ and the rest ___

A

stay in place

displaces

84
Q

can tell if someone has a tendon injury if when they lie their hand volarly ___

A

fingers dont naturally flex

85
Q

tendons present at the distal 1/3 of fingers =

A

FDP

86
Q

tendons present in the proximal 2/3 of fingers and tip of distal palm

A

fds + fdp in same sheath

87
Q

in the middle of the palm the tendons are/ arent in a sheath

A

arent

88
Q

at the base of the palm lies the ____ ligament

A

transvere carpal

89
Q

to test FDP tendon =

A

hold just below DIPJ straight and flex DIPJ

90
Q

to test FDS

A

hold other fingers and ask ptnt to flex PIPJ - it acts independently whereas FDP work together

91
Q

Rx of tendon injuries of the hand =

A

Sx repair

mobilise early so no stiffness

92
Q

eschar =

A

thick leathery inelastic skin post burn

93
Q

mutilating injuries of the hand = ___ early and leave ____ for ___wks to decrease infection risk

A

debribe

uncovered 2-3wks

94
Q

chronic tendon injury with damage to tendon ECM =

A

tendonosis

95
Q

predominant cells in tendon =

90% is __

A

fibroblasts

type 1 collagen

96
Q

arrangement of fibres in a tendon =

___>__>___> fascicle

A

microfibrils
subfibrils
fibrils
fascicle

97
Q

fascicles in tendons are separated by ___ and covered by ___

A

separated by endotenon

covered in epitenon

98
Q

blood supply to tendons = ++_

A

perimyseum
periosteal tendon insertion
paratenon

99
Q

histological degeneration of collagen and ECM =

A

tendonosis

100
Q

tendonosis is caused by increased ___ most likely

these increse with __+__

A

MMPs

age and repetitive strain

101
Q

tendonosis can be __ and usually occur where there is a ___

A

painless

poor blood supply

102
Q

most tendon injuries settle with ++_

A

rest, analgesia and anti-inflammatories

103
Q

cortisone/anaesthetic can be used in + tendon problems but NOT __ or ____

A

rotator cuff and tennis/golfer’s elbow = fine

NOT achilles or extensor knee mechanism

104
Q

Rx for achilles tear =

A

splint/cast

105
Q

__+___ tendon problems can be treated with decompression

A

supraspinatus tendonitis

subacromial tendonitis

106
Q

synovectomy is used to prevent rupture in ___+__

A

RA of extensor wrist tendons and tibialis posterior

107
Q

tendon transfer can be used to treat __+__ tendons

A

tibialis posterior and extensor pollicis longus

108
Q

most common rotator cuff muscle to be injured =

A

supraspinatus

109
Q

s+s for rotator cuff tear

A 
achy pain down arm that gradually increases
difficulty sleeping on affected side
\+ve impingement signs
hard to reach overhead+lift
painful arc/weakness
110
Q

Rx for rotator cuff tear

A 
conservative = rest physio and injections
Sx = repair and subacromial decompression
111
Q

gold standard test for rotator cuff tear =

___ scan can also detect ___

A

US - dynamic scan can also detect impingement

112
Q

biceps tendinopathy tends to occur where ___ passes through ___ on ____

A

long head
bicipital groove
anterior humerus

113
Q

s+s of biceps tendinopathy

A

anterior shoulder pain
elbow pain that is worse on shoulder flexion, forearm pronation and elxbow flexion
click/snaps with shoulder movement if subluxed

114
Q

scan for biceps tendinopathy =

A

US

115
Q

popeye sign + extensive bruising =

A

biceps tendon rupture

116
Q

Rx for biceps tendinopathy

A

conservative

Sx (high risk of neurovasc complications)

117
Q

s+s of leteral epiconylitis (Tennis)

A

pain and tender and lat epicondyle greater when muscles stretched
pain with resisted extension of middle finger
Mills test +ve

118
Q

Mills test for lateral epicondylitis =

A

palpate ptnt’s lateral epicondyle with thumb while passively pronating forearm, flexing wrist and extending elbow
+ve test = reproduction of pain near the lateral epicondyle

119
Q

lateral epicondylitis is non ___

A

non-inflammatory

120
Q

avoid injections for medial epicondylitis (Golfers) because ___

A

is near the path of the ulnar nerve

121
Q

s+s of medial epicondylitis (Golfers)

A

pain greater on wrist flexion and pronation, also greater on grasping
some ass with ulnar neuropathy

122
Q

Rx of medial and lateral epicondylitis

A

usually conservative

Sx release is last resort

123
Q 
DeQuervains Tenosynovitis affects \_\_\_ containing \_\_+\_\_\_
pain over \_\_\_\_
F:M
age 
ass with \_\_+\_\_
A 
1st extensor compartment
APL and EPB
radial styloid process
F>M
30-50yo
preg and RA
124
Q

test for DeQuervains Tenosynovitis

A

Finklesteins test - thumb in fist and ulnar deviate hand => pain

125
Q

__+__ DeQuervains Tenosynovitis to rull out CMC OA

A

US xray

126
Q

Rx for DeQuervains Tenosynovitis

A

splint rest physio
analgesia
injections
Sx decompress

127
Q

s+s of hand extensor mechanism rupture =

A

weak wrist extension and dropped finger

128
Q

hand extensor mechanism rupture Rx =

A

tendon transfer

129
Q

EPL rupture is ass with __+__

A

RA

post colles #

130
Q

hand extensor mechanism rupture is ass with __ which causes an AI attack on __ and leads to tendon __

A

RA
synovium
transfer

131
Q

Rx of EPL rupture that is causing loss of function

A

tendon transfer

132
Q

___ can prevent RA causing a hand extensor mechanism rupture

A

synovectomy

133
Q

development of trigger finger:

stenosing ___ > ____ metaplasia >nodule ____ > catches on ____ > triggering

A

tenosynovitis
fibrocartilaginous
FDS tendon
A1 pulley

MSKJaz (28 decks)

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