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My MSK > Upper limb > Flashcards

Upper limb Flashcards

1
Q

What is the shoulder girdle formed of?

A
  • scapula
  • clavicle
  • proximal humerus
  • supporting muscles including the deltoid and rotator cuff muscles
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2
Q

Where do the muscles of the rotator cuff attach and what action do they perfom?

A

attach to greater tuberosity=

  • supraspinatus: initiation of abduction
  • infraspinatus: external rotator
  • teres minor: external rotator

attach to lesser tuberosity=
- subscapularis: internal rotator

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3
Q

What is important to ask if people have pain in their shoulder?

A

elbow pain

neck pain

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4
Q

What is acute calcific tendonitis?

A

acute onset of severe shoulder pain with calcium deposition in the supraspinatus tendon

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5
Q

How is acute calcific tendonitis treated?

A
  • subacromial steroid

- local anaesthetic injection

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6
Q

What are the referred shoulder pain problems?

A
  • angina
  • neck problems
  • diaphragmatic irritation (biliary colic, hepatic or subphrenic abscess)
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7
Q

What are the ways that the axillary nerve can be damaged?

A
  • humeral dislocation

- fracture of the humerus

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8
Q

What does the axillary nerve pass through?

A

the quadrangular space: teres minor on top, teres major on bottom, humerus and long head of biceps brachii and sides

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9
Q

What results from axillary nerve damage?

A
  • teres minor: lateral rotation
  • deltoid: abduction of the arm
  • cutaneous innervation: badge patch area
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10
Q

What does the radial nerve supply and what can disrupt it?

A
  • supplies posterior arm and forearm

- can be disrupted by mid humerus fracture

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11
Q

What does the radial nerve split into?

A
  • superficial branch (S)
  • posterior interosseous nerve (M): goes into supinator so hypertrophy of this compresses it (screwing with extended arm)
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12
Q

What is damage to the radial nerve seen as clinically?

A

wrist drop

no finger extension

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13
Q

What is the location of the median nerve?

A
  • runs within the cubital fossa

- TAN: biceps brachii tendon, brachial artery and medial nerve

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14
Q

What can affect the median nerve?

A
  • elbow dislocation

- it pierces pronator so using this muscle can hurt it (screwing other way)

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15
Q

What are the features of the flexor digitorum superficialls?

A
  • 2-5
  • flexes PIP
  • median nerve
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16
Q

What are the features of the flexor digitorum profundus?

A
  • 2-5
  • flexes DIP
  • ulnar medially and interosseous laterally
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17
Q

What are the features of the flexor pollicis longus?

A
  • flexes thumb

- anterior interosseous

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18
Q

What innervates the thenar eminence?

A

recurrent median

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19
Q

What are the features of the lumbricals?

A
  • flex MCP and extend PIP and DIP

- ulnar and median innervation

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20
Q

What is ape hand?

A
  • can’t abduct thumb

- median nerve injury

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21
Q

What is hand of benediction?

A
  • median nerve cut up at elbow
  • thumb can’t move
  • lumbricals, FDS and FDP not working
  • thumb and radial fingers can’t make a fist
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22
Q

What is the ulnar nerve paradox?

A
  • cut at elbow: FDS is not working
  • cut at wrist: FDS not working, lumbricals not working
    for two ulnar digits
23
Q

How many views of the upper limb are needed on XR?

A
  • two normally
  • 3 for spine
  • 4 for scaphoid
24
Q

What is avulsion?

A

a tearing off injury

25
Q

What are comminutive fractures?

A

several pieces

26
Q

What are displaced fractures?

A

no continuity between the ends

27
Q

What things can mimic acute avulsion fractures?

A
  • sesamoid bones
  • accessory ossification centres
  • old non-united fractures
28
Q

What is the posterior fat pad sign?

A

due to displaced fat pat due to trauma which causes an effusion which is very bad

29
Q

What are the features of children’s fractures?

A
  • their bones bend or bow
  • there are incomplete fractures called greenstick fractures
  • growth plate is a weak point which is prone to injury
  • use Salter-Harris guidelines
30
Q

What are examples of bony rings that can break?

A
  • spinal canal
  • pelvis
  • forearm
  • lower leg
    !!NB these can break in more than one place
31
Q

What is the best XR view for a posterior shoulder dislocation?

A

oblique view

hard to see on AP

32
Q

What are the things to look for on an XR for a supracondylar fracture?

A
  • visible posterior fat pat helps
  • always check humerocapitellar alignment
  • careful of brachial artery damage
33
Q

What can be the result of a scaphoid fracture?

A

can lead to avascular necrosis and then early wrist OA

!!NB these aren’t visible until after 10 days

34
Q

What is a Bennett’s fracture?

A
  • involves the articular surfaces of first metacarpal base

- tendons cause deformity, dysfunction and arthritis if untreated

35
Q

What are the features of a subungual haematoma?

A
  • painful
  • blood release is necessary
  • nail will fall off and grow back
36
Q

What is skiers thumb?

A

partial or complete rupture of ulnar collateral ligament of MCPJ

37
Q

What is mallet finger?

A
  • extensor ten don tear so there is recited extension and tenderness
  • splint for 6 weeks 24/7
  • occasional fix with wire
38
Q

What is the treatment for a PIPJ dislocation?

A
  • pop back into place
  • needs strapped
  • delayed presentation is very bad
39
Q

What is a Bennett’s fracture?

A
  • base of thumb

- need to ensure articular surface is returned otherwise there is OA

40
Q

What is the treatment for burns in the hand?

A
  • excise the damaged skin

- mobilise aggressively

41
Q

What is eschar?

A

thick, leathery inelastic skin after burns which might need surgical release to allow movement

42
Q

What are the main predisposing factors for tendon problems both intrinsic and extrinsic?

A
  • intrinsic= age, gender, obesity, RA, anatomical malalignment
  • extrinsic= trauma, repetitive injury, drugs eg steroids and antibiotics
43
Q

What are the features of tendonosis?

A
  • degeneration of collagen and extra-cellular matrix
  • due to MMPs
  • can be present with no pain
  • manage conservatively (injections, NSAIDs, rest and physio) or surgically (decried, decompress, synovectomy and tendon transfer)
44
Q

What is the general rule for injecting steroids in the body?

A
  • inject in the upper limb

- don’t inject in the lower limb

45
Q

What is the extensor origin of the elbow?

A

lateral epicondyle

46
Q

What is the flexor origin of the elbow?

A

medial epicondyle

47
Q

What are the features of arthritis in the elbow?

A
  • only after trauma
  • radio-capitellar joint= surgical excision of radial head
  • severe needs a total elbow replacement but then there will be weight restriction
48
Q

What is the treatment for OA at the thumb base?

A
  • steroid injection fot flares

- fusion/excision for chronic issues

49
Q

What is a Swan neck deformity?

A 
PIP = hyperextension
DIP = flexion
50
Q

What is a Boutonniere deformity?

A 
PIP = flexion
DIP = hyperextension
51
Q

Where are the most common places for a ganglion cyst?

A 
hand
wrist
foot 
ankle
knee (Baker)
52
Q

What phase of Dupuytren’s contracture involves development of nodules and myofibroblasts?

A

active contractile phase

53
Q

What are the phases of Dupuytren’s contracture?

A
  • proliferative phase: high concentration of immature myofibroblasts and fibroblasts arranged in a whorled pattern
  • involution phase: aligned fibroblasts in the longitudinal axis of the hand following lines of tension
  • residual phase: acellular collagen-rich chords remain causing contracture deformity
54
Q

What causes a claw hand?

A

ulnar nerve deformity

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