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Phase 2- MSK > Upper Limb Pathologies > Flashcards

Upper Limb Pathologies Flashcards

1
Q

What is adhesive capsulitis?

A

Pain and loss of motion in the shoulder (frozen shoulder)

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2
Q

Give 3 conditions which are associated with adhesive capsulitis

A

Diabetes, thyroid disorders, previous surgery to lung and breast

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3
Q

Describe the 3 phases of adhesive capsulitis

A

Phase 1- painful, gradual onset (6 weeks-9 months)
Phase 2- stiff, extreme decrease in ROM (4-9 months)
Phase 3- thawing, gradual return of motion (5 to 26 months)

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4
Q

How would adhesive capsulitis be managed non-surgically?

A

NSAIDs, physiotherapy, steroid injections

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5
Q

How would adhesive capsulitis be managed surgically?

A

Manipulation under anaesthesia

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6
Q

Give 3 potential complications of adhesive capsulitis

A

Axillary nerve injury, rotator cuff tendon disruption, recurrent stiffness, fracture or dislocation

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7
Q

What type of shoulder dislocation is the most common?

A

Anterior dislocation

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8
Q

How will an anterior shoulder dislocation present?

A

Arm externally rotated and shoulder flattened. May see a bulge anteriorly

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9
Q

What x-ray views are required for an anterior shoulder dislocation?

A

AP and Y view

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10
Q

How is an anterior shoulder dislocation treated?

A

Closed reduction alongside period of immobilisation

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11
Q

Give 5 complications of an anterior shoulder dislocation

A 
Shoulder instability 
Hill-Sachs lesion 
Bankart lesion 
Damage to brachial plexus 
Damage to axillary artery
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12
Q

What is a Hill-Sachs lesion?

A

Posterolateral humeral head compression fracture

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13
Q

What is a Bankart lesion?

A

Detachment of the anterior inferior labrum from the glenoid

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14
Q

What mechanism may cause a posterior shoulder dislocation?

A

Humeral head forced posteriorly in internal rotation as the arm is abduction. Seen in electrocution and convulsive disorders.

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15
Q

What will be seen on an xray of a posterior shoulder dislocation?

A

Absence of external rotation
Light Bulb sign (internally rotated humeral head is rounded)
Trough line sign
Loss of half moon overlap sign
Rim sign (widened glenohumeral joint >6mm)

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16
Q

Give 3 other injuries associated with a posterior shoulder dislocation

A

Reverse Bankart lesion
Reverse Hill-Sachs lesion
Proximal humerus fractures

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17
Q

How is a posterior shoulder dislocation managed?

A

Normally self-reduce, if needed can use closed reduction

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18
Q

How will an inferior shoulder dislocation present?

A

Arm will be in fixed abduction

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19
Q

What score is used to assess hypermobility? What is the score out of?

A

Beighton score- score out of 9

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20
Q

Describe what is involved in the Beighton score

A 
Touch toes from forward flexion 
Thumb to anterior forearm x2
Little finger to posterior forearm x2
Invert elbows x2
Bend knee backwards x2
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21
Q

Give 3 common ways the brachial plexus can be injured

A

Trauma
Obstetrics
Burners and stingers (sports injury)

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22
Q

What nerve roots are affected in Erb’s palsy?

A

C5,C6

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23
Q

How will an Erb’s palsy present? What is the arm position known as?

A

Clinically the arm will be adducted and internally rotated at the shoulder, pronated and extended at the elbow
Waiter’s Tip position

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24
Q

What muscles will be weakened in a C5 injury?

A

Deltoid, Teres Minor, Supraspinatus, Infraspinatus, Biceps brachii

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25
Q

What muscles will be weakened in a C6 injury?

A

Brachioradialis, Supinator

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26
Q

What nerve roots are affected in Klumpke palsy?

A

C8,T1

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27
Q

How will a patient with Klumpke palsy present?

A

Weakness of the intrinsic muscles of the hand –> claw hand

wrist in extreme extension, hyperextension in the MCP joints, IP joints flexed

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28
Q

Where do most clavicle fractures occur?

A

Medial 1/3rd

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29
Q

Why are clavicle fractures always displaced?

A

SCM muscle pulls medial fragment posterosuperiorly

Pectoralis and gravity pull lateral segment inferomedially

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30
Q

When is a clavicle fracture operated on?

A

When the fracture is displaced

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31
Q

What surgical options are available for a clavicle fracture?

A

Open reduction and internal fixation

Closed reduction and intramedullary fixation

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32
Q

What is a flail chest?

A

3 or more rib fractures

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33
Q

What other injuries with a flail chest often present with?

A

Scapula fracture
Clavicle fracture
Pneumothorax
Haemothorax

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34
Q

What are the signs of a flail chest?

A

Paradoxical respiration
Chest wall deformity
Soft tissue crepitus

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35
Q

Why are scapula fractures only associated with high energy trauma?

A

Thick, sturdy bone

Surrounded by muscle and soft tissue on both sides

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36
Q

What is a SIT rotator cuff tear?

A

Tear of the supraspinatus, infraspinatus and teres minor muscles

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37
Q

When do SIT rotator cuff tears occur?

A

After a shoulder dislocation in elderly patients

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38
Q

When do subscapularis tears occur?

A 
Acute avulsion in younger patients 
Iatrogenic injury (failure of surgical repair)
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39
Q

What are 3 risk factors for rotator cuff tears?

A

Older age, smoking, hypercholesterolaemia, family history, overhead throwing athlete

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40
Q

What are the common symptoms of a rotator cuff tear?

A

Pain in deltoid, night pain, pain worse when lifting arm overhead, loss of active ROM

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41
Q

What are the 2 blood vessels which supply the humeral head?

A

Ascending branch of humeral circumflex artery –> arcuate artery
Posterior humeral circumflex artery

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42
Q

Give 6 potential causes of avascular necrosis of the shoulder

A 
ASEPTIC
Alcohol/AIDS
Steroids/SLE/Sickle cell
Erlenmeyer flask 
Pancreatitis
Trauma 
Idiopathic/Infection 
Caisson (the bends)
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43
Q

What classification system is used for avascular necrosis of the shoulder?

A

Cruess classification

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44
Q

What are the symptoms of avascular necrosis of the shoulder?

A

Pain, loss of motion, crepitus, weakness of rotator cuff and deltoid muscles

45
Q

When is a hemi-arthroplasty needed in avascular necrosis of the shoulder?

A

Stage III and IV
Subchondral fracture
Flattening and collapse of the humeral head

46
Q

When is a total shoulder replacement needed in avascular necrosis of the shoulder?

A

Stage V

Degenerative changes extend into the glenoid

47
Q

What is a shoulder hemi-arthroplasty?

A

Humeral articular surface is replaced with a stemmed humeral component and a new humeral head

48
Q

When is a shoulder hemi-arthroplasty contraindicated?

A

Infection
Neuropathic joint
Unmotivated patient
Coracoacromial ligament deficiency

49
Q

What is a total shoulder arthroplasty?

A

Replacement of the humeral head and glenoid resurfacing.

50
Q

What are the symptoms of a winged scapula?

A

Shoulder and scapula pain, weakness in overhead lifting, discomfort when sitting in a chair

51
Q

What is the cause of medial winged scapula?

A

Damage to long-thoracic nerve (C5,6,7)

Can be caused by anaesthesia complications, repetitive stretch injury, compression injury, scapula fracture.

52
Q

How will a medial winged scapula present?

A

Superior medial scapula elevates and moves medially. There is wasting of the anterior scalene triangle

53
Q

What is the cause of lateral winged scapula?

A

Damage to cranial nerve 11 affecting trapezius muscle. It is often caused iatrogenically from general surgery or neurosurgery

54
Q

How will a lateral winged scapula present?

A

Superior medial scapula drops downwards and lateral. Shoulder girdle appears to droop. There will be anterior scalene atrophy.

55
Q

How are proximal humeral fractures classified?

A

Neer classification

Based on the anatomical relationship of the fragments

56
Q

What are the symptoms of a proximal humeral fracture?

A

Pain, swelling, decreased range of motion

57
Q

How may a proximal humeral fracture present?

A

Extensive ecchymosis on chest and arm, loss of sensation in regimental badge area, lack of brachial and radial pulses

58
Q

Give 5 complications of a proximal humeral fracture

A 
Avascular necrosis
Nerve injury 
Malunion 
Nonunion 
Rotator cuff injury 
Adhesive capsulitis
Infection
59
Q

What is a Holstein-Lewis fracture?

A

Spiral fracture of the distal 1/3rd of the humeral shaft commonly associated with damage to the radial nerve.

60
Q

How may a humeral shaft fracture present?

A

Limb shortened and in varus, may be some neurovascular deficit

61
Q

What is the main treatment of humeral shaft fractures?

A

Coaptation splint with functional brace

62
Q

Which nerve is most at risk in a humeral shaft fracture?

A

Radial nerve

63
Q

What is a sail sign when seen on a distal humerus fracture x-ray?

A

Soft tissue swelling around the fracture

64
Q

What are the symptoms of a distal humerus fracture?

A

Elbow pain, elbow swelling, numbness in arm, lack of pulses

65
Q

What nerve is most at risk in a distal humerus fracture?

A

Ulnar nerve

66
Q

What is CRITOL used for and what does it stand for?

A 
CRITOL is used for telling a child's age from the areas of growth on an x-ray of the elbow
Capitulum at 1 year 
Radius (head of) at 3 years 
Internal (medial) epicondyle at 5 years 
Trochlea at 7 years 
Olecranon at 9 years 
Lateral epicondyle at 11 years
67
Q

In which direction are most elbows dislocated?

A

Posterolaterally

68
Q

Give 3 complications of an elbow dislocation

A

Early stiffness
Neurovascular injuries
Compartment syndrome
Recurrent instability

69
Q

How is a dislocated elbow managed nonoperatively?

A

Closed reduction and splinting

70
Q

How is a dislocated elbow managed operatively?

A

ORIF

Capsular release

71
Q

What is lateral epicondylitis?

A

Tennis Elbow

Overuse of the common extensor tendon which leads to tendonitis and inflammation

72
Q

What are the symptoms of lateral epicondylitis?

A

Pain with resisted wrist extension, pain on gripping, decreased grip strength

73
Q

What is the 1st line treatment of tennis elbow?

A

Rest, activity modification, NSAIDs, physiotherapy

74
Q

Which nerve is at risk in tennis elbow?

A

Radial nerve

75
Q

What is medial epicondylitis?

A

Golfer’s elbow

Overuse of the flexor-pronator origin point. Rarer than tennis elbow.

76
Q

What are the symptoms of golfer’s elbow?

A

Pain over medial epicondyle, pain worse on forearm motion and gripping, may have tingling in ulnar digits

77
Q

What is the first line treatment of golfer’s elbow?

A

Rest, activity modification, bracing, NSAIDs, corticosteroid injections

78
Q

Which nerve is at risk in Golfer’s elbow?

A

Ulnar nerve

79
Q

What is a Monteggia fracture?

A

Proximal 1/3rd ulnar fracture with associated radial head dislocation or instability

80
Q

What are some symptoms of Monteggia fractures?

A

Pain and swelling at the elbow joint
Radial deviation of the hand
Weakness in the hand

81
Q

What is a Galeazzi Fracture?

A

Distal 1/3rd radial shaft fracture and associated distal radioulnar joint injury.

82
Q

Why do the radius and ulna commonly fracture together?

A

In close proximity

Interosseous membrane attaches the two bones

83
Q

What are the symptoms of a radial and ulna shaft fracture?

A

Gross deformity, pain, swelling, loss of forearm and hand function, pain on passive stretching of the fingers

84
Q

What is a Colle’s fracture?

A

Dorsally displaced, extra-articular radial fracture

85
Q

What is a Smith’s fracture?

A

Volar displaced, extra-articular radial fracture

86
Q

How is a distal radial fracture managed if there is no radial shortening?

A

Closed reduction and cast immobilisation

87
Q

How is a distal radial fracture managed if there is instability, displacement, severe osteoporosis or >5mm of radial shortening?

A

Closed reduction and percutaneous pinning
External fixation
ORIF

88
Q

Give 3 common ways the radial nerve can be damaged

A

Use of crutches
Humeral fractures
Saturday night palsy- leaning on elbow for long time

89
Q

Give 3 clinical features of a radial nerve palsy

A

Weakness of forearm extension and flexion
Wrist drop
Weakness of thumb adductor and extensor muscles
Sensory loss on the dorsum of the hand

90
Q

Where are the most common site to injure the ulnar nerve?

A

Elbow and hand

91
Q

What is an ulnar claw?

A

Hyperextension of MCP, flexion of DIP and PIP of ring and little finger. The hand is stuck in this position.

92
Q

What is the ulnar paradox?

A

A lesion to the ulnar nerve above the wrist will result in a less pronounced clawing even though the damage is worse because the flexor digitorum profundus is paralysed and so the DIP joints cannot flex.

93
Q

What is the hand of Benediction?

A

Result of a median nerve palsy which causes loss of flexion at the MCP and IP joints in the lateral 3 fingers. This is because the flexor digitorum superficialis and the flexor digitorum profundus lose their innervation. If the patient tries to make a fist, their 2nd and 3rd fingers will not move.

94
Q

What are the causes of carpal tunnel syndrome?

A 
MEDIAN TRAP
Myxoedema
Ethanol 
Diabetes
Idiopathic
Acromegaly
Neoplasms
Trauma
Rheumatoid arthritis 
Amyloidosis
Pregnancy
95
Q

What are the symptoms of carpal tunnel syndrome?

A

Numbness and tingling in radial fingers
Clumsiness
Pain and paresthesia at night

96
Q

What is Phalen’s test?

A

Wrist volar flexion held for 1 minute will reproduce the symptoms

97
Q

What is Tinel’s test?

A

When the median nerve is tapped the symptoms start

98
Q

What is Dupuytren’s contracture?

A

Fibromatosis of the palmar fascia which leads to flexion deformities.

99
Q

What is De Quervain’s tenosynovitis?

A

Inflammation of the sheath which surrounds the tendons of the abductor pollicis longus and extensor pollicis longus.

100
Q

What are the symptoms of De Quervain’s tenosynovitis?

A

Pain on radial side of the hand, spasms, tenderness, swelling over the thumb, occasional burning sensation in the hand.

101
Q

What is the major risk if someone has a scaphoid fracture and why is it a risk?

A

Avascular necrosis of the scaphoid. Blood supply is distally to proximally

102
Q

What are some symptoms of a scaphoid fracture?

A

Pain, restricted pronation, scaphoid tubercle tenderness, pain in anatomical snuffbox

103
Q

What is trigger finger?

A

Tenosynovitis caused by inflammation of the flexor tendon sheath. The inflammation causes the tendon to become stuck in the finger pulleys so the finger does not flex smoothly

104
Q

How is trigger finger treated?

A

Nonoperatively –> night splinting, activity modification, NSAIDs, steroids
Operatively –> surgical debridement, release of pulley

105
Q

What is a Boxer’s fracture?

A

Fracture of the 5th metacarpal usually caused by a direct blow to the hand eg. punch

106
Q

What is mallet finger? What is the main cause?

A

Finger deformity caused by disruption of the terminal extensor tendon distal to the DIP joint. It is often caused after a traumatic, sudden forced flexion of the tip of the finger in the extended position.

107
Q

What is Raynaud’s?

A

Exaggerated vasoconstriction of the arteries in the extremities. The fingers will go white, blue and then red and then become painful.

108
Q

What is the difference between Raynaud’s disease and syndrome?

A

Raynaud’s disease is when there is no known cause and Raynaud’s syndrome is when there is a known cause such as SLE, RA or scleroderma.

Phase 2- MSK (7 decks)

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