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MSK > upper limb conditions > Flashcards

upper limb conditions Flashcards

1
Q

impingement syndrome

A

where tendons of rotator cuff are compressed in the tight subacromial space during movement producing pain

supraspinatus = commonest

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2
Q

impingement syndrome presentation

A

30-40s
painful arc
pain radiates to deltoid + upper arm
tenderness may be felt lateral edge of acromion

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3
Q

special test for rotator cuff impingement

A

arc

Hawkins-Kenedy test - internally rotating flexed shoulder

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4
Q

management of impingement

A

resolves in most cases
NSAIDs, physio
subacromial steroid injections - up to 3

surgery = subacromial decompression - create more space for tendon, open or arthroscopic

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5
Q

causes of rotator cuff tears

A

acute injury - FOOSH
degenerative changes
overhead activities - playing tennis, construction

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6
Q

rotator cuff tear presentation

A

acute or gradual
shoulder pain - disrupt sleep

weakness + pain with specific movement relating to side of tear
–> supraspinatus = abduction

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7
Q

rotator cuff tear investigation

A

US or MRI

x-ray for exclusion of bony pathology - OA

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8
Q

rotator cuff tear management

A

degenerative = conservative

active/young = surgery if physio fails
-> arthroscopic rotator cuff repair

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9
Q

adhesive capsulitis (frozen shoulder)

A

inflam + fibrosis in joint capsule leads to adhesions (scar tissue) - adhesions bind the capsule + cause it to tighten around the joint + restrict movement

primary - no trigger
secondary - trauma, surgery, immobilisation

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10
Q

risk factors for adhesive capsulitis

A

middle aged, diabetes, thyroid problems

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11
Q

test for acromioclavicular OA

A

scarf test

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12
Q

adhesive capsulitis (frozen shoulder) presentation

A

3 phases -

  1. painful - may be worse at night
  2. stiff - esp external rotation
  3. thawing - gradual improvement in stiffness -> normal

lasts 1-3yrs

  • 6ish months in each phase
  • 50% have persistent symptoms
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13
Q

diagnosis of adhesive capsulitis

A

CLINICAL

US, CT, MRI show thickened joint capsule
- x-ray to exclude OA

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14
Q

adhesive capsulitis management

A

conserv = NSAIDs, physio, intra-articular steroid injections, hydrodilation (injecting fluid to stretch capsule)

surgery (resistant/severe)

  • manipulation under anaesthesia - forcefully stretching capsule
  • arthroscopy - cut adhesions
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15
Q

most common type of shoulder dislocation

A

anterior (90%)

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16
Q

cause of anterior shoulder dislocations

A

arm forced backward whilst abducted + extended

fall with shoulder in external rotation

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17
Q

causes of posterior shoulder dislocation

A

seizures
electric shocks

fall in internal rotation, direct blow anteriorly

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18
Q

what else must be assessed for in shoulder dislocations?

A

fractures

vascular damage - pulses, cap refil, palor

nerve damage - loss of sensation in regimental patch area (axillary nerve

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19
Q

posterior shoulder dislocation on xray

A

hard to see

“light bulb” sign

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20
Q

complications of shoulder dislocations

A

Bankart lesions - tear to anterior part of labrum

fractured humeral head (Hill-Sachs lesion)

axillary nerve damage - anterior dislocation

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21
Q

how would you check for axillary nerve damage?

A

loss of sensation in “regimental badge” area

motor weakness in deltoid + teres minor muscles

(comes from C5 + C6)

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22
Q

shoulder dislocation investigations

A

apprehension (recurrent subluxs)

x-ray - not always before, always after to confirm reduction + check for fractures

magnetic resonance arthrography (MRI with contrast injected into shoulder joint)
-> Bankart + Hill-Sachs lesions

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23
Q

why is important to reduce dislocations ASAP

A

muscle spasms occur over time making it harder to relocate + increasing risk of neurovascular damage

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24
Q

ulnar nerve damage checks

A

sensation to pinkie + half ring finger on both sides of hand

ability to abduct all fingers

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25
Q

radial nerve damage checks

A

sensation between thumb + index finger and DORSAL surface of hand

ability to extend wrist

26
Q

median nerve damage checks

A

sensation between thumb + index PALMAR surface

ability to to bring thumb and pinkie together

27
Q

what sport is associated with lateral epicondylitis?

A

tennis (elbow)

the tendon that inserts to the lateral epicondyle acts to extend the writst

28
Q

what sport is associated with medial epicondylitis?

A

Golfer’s elbow

tendon that inserts into medial epicondyle acts to flex the wrist

29
Q

management of epicondylitis

A 
analgesia, physio
orthotics (elbow braces)
steroid injections - avoid nerves
platelet rich plasma (PRP) injections
extracorpeal shockwave therapy
30
Q

cubital tunnel syndrome pathophysio

A

compression of ulnar nerve behind medial epicondyle (funny bone area)

-> can be due to tight band of fascia forming roof (Osbourne’s fascia) or tightness at intermuscular septum

31
Q

cubital tunnel syndrome presentation

A

parathesia in ulnar fingers = pinkie + half of ring finger

32
Q

cubital tunnel syndrome investigations

A

Tinel’s test over cubital tunnel
Froment’s test - paper between thumb + fist

nerve conduction studies to confirm diagnosis

33
Q

what 2 tendons are primarily affects in De Quervains tenosynovitis?

A

abductor pollicis longus (APL)

extensor pollicis brevis (EPB)

–> both act to abduct thumb + wrist

34
Q

notable cause of de querbains tenosynovitis in babies

A

parents repetively lifting newborns in a way that stresses tendons of the thumb

-> sometimes referred to as “mummy thumb”

35
Q

de quervains tenosynovitis

A

swelling + inflammation of tendon sheaths in the wrist

repetitive strain injury
causes pain on radial side of wrist

36
Q

de quervains tenosynovitis pathophysio

A

APL + EPB pass under the extensor retinaculum which wraps across the back of the wrist

repetitive movement of APL + EPB under extensor retinaculum results in inflammation + swelling of tendon sheaths

37
Q

de quervains tenosynovitis presentation

A 
symptoms at radial aspect of the wrist - near base of thumb
>pain - radiate forearm
> aching, burning
> weakness, numbness
> tenderness
38
Q

special tests for de quervains tenosynovitis

A

finklesteins = examiner flexes patients thumb into palms causing wrist to adduct (pos = pain)

eichoff’s = fist with thumb inside, wrist abducting

39
Q

de quervains tenosynovitis management

A

rest, analgesia, physio
splints
steroid injections

surgery (rarely) - cut extensor retinaculum

40
Q

carpal tunnel syndrome risk factors

A 
obesity
menopause
rheumatoid arthritis
diabetes
acromegaly 
hypothyroidism
41
Q

what is the carpal tunnel made up of / what does it contain?

A

between carapal bones + flexor retinaculum

contains = median nerve + flexor tendons of forearm

42
Q

what motor function does the median nerve supply?

A

to 3 thenar muscles (bulge at base of thumb responsible for its movements)

  • abductor pollicis brevis - abduction
  • opponens pollicis - opposition (reaching across palm to touch fingertips)
  • flexor pollicis brevis - flexion
  • adduct pollicis - adduction (innervated by ulnar)
43
Q

is palmar sensation of thumb, index + middle finger affected in carpal tunnel syndrome?

A

yes

palmar DIGITAL cutaneous branch of median nerve passes through tunnel

44
Q

carpal tunnel syndrome presentation

A

gradual onset symptoms

  • initially intermittent
  • often worse at night
  • shake hand to relieve

sensory (palmar thumb half)

  • numbness, paraesthesia
  • burning, pain

motor (thenar, thumb movements)

  • weak thumb movements
  • weak grip strength
  • difficult with fine movements
  • wasting of thenar muscles
45
Q

carpal tunnel syndrome special tests

A

phalens - flexing hands, putting backs of hands together

tinel’s - tapping over carpal tunnel

positive = triggering of symptoms - numbness/paraesthesia

46
Q

carpal tunnel syndrome management

A
  • rest, altered activities
  • wrist splints that maintain a neutral position of the wrist that can be worn at night (min 4 weeks)
  • steroid injections
  • surgery - cut flexor retinaculum
47
Q

which fingers are most commonly affected in trigger finger?

A

middle + ring finger

48
Q

risk factor for trigger finger (stenosing tenosynovitis)

A

40s, 50s
women
diabetes

49
Q

which pulley is most commonly affected in trigger finger?

A

first annular pulley (A1) at MCP joint

50
Q

trigger finger (stenosing tenosynovitis) pathophysio

A

thickening of tendon or tightening of sheath that tendons pass through
-> prevents tendon from smoothly runnign through - pain,stiffnes + catching symptoms

nodule can get stuck at entrance to pulley - causing finger to lock/stuck in bent position
–> may release with painful pop/click

51
Q

trigger finger (stenosing tenosynovitis) presentation

A

movement of finger produces clicking sensation - may be painful

finger may lock in position - patient may have to forcibly manipulate finger to regain extension (with PAIN)

52
Q

trigger finger management

A

most resolve spontaneously - rest, analgesia

splinting
steroid injections
surgery to release A1 pulley - division of A1 does not affect function

53
Q

dupuytren’s pathophysio

A

fascia of hand becomes thickened + tight leading to finger contractures (flexed, can’t fully extend)

proliferation of myofibroblasts + production of abnormal type 3 collagen

contracture = shortening of soft tissue that leads to restricted movement

54
Q

most common finger affected by dupuytren’s

A

ring + pinkie

55
Q

dupuytren’s risk factors

A 
age
family history - autosomal dominant pattern
male
manual labour (vibrating tools)
diabetes (esp type 1)
epilepsy
smoking + alcohol

high prevalence in scandinavian

56
Q

dupuytren’s managment

A

conservative
surgery, needle fasciotomy, limited fasciectomy, dermofasciectomy

recurrence in young
severe (fingers in palm) = amputation

57
Q

ganglion cyst pathophysio

A

thought to occur when the synovial membrane of tendon sheath or joint herniates forming a puch

synovial fluid flows from the tendon sheath or joint into the pouch forming a cyst

58
Q

ganglion cyst presentation

A

visible + palpable lump
firm + non-tender on palpation
skin mobile - fixed to underlying structures

transilluminates (shing a torch into cyst causes it to light up)

59
Q

ganglion cyst diagnosis

A

clinical

US can help confirm + exclude other causes of lumps

60
Q

ganglion cysts management

A

conservative - 40-50% resolve spontaneously (can take years)

needle aspiration - not really done, recurrence in >50%

surgical excision - open/endoscopic

MSK (14 decks)

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