Upper Limb Coretext

Question 1

What are the muscles of the rotator cuff?

Answer 1

Supraspinatous

Infraspinataous

Teres Minor

Subscapularis

Question 2

Name the muscles numbered

Answer 2

1. Supraspinatus
2. Infraspinatus
3. Teres Minor
4. Subscapularis

Question 3

Where do the supraspinatus, infraspinatus and teres minor muscles attach on to?

Answer 3

Greater tuberosity of the humerus

Question 4

What shoulder problems are common in each age group?

young

old

elderly

Answer 4

Young- instability

Old- rotator cuff tears

Elderly - Glenohumeral Osteoarthritis

Question 5

What is Impingement sydrome?

Answer 5

The tendons of the rotator cuff (usually the supraspinatus muscle) are compressed in the tight subacromial space during movement resulting in pain.

Question 6

What range of motion is known as the painfull arc?

Answer 6

60-120 degrees of abduction

Question 7

Name three causes of impingement syndrome

Answer 7

1. Tendonitis Subacromial Bursitis
2. Acromioclavicular OA with inferior osteophytes
3. A hooked acromion rotator cuff tear

Question 8

What is the management plan for Impigement Syndrome?

Answer 8

Treatment is conservative

NSAIDs

Physiotherapy

Subacromial Injection

Subacromial decompression surgery if necessary

Question 9

What is a rotator cuff tear?

Answer 9

Tendons of a rotator cuff muscle tear.

Can be partial or full thicknes

Classic history of a sudden jerk

degenerative changes in the tendons

Question 10

What is the management plan for Rotator cuff tears?

Answer 10

Physiotherapy to strength remain cuff muscles

Surgical Rotator Cuff repair.

Question 11

What is another name for Adhesive Capsulitis?

Answer 11

Frozen Shoulder

Question 12

What is adhesive capsulitis?

Answer 12

Progressive pain and siffness of the shoulder in patients between 40 and 60 - resloving after 18-24 months

Question 13

What is the principle clinical sign of frozen shoulder?

Answer 13

Loss of external rotation

Question 14

How do you treat frozen shoulder?

Answer 14

Phsyiotherapy

Analgesic - Intra-articular injections

Question 15

What can be seen on this X-ray?

Answer 15

Acute calcific tendonitis

Question 16

What would the patient experiance in acute calcific tendoitis?

Answer 16

Acute onset of severe shoulder pain

Question 17

What tendon is usually affected in acute calcific tendonitis?

Answer 17

Suprapspinatous tendon

Question 18

What is the prognosis of acute calcific tendonitis?

Answer 18

Self limiting with pain easing as the calcification reabsorbs

Question 19

What are the two types of shoulder instability that exist?

Answer 19

Traumatic instabiliy

Atraumatic - patients with generalized ligamentous laxity

Question 20

What is Carpal Tunnel syndrome?

Answer 20

Compression of the median nerve as it passes through the carpal tunnel.

Question 21

What nerve is affected in carpal tunnel sydrome?

Answer 21

Median nerve

Question 22

What do patients with carpal tunnel syndrome present with?

Answer 22

Symptoms affecting only the thumb and raidal 2.5 fingers

• Parathesia of the thumb
• Loss of sensation
• weakeness
• Clumbsiness

Question 23

What are some of the secondary causes of Carpal Tunnel Syndrome?

Answer 23

Rheumatoid Arthritis
Pregnancy

Diabetes

Chronic renal failure

Question 24

What is the management plan for carpal tunnel syndrome?

Answer 24

Non operative

wrist splints at night to prevent flexion.

Steroid Injections

Surgical treatments

Carpal tunnel decompression - division of the carpal ligament under local anaesthetic

Question 25

What is Cubital Tunnel Syndrome?

Answer 25

Compression of the Ulnar nerve at the elbow behind the medial Epicondyle

Question 26

What do patients with cubital tunnel syndrome usually present with?

Answer 26

only the 1.5 ulnar fingers are affected Paraesthesiae Weakness

Question 27

What is the management plan for cubital tunnel sydrome ?

Answer 27

surgery to release any tight structures

Question 28

What examination can be preformed to diagnose carpal or cubital tunnel syndrome?

Answer 28

Nerve conduction studies

Question 29

Where do the tricept muslces insert?

Answer 29

Olecranon process

Question 30

What is another name for Lateral Epicondylitis?

Answer 30

Tennis elbow

Question 31

What are the clincial features of Tennis Elbow?

Answer 31

Painful and tender lateral epicondyle painful middle finger and wrist extension

Question 32

What is the management plan for tennis elbow

Answer 32

Self limiting condition Rest Physiotherapy NSAIDs sometimes steroids sometimes brace

Question 33

What is another name for Medial epicondylitis?

Answer 33

Golfers elbow Golf - medial Tennis - lateral

Question 34

What is the management plan for medial epicondylitis?

Answer 34

self limiting Physio rest NSAIDs Injection carries risk of injury to the ulna nerve

Question 35

If you have a Total Elbow Replacement what is the maximum weight you can lift?

Answer 35

2.5kg

Question 36

What can you see here?

Answer 36

Dupuytren's contracture

Question 37

What is Dupuytren's contracture?

Answer 37

Ploiferative connective tissue disorder where specialized palmar fascia undergoes hyperplasia resulting in contractures at the MCP and PIP joints.

Question 38

What type of collagen is produce in Dupurytren's contracture and what collagen is normally produced?

Answer 38

Type 3 rather than type 1

Question 39

What do people with dupuytren's contracture present with?

Answer 39

Contractures of the ring and little fingers

Question 40

What is the management plan for duputures contracture

Answer 40

Mild - leave it Severe - surgery

Question 41

Why do people get trigger finger?

Answer 41

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

Question 42

How do you treat trigger finger

Answer 42

Steroid injection around the tendon within the sheath or Surgery

Question 43

What joints of the hand does OA usually occour in ?

Answer 43

DIP and PIP 1st carpometacarpal joint (base of thumb) common in woman

Question 44

What hand joints are spared in Rheumatoid Arthritis?

Answer 44

DIPs

Question 45

What are the three stages of Rheumatoid Arthritis in the hand?

Answer 45

1. Synovitis and tenosynovitis 2. Erosions of the joint 3. Joint instability and tendon rupture

Question 46

What is a ganglion cyst?

Answer 46

Common mucinous filled cysts found adjacent to a tendon or synovial joint

Question 47

What do people with ganglion cysts present with?

Answer 47

pain and irriation cosmetic reasons

Question 48

What is going on here?

Answer 48

Giant cell tumour of the tendon sheath