Upper Limb Pathologies

Question 1

Where could pain in the right shoulder be referred from?

Answer 1

Gall bladder
Angina pectoris
Diaphragmatic irritation from biliary colic, subphrenic abscess

Question 2

Suspect impingement syndrome, what examination special test would you do?

Answer 2

Jobes test where rotate outstreched hands from thumb side up to pinky side up, then push down above the elbow. Should reproduce the pain

Question 3

What is the common muscle in the rotator cuff to be impinged?

Answer 3

Supraspinatous

Question 4

What is the treatment for impingement syndrome?

Answer 4

NSAIDs, anaglesia, physio, subacromial steroid injection, if symptoms dont improve then surgery

Question 5

40 year old painter presents with pain and weakness of his right arm. It has a non-specific ache and he cant sleep on his right side. He was standing on a bus holding a railing that suddenly stopped when he felt a pain, and its been bad ever since. On exam active movement is limited by passive ROM good when not inhibited by pain. What investigation would you send for? Likely diagnosis?

Answer 5

Rotator cuff tear

Ultrasound to see the rotator cuff muscles (supraspinatous, infraspinatous, teres minor, subscapularis)

Question 6

What is the treatment for rotator cuff tear?

Answer 6

Surgical
Repair muscle with subacromial decompression
Reversed ball/ socket surgery
Physiotherapy

Question 7

Diabetic 50 year old presents with progressive pain and stiffness of her shoulder over 3 months, the pain is now subsiding but the stiffness is getting worse. On examination there is loss of external rotation. What investigations would you run. Likely diagnosis?

Answer 7

X-ray to exclude other diagnosis
Adhesive capsulitis (frozen shoulder

Question 8

What is the treatment for frozen shoulder?

Answer 8

It is a self ilmiting condition so physiotherapy and analgesia

Question 9

Man presents with acute onset of severe pain in the shoulder. On xray there was calcium deposition proximal to greater tuberosity. Likely diagnosis? Treatment?

Answer 9

Acute calcific tendonitis

Self limiting so subacromial steroid injection

Question 10

Man 70 years presents with pain in his shoulder, it is worse with full abduction. On examination he is scarf sign positive. Likely diagnosis?

Answer 10

Acromioclavicular OA

Question 11

Man presents with pain in his anterior shoulder radiating to the elbow particularly during flexion. He is unable to pronate his forearm. He is pop-eye positive. Diagnosis?

Answer 11

Biceps ruputre

Question 12

Patient presents with pain in the lateral epicondyle. It is pinpoint pain, it is the common extensor origin. What would you expect to find on examination?

Answer 12

Pain on wrist extension and middle finger.
Pain on resisted extension of the finger

Lateral epicondylitis

Question 13

What is the treatment for epicondylitis?

Answer 13

Self limiting so rest (but may take up to 4 years)
Physiotherapy
NSAIDs
Steroid injections but if medial then careful dont hit ulnar nerve

Question 14

What would you expect to find on examination with someone with medial epicondylitis?

Answer 14

Paraesthesia of little finger and ring finger due to compression of the ulnar nerve

Question 15

Women presents with numbness of her ring and pinky finger, and a weakness of her wrist to flex. On examination she is Tinels test positive. Diagnosis?

Answer 15

Cubital tunnel syndrome

Tinels test is percussion over ulnar nerve to ellicit pins/needle sensation

Question 16

Pregnant women presents with pins and needles in her thumb, index and middle fingers. Its worse at night, and is finding it difficult to grip things. On examination there is thenar eminence wasting and phalens test positive. Diagnosis and treatment?

Answer 16

Carpal tunnel syndrome

Wrist splints at night to prevent over flexion, steroid injections

Question 17

What is the pathology of dupuytrens contracture?

Answer 17

Specialzed palmar fascia undergoes hyperplasic forming nodules and cords that cause contractures. It is a change of fibroblasts to myofibroblasts that then produce type 3 collagen instead of 1

Question 18

What are the most common sites for dupuytrens contracrture?

Answer 18

Ring and little finger

Question 19

What are the treatments for dupytrens contracture? Depends on what?

Answer 19

Site of joint infected. If PIP joint then must do surgery urgently to fix it

If MCP joint then can wait for however long want to do surgery as outcome will be the same.

Can also do percutaneous needles fasciotomy, collagenase injections

Question 20

What is the pathology of trigger finger?

Answer 20

Tendonitis of flexor tendon distal to fascial pully causing nodules to form that get stuck underneath an annular pulley

Question 21

What are some of the symptoms of trigger finger? And treatment

Answer 21

Unable to regain full extension
Clicking sensation during flexion
Painful

Steroid injection to tendon sheath

Question 22

What is a heberdens node

Answer 22

Where there is swelling of the DIP joint

H further in alphabet than b so why end of finger

Question 23

What is bouchards node

Answer 23

Swelling of the PIP joint

B beginning of alphabet so closer to the body

Question 24

Women with known arthritis of the knees presents with a swelling behind her knee. It fluctuates in size, it isnt painful but cosmetically annoying. Diagnosis?

Answer 24

Bakers cyst

Question 25

Women who has recently gave birth presents with a really red, tender and swollen base of thumb. She cannot extend it without pain. She is finklesteins test positive. Diagnosis and treatment>

Answer 25

Deqervains tenosynovitis
Splinting, steroid injections, physiotherapy, surgical management

Finklesteins is where make a fist and close thumb in it, should cause pain

Question 26

Women presents with extremenly painful, red, index finger. She cannot move it due to the pain, she has a fever and you can see redness up the anterior forearm. Likely diagnosis,treatment?

Answer 26

Flexor tendon sheath infection
URGENT
Elevate the finger, wash out the infection

Question 27

Wrist drop is due to what nerve being damaged

Answer 27

Radial nerve