Upper Limb Orthopaedics

Question 1

Cubital tunnel syndrome results in compression of which nerve?

Answer 1

Ulnar nerve

Question 2

Lateral epicondylitis is also known as what?

Answer 2

Tennis elbow

Question 3

What investigation can be used to confirm a diagnosis of an upper limb compressive neuropathy, i.e. carpal or cubital tunnel syndrome?

Answer 3

Nerve conduction studies

Question 4

Weakness in initiation of abduction suggests a rotator cuff tear has affected which muscle?

Answer 4

Supraspinatous

Question 5

Most cases of a rotator cuff tear will settle without surgery over what time period?

Answer 5

1-2 years

Question 6

Tinel’s test can be used to identify carpal tunnel- what is done in this test?

Answer 6

Percussion over the median nerve

Question 7

The elbow joint is most likely to be affected by which type of arthritis?

Answer 7

Rheumatoid arthritis

Question 8

DeQuervain’s tenosynovitis is a painful condition which affects the extensor tendons, as they run through a tunnel on which side of the wrist?

Answer 8

Radial side

Question 9

What is the mainstay of treatment for both medial and lateral epicondylitis?

Answer 9

Rest, analgesia and physiotherapy

Question 10

How is DeQuervain’s tenosynovitis treated?

Answer 10

NSAIDs, splinting and rest

Question 11

Hyperextension at the PIP joint with flexion at the DIP joint describes what abnormality of the hands?

Answer 11

Swan neck deformity

Question 12

Where are ganglion cysts most likely to be found?

Answer 12

At the DIPs and the wrist

Question 13

Biceps tendonitis causes anterior shoulder pain which will be exacerbated by which movements?

Answer 13

Flexion of the elbow and shoulder, and pronation of the forearm

Question 14

Osteoarthritis of the glenohumeral joint can cause pain, crepitus and loss of movement. What is often the first movement to be lost?

Answer 14

External rotation

Question 15

How does acute calcific tendonitis present?

Answer 15

Acute onset of severe shoulder pain

Question 16

What is the main anatomical structure that is affected in trigger finger?

Answer 16

A1 pulley

Question 17

Pain from impingement syndrome can be recreated using what clinical test?

Answer 17

Hawkin’s-Kennedy test (internally rotating a flexed shoulder)

Question 18

An important test for DeQuervain’s tenosynovitis is Fincklestein’s test- describe what happens here?

Answer 18

Ask the patient to make a fist and the examiner presses down on the base of the thumb- this should elicit pain

Question 19

Acute calcific tendonitis involves calcium deposition where?

Answer 19

In the supraspinatous tendon

Question 20

A ‘Popeye deformity’ of the upper limb is a sign of what pathology?

Answer 20

Biceps tendon rupture

Question 21

The tendon of which rotator cuff muscle is most likely to be compressed in impingement syndrome?

Answer 21

Supraspinatous

Question 22

Clinical features of lateral epicondylitis include pain and tenderness over the lateral epicondyle- the pain is often worse on what movement?

Answer 22

Resisted middle finger and wrist extension

Question 23

How are giant cell tumours of the tendon sheath treated?

Answer 23

Surgical excision

Question 24

Phalen’s test can be used to identify carpal tunnel- what is done in this test?

Answer 24

Hyperflexion of the wrist

Question 25

Ganglion cysts are filled with what?

Answer 25

Synovial fluid

Question 26

What clinical test can be used to assess for weakness of the ulnar nerve innervated muscles in the hand, as a result of cubital tunnel syndrome?

Answer 26

Froment's test

Question 27

Carpal tunnel syndrome results in the compression of which nerve?

Answer 27

Median nerve

Question 28

Patients with cubital tunnel syndrome typically complain of pain and paraesthesia affecting which digits?

Answer 28

The ulnar one and a half digits

Question 29

In the painful phase of adhesive capsulitis, steroid injections can be useful for pain relief. Where can these be injected?

Answer 29

Glenohumeral joint

Question 30

Medial epicondylitis is also known as what?

Answer 30

Golfer's elbow

Question 31

Where are giant cell tumours of the tendon sheath most likely to be located?

Answer 31

The PIP joint of the middle or index finger

Question 32

Flexion at the PIP joint with hyperextension at the DIP joint describes what abnormality of the hands?

Answer 32

Boutonniere's deformity

Question 33

The principle sign of adhesive capsulitis is the loss of which movement?

Answer 33

External rotation

Question 34

The diagnosis of a rotator cuff tear can be diagnosed on one of which two imaging methods?

Answer 34

Ultrasound or MRI

Question 35

How can trigger finger be treated?

Answer 35

Steroid injections and splints

Question 36

How long does it usually take for adhesive capsulitis to resolve?

Answer 36

18-24 months

Question 37

In those aged under 20 years, what is the chance of re-dislocation after one anterior shoulder dislocation?

Answer 37

80%

Question 38

Dupuytren's contracture may occur as a side effect of therapy with what drug?

Answer 38

Phenytoin

Question 39

When are symptoms of carpal tunnel syndrome often worse?

Answer 39

At night

Question 40

Patients with carpal tunnel syndrome typically complain of pain and paraesthesia affecting which digits?

Answer 40

The thumb and the radial two and a half digits

Question 41

Describe a classical history of a degenerate rotator cuff tear?

Answer 41

A sudden jerk in someone aged \> 40 leads to subsequent pain and weakness

Question 42

Weakness in internal rotation of the shoulder suggests a rotator cuff tear has affected which muscle?

Answer 42

Subscapularis

Question 43

In patients with recurrent shoulder dislocations, what surgical treatment can be used to stabilise the shoulder?

Answer 43

Bankhart repair

Question 44

What condition is responsible for causing medial elbow pain, with a tender point over the flexor origin?

Answer 44

Medial epicondylitis

Question 45

Cases of impingement syndrome which do not respond to conservative treatment may respond to what surgical management?

Answer 45

Subacromial decompression

Question 46

Having which other medical condition is the most significant risk factor for the development of adhesive capsulitis?

Answer 46

Diabetes

Question 47

What are the two main risk factors for the development of DeQuervain's tenosynovitis?

Answer 47

Pregnancy and rheumatoid arthritis

Question 48

What is the aim of physiotherapy for a rotator cuff tear?

Answer 48

To strengthen the other rotator cuff muscles to compensate for the loss of supraspinatous

Question 49

Weakness in external rotation of the shoulder suggests a rotator cuff tear has affected which muscle?

Answer 49

Infraspinatous

Question 50

What condition is characterised by progressive pain and stiffness of the shoulder in patients aged between 40 and 60 years?

Answer 50

Adhesive capsulitis (frozen shoulder)

Question 51

Impingement syndrome should be managed in the first instance with analgesia and physiotherapy. What are the best options for analgesia?

Answer 51

NSAIDs and subacromial steroid injections

Question 52

Rotator cuff tears are most likely to involve which muscle?

Answer 52

Supraspinatous

Question 53

Why should steroid injections be avoided in cases of medial epicondylitis?

Answer 53

Risk of damage to the ulnar nerve

Question 54

Dupuytren's contracture is a fixed flexion deformity of the digits as a result of what?

Answer 54

Thickening and contracture of the palmar fascia

Question 55

Lateral epicondylitis tends to occur in individuals who regularly perform what movement?

Answer 55

Resisted extension at the wrist

Question 56

Impingement syndrome typically causes pain on what movement?

Answer 56

60-120 degrees of abduction