Upper Limb

Question 1

Which tendons are involved in DeQuervain’s? (2)

Answer 1

Abductor pollicis longus

Extensor pollicis brevis

Question 2

How may a DeQuervain’s present? (Pt group/Hx)

What is the main DDx

Answer 2

Acute pain base of thumb
After repeated movements
Post-partum/middle-aged

Base of thumb OA

Question 3

What will be seen O/E in DeQuervain’s?

Answer 3

LOOK: normal / swelling (radial border)
FEEL; normal / tender (radial styloid)
MOVE: painful thumb abduction (against Rx)
TEST: Finklestein’s

Question 4

How is DeQuervain’s managed? (RASSS)

Answer 4

Rest
Analgesia (NSAIDs)
Splinting
Steroid injections
Surgical (longitudinal compartment release)

Question 5

what tendons are in the carpal tunnel (9)

Answer 5

4 Flexor digitorum profundus
4 Flexor digitorum superficialis
1 Flexor pollicis longus

Question 6

List the causes of carpal tunnel (6)

Answer 6

Idiopathic
Trauma (Colles')
Hypothyroid
Acromegaly
DM
RA

Question 7

Describe the presenting features of carpal tunnel syndrome (3)

Answer 7

Pain/paraesthesia
Shakes hand for relief (esp night, may awaken)
Sensory loss (rarely noticed)

Question 8

What would be seen O/E in carpal tunnel?

Answer 8

LOOK: thenar wasting
FEEL: reduced thenar bulk
MOVE: weak thumb abduction
TEST: Tinel’s/Phalen’s

Question 9

How is Carpal Tunnel managed? (RASSS)

Answer 9

Nerve conduction studies

Rest (activity modification)
Analgesia (NSAIDs)
Splinting (night-time)
Steroid injection
Surgical: flexor retinaculum division

Question 10

List some causes of Cubital Tunnel Syndrome (4)

Answer 10

Prolonged elbow flexion (eg typing at desk)
Valgus deformity
Tight fascial bands
Ulnar fracture

Question 11

What are the features of cubital tunnel syndrome?

Answer 11

Pain at elbow
Paraesthesia in ulnar distrib
Weak pinch
Severe: clawing (hypothenar/inteross wasting)

Question 12

What would be seen O/E in cubital tunnel syndrome?

Answer 12

LOOK: hypothenar / 1st dorsal inteross wasting (gutter)
FEEL: cubital tunnel tenderness
MOVE: weak ext DIPJs / weak ab/add 5th
TEST: Tinel’s / Elbow Flexion test

Question 13

How is cubital tunnel syndrome managed? (RASS)

Answer 13

Nerve conduction studies
XR (osteophytes)

Rest (activity modification)
Analgesia (NSAIDs)
Splints (night-time)
Surgical: decompression / anterior transposition of nn

Question 14

What does a ganglion cyst contain?
Where can they appear in the hand? (4)

What pt grps/cause

Answer 14

Degenerative myxoid fluid of underlying structure

Dorsal scapholunate
Volar scaphotrapezial
Volar Finger base
Dorsal DIPJ

Question 15

How do ganglion cysts present? (Sx/features in Hx)

Answer 15

Young women (20–40)
Idiopathic / trauma

Lump in hand ± pain

Question 16

How are ganglion cysts managed? RAASS

Answer 16

Reassurance
Analgesia (NSAIDs)
Aspiration ± Steroid injection (works in 40%)
Surgical excision (40% recurrence)

Question 17

What may be seen O/E in trigger finger?

Answer 17

LOOK: PIP/DIPJ flexion
FEEL: Nodule at finger base when flexed
MOVE: jerky active flex/ext
TEST: n/a

Question 18

How is trigger finger managed? RASS

Answer 18

Rest (activity modification)
Analgesia (NSAIDs)
Steroid injection (into tendon sheath)
Surgical: A1 pulley release / tenosynovectomy (RA pts)

Question 19

What are some RFs for Dupuytren’s?

Answer 19

Male
Nordic
Alcoholic
Liver disease

Phenytoin
DM
Trauma

Question 20

What may be seen O/E in Dupuytren’s?

Answer 20

LOOK:
Nodule/cord in palm
Fixed MCP-PIP flexion (3rd/4th)
Garrod’s pads (dorsal PIPJs)

FEEL: thickened palmar fascia

MOVE: loss active/passive flexion/extension
TEST: n/a

Question 21

How is Dupuytren’s managed?

Answer 21

Conservative if no func problem

Surgical:
Needle aponeurotomy
Fasciotomy
Fasciectomy

Question 22

What are the features of Thumb Base OA?

Answer 22

Pain on gripping/pinching
Tenderness at CMCJ
Swelling/deformity

Question 23

What may be seen O/E in thumb base OA

Answer 23

LOOK:
Thumb base swelling
Thumb base subluxation (fixed flex-add)
Thenar wasting

FEEL:
Warmth / swelling / crepitus
Reduced thenar bulk

MOVE:
Pain/stiffness at CMCJ movements (add/abd/opp)

TEST: n/a

Question 24

How is Base of the Thumb OA managed?

Answer 24

As per OA conservatively

Surgical:
Denervation
Trapeziectomy
Joint fusion
Arthroplasty

Question 25

What would be seen O/E in ganglion cyst?

Answer 25

LOOK: obvious swelling/nodule in (1/4) areas
FEEL: mobile, either hard/soft
MOVE: more obi on movement / limited end-range
TEST: transilluminates

Question 26

What is seen o/XR in acute calcific rotator cuff tendinitis?

How is it managed?

Answer 26

XR: calcification above greater tuberosity

Rest (resolves in 1-3wks)
Analgesia (NSAIDs - prescribed)
Sling
Steroid injection (severe)

Question 27

What is seen O/E in acute rotator cuff tendinitis?

What is seen O/E in chronic?

Answer 27

Acute:
LOOK: Arm held immobile
FEEL: too tender to palpate
MOVE: too painful

Chronic:
LOOK: Normal
FEEL: tender anterior acromion
MOVE: painful arc (60-120º) / less painful on passive
TEST: Power normal (DDx to tear)

Question 28

Outline the Ix / Management of chronic rotator cuff tendinitis

Answer 28

MRI/USS Dx (thickened bursa)
XR (±calcification from former events)

Rest
Analgesia (NSAIDs)
Strengthen (physio)
Steroid inj
Surg: arthroscopic decompression (CA lig / osteophyte excision)