Upper Limb Coretext Flashcards
What are the muscles of the rotator cuff?
Supraspinatous
Infraspinataous
Teres Minor
Subscapularis
Name the muscles numbered
- Supraspinatus
- Infraspinatus
- Teres Minor
- Subscapularis
Where do the supraspinatus, infraspinatus and teres minor muscles attach on to?
Greater tuberosity of the humerus
What shoulder problems are common in each age group?
young
old
elderly
Young- instability
Old- rotator cuff tears
Elderly - Glenohumeral Osteoarthritis
What is Impingement sydrome?
The tendons of the rotator cuff (usually the supraspinatus muscle) are compressed in the tight subacromial space during movement resulting in pain.
What range of motion is known as the painfull arc?
60-120 degrees of abduction
Name three causes of impingement syndrome
- Tendonitis Subacromial Bursitis
- Acromioclavicular OA with inferior osteophytes
- A hooked acromion rotator cuff tear
What is the management plan for Impigement Syndrome?
Treatment is conservative
NSAIDs
Physiotherapy
Subacromial Injection
Subacromial decompression surgery if necessary
What is a rotator cuff tear?
Tendons of a rotator cuff muscle tear.
Can be partial or full thicknes
Classic history of a sudden jerk
degenerative changes in the tendons
What is the management plan for Rotator cuff tears?
Physiotherapy to strength remain cuff muscles
Surgical Rotator Cuff repair.
What is another name for Adhesive Capsulitis?
Frozen Shoulder
What is adhesive capsulitis?
Progressive pain and siffness of the shoulder in patients between 40 and 60 - resloving after 18-24 months
What is the principle clinical sign of frozen shoulder?
Loss of external rotation
How do you treat frozen shoulder?
Phsyiotherapy
Analgesic - Intra-articular injections
What can be seen on this X-ray?
Acute calcific tendonitis
What would the patient experiance in acute calcific tendoitis?
Acute onset of severe shoulder pain
What tendon is usually affected in acute calcific tendonitis?
Suprapspinatous tendon
What is the prognosis of acute calcific tendonitis?
Self limiting with pain easing as the calcification reabsorbs
What are the two types of shoulder instability that exist?
Traumatic instabiliy
Atraumatic - patients with generalized ligamentous laxity
What is Carpal Tunnel syndrome?
Compression of the median nerve as it passes through the carpal tunnel.
What nerve is affected in carpal tunnel sydrome?
Median nerve
What do patients with carpal tunnel syndrome present with?
Symptoms affecting only the thumb and raidal 2.5 fingers
- Parathesia of the thumb
- Loss of sensation
- weakeness
- Clumbsiness
What are some of the secondary causes of Carpal Tunnel Syndrome?
Rheumatoid Arthritis
Pregnancy
Diabetes
Chronic renal failure
What is the management plan for carpal tunnel syndrome?
Non operative
wrist splints at night to prevent flexion.
Steroid Injections
Surgical treatments
Carpal tunnel decompression - division of the carpal ligament under local anaesthetic
What is Cubital Tunnel Syndrome?
Compression of the Ulnar nerve at the elbow behind the medial Epicondyle
What do patients with cubital tunnel syndrome usually present with?
only the 1.5 ulnar fingers are affected
Paraesthesiae
Weakness
What is the management plan for cubital tunnel sydrome ?
surgery to release any tight structures
What examination can be preformed to diagnose carpal or cubital tunnel syndrome?
Nerve conduction studies
Where do the tricept muslces insert?
Olecranon process
What is another name for Lateral Epicondylitis?
Tennis elbow
What are the clincial features of Tennis Elbow?
Painful and tender lateral epicondyle
painful middle finger and wrist extension
What is the management plan for tennis elbow
Self limiting condition
Rest
Physiotherapy
NSAIDs
sometimes steroids
sometimes brace
What is another name for Medial epicondylitis?
Golfers elbow
Golf - medial
Tennis - lateral
What is the management plan for medial epicondylitis?
self limiting
Physio
rest
NSAIDs
Injection carries risk of injury to the ulna nerve
If you have a Total Elbow Replacement what is the maximum weight you can lift?
2.5kg
What can you see here?
Dupuytren’s contracture
What is Dupuytren’s contracture?
Ploiferative connective tissue disorder where specialized palmar fascia undergoes hyperplasia resulting in contractures at the MCP and PIP joints.
What type of collagen is produce in Dupurytren’s contracture and what collagen is normally produced?
Type 3 rather than type 1
What do people with dupuytren’s contracture present with?
Contractures of the ring and little fingers
What is the management plan for duputures contracture
Mild - leave it
Severe - surgery
Why do people get trigger finger?
Tendonitis of a flexor tendon to a digit resulting in nodular enlargement of the affected tendon which gets stuck in the fascial pully over the tendon neck
How do you treat trigger finger
Steroid injection around the tendon within the sheath
or
Surgery
What joints of the hand does OA usually occour in ?
DIP and PIP
1st carpometacarpal joint (base of thumb) common in woman
What hand joints are spared in Rheumatoid Arthritis?
DIPs
What are the three stages of Rheumatoid Arthritis in the hand?
- Synovitis and tenosynovitis
- Erosions of the joint
- Joint instability and tendon rupture
What is a ganglion cyst?
Common mucinous filled cysts found adjacent to a tendon or synovial joint
What do people with ganglion cysts present with?
pain and irriation
cosmetic reasons
What is going on here?
Giant cell tumour of the tendon sheath
