Upper Limb Flashcards
What forms the shoulder girdle?
Scapula Clavicle Proximal humerus Deltoid Rotator cuff muscles
What muscles in the rotator cuff attach to the greater tuberosity and are posterior?
Supraspinatus
Infraspinatus
Teres minor
What rotator cuff muscle is anterior and attaches to the lesser tuberosity?
Subscapularis
What rotator cuff muscle initiates abduction?
Supraspinatus
What rotator cuff muscles are responsible for external rotation?
Infrapsinatus
Teres minor
What rotator cuff muscle is responsible for internal rotation?
Subscapularis
What occurs in impingement syndrome?
Tendons of supraspinatus are compressed in the subacromial space
Give some causes of impingement syndrome
Tendonitis
AC osteoarthritis
Rotator cuff tear
Give some clinical features of impingement syndrome
Painful arc
Painful deltoid
+ve Hawkins-Kennedy test
How is impingement syndrome treated?
NSAIDs
Physiotherapy
Steroid injection
Subacromial decompression surgery
What muscle is most commonly affected in rotator cuff tears?
Supraspinatus
Give some causes of a rotator cuff tear
Sudden jerk injury
Tendon degeneration
What is the main clinical feature of a rotator cuff tear?
Weakness in initiating abduction
What occurs in adhesive capsulitis?
Progressive pain and stiffness of shoulder resolving after 18-24 months
Give some causes for adhesive capsulitis
Triggering injury
Diabetes
High cholesterol
Dupuytren’s
What is the main sign of adhesive capsulitis?
Loss of external rotation
How is adhesive capsulitis treated?
Physiotherapy
Analgesia
Intra-articular injections
Where is calcium deposited in acute calcific tendonitis?
Supraspinatus tendon
How is acute calcific tendonitis treated?
Subacromial steroid injection
How is shoulder instability commonly treated?
Bankart repair
What occurs in carpal tunnel syndrome?
Swelling within the carpal tunnel compresses the median nerve
Give some secondary causes of carpal tunnel syndrome
Rheumatoid arthritis Pregnancy Diabetes Chronic renal failure Hypothyroidism Colles fracture
What are the clinical features of carpal tunnel syndrome?
Paraesthesia in median nerve innervated fingers
Weakness of thumb
+ve Tinel’s/Phalen’s test
How is carpal tunnel syndrome treated?
Non-surgical - wrist spint/steroid injection
Surgical - division of transverse carpal ligament
What occurs in cubital tunnel syndrome?
Compression of ulnar nerve behind medial epicondyle
What tight fascia is formed in cubital tunnel syndrome?
Osborne’s fascia
What fingers are affected by cubital tunnel syndrome?
Little finger
Medial 1/2 of ring finger
What two joints does the elbow consist of?
Humero-ulnar
Radio-capitallar
The elbow is flexed by the biceps brachii and the brachialis. True/false?
True
What causes tennis elbow?
Repetitive strain injury to due repeated resisted wrist extension
What is the main symptom of tennis elbow?
Pain on resisted middle finger/wrist extension
Tennis elbow affects the medial/lateral epicondyle
Lateral
How is tennis elbow treated?
Rest, physiotherapy, NSAIDs
Steroid injection
Brace
What occurs in Dupuytren’s contracture?
Hyperplasia of the palmar fascia forming nodules and cords causing MCP/PIP contractures
There is proliferation of what cells and production of what type collagen in Dupuytren’s?
Proliferation of myofibroblasts
Production of type III collagen
What is Dupuytren’s associated with?
Alcoholism
Diabetes
What fingers are most commonly affected by Dupuytren’s?
Ring
Little
How is Dupuytren’s treated?
Fasciectomy
Fasciotomy
What occurs in trigger finger
Tendonitis of flexor tendon causes nodular enlargement over A1 pulley
What are the symptoms of trigger finger?
Painful clicking sensation
Finger locked in flexion
How is trigger finger treated?
Steroid injection
Surgical division of A1 pulley
Swelling of DIPs in osteoarthritis is called what?
Hebreden’s nodes
Swelling of PIPs in osteoarthritis is called what?
Bouchard’s nodes
How is mild to moderate DIP osteoarthritis treated?
Removal of osteophytes/mucous cyst
How is severe DIP osteoarthritis treated?
Arthrodesis
Osteoarthritis of the PIP on the index finger is treated with what?
Arthrodesis
Osteoarthritis of the PIPs on all fingers apart from index is treated with what?
Arthroplasty
What occurs in rheumatoid arthritis?
Inflammation within joints and tendon sheath causes articular cartilage erosion leading to joint instability and tendon rupture
What are the symptoms of rheumatoid arthritis?
Ulnar deviation
Swan-neck deformity
Boutonniere deformity
Z-shaped tumb
How is rheumatoid arthritis treated?
DMARDs
Tenosynovectomy
Soft tissue releases
What occurs in a ganglion cyst?
Mucinous filled cysts form adjacent to a tendon/synovial joint
How are ganglion cysts treated?
Needle aspiration
Surgical excision
