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MSK > Upper Limb Pathology > Flashcards

Upper Limb Pathology Flashcards

1
Q

In trigger finger, which pulley most commonly has a nodular enlargement distal to it?

A

A1

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2
Q

In trigger finger which fingers are most commonly affected?

A

Middle and ring finger

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3
Q

In OA, what are the two types of nodes that can be seen and where do they form?

A

Heberden’s nodes - DIP joints

Bouchard’s nodes - PIP joints

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4
Q

In RA, what hand joints tend to be spared?

A

DIP joints

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5
Q

Briefly, what are the 3 stages of natural history of RA?

A

synovitis and tenosynovitis
erosion of the joints
joint instability and tendon rupture

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6
Q

What are the 5 hand deformities of RA?

A

Volar MCPJ subluxation
Ulnar deviation
Swan neck deformity (hyperextension at PIPJ with flesion DIPJ)
Boutonniere deformity (flexion at PIPJ with hyperextension at DIPJ)
Z-shaped thumb

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7
Q

What is a ganglion cyst?

A

mucinous filled cysts found adjacent to a tendon or synovial joint

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8
Q

With rotator cuff tear, what are the symptoms?

A

weakness
muscle wasting
night pain

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9
Q

In carpal tunnel syndrome, which nerve is compressed?

A

Median nerve

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10
Q

What is the most common cause of carpal tunnel syndrome?

A

Tendinitis (often caused by RA)

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11
Q

What else can cause carpal tunnel syndrome?

A 
Diabetes causing polyneuropathy 
trauma 
neoplasm
idiopathic 
developmental 
degenrative
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12
Q

What are the symptoms of carpal tunnel syndrome?

A

Numbness (3 fingers supplied by median nerve)
altered sensation = dyasthesia
pain
night awakening

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13
Q

What investigations are used in carpal tunnel syndrome?

A

Nerve conduction studies
PV
X-ray

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14
Q

Give conservative treatments for carpal tunnel syndrome.

A

Corticosteroid injection
Splint
workplace task modification

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15
Q

What are the indications for decompression in carpal tunnel sydrome?

A

Failed conservative treatment
constant numbness
weakness

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16
Q

What are the 2 kinds of carpal tunnel release operative treatments?

A

Endoscopic or mini

standard open carpal tunnel release or arthroscopic

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17
Q

What can cause cubital tunnel syndrome?

A

Acute or delayed trauma
OA
RA
Anconeus epitrochlearis

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18
Q

What nerve is compressed and stretched in cubital tunnel syndrome? What are the symptoms of cubital tunnel syndrome?

A 
Ulnar nerve
pain 
paraesthesia - 1.5 fingers supplied by ulnar nerve
numbness 
weak pinch
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19
Q

What are the treatment options for cubital tunnel syndrome?

A

Splint
Neurolysis
Anterior transposition

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20
Q

What does the patient present with in cubital tunnel syndrome?

A

Pain
Paraesthesia
Numbness
Weak pinch

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21
Q

Colles Fracture

A

Dorsal angulation of radius with associated ulner styloid fracture
Elderly with osteoporosis - FOOSH

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22
Q

Radia buckel fracture

A

children with soft bones (un-fused growth plates and un-ossified carpal bones) - FOOSH

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23
Q

Scaphoid fracture

A

Pain in anatomical snuff box

Young males - FOOSH

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24
Q

How many x-ray views are required in a suspected scaphoid fracture?

A

4

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25
Q

What complication may occcur from a scaphoid fracture?

A

Proximal scaphoid blood supply may be disrupted leading to ANV or non-union
This may lead to early wrist OA

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26
Q

What nerve is commonly injured in surgical neck of humerus fractures?

A

Axillary nerve (regimental badge area loss of sensation)

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27
Q

What x-ray view is required in suspected posterior shoulder dislocation?

A

Oblique view

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28
Q

In a posterior shoulder dislocation, what is the typical sign seen on x-rays?

A

lightbulb sign

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29
Q

In a supracondylar fracture, what sign can be seen on x-rays?

A

Visible posterior fat pads - always pathological.

30
Q

Is seeing the anterior fat pad in the elbow always pathological?

A

No it is a normal sign

31
Q

What artery could be damaged in a supracondylar fracture?

A

Brachial artery

32
Q

What does a Bennet’s fracture involve?

A

The articular surfaces of the 1st MC base

33
Q

Tendinopathy

A

Disease of a tendon

34
Q

Tendinitis

A

Tendon injuries that involve larger scale acute injuries accompanied by inflammation

35
Q

Tendonosis

A

Chronic tendon injury with damage to a tendon at cellular level

36
Q

Tenosynovitis

A

Inflammation of the tendon sheath

37
Q

Enthesopathy

A

Inflammation of the tendon origin or insertion into bone

38
Q

What is the clinical presentation of a rotator cuff tear?

A 
achy pain 
shoulder tenderness 
difficulty sleeping on affected side, reaching overhead and on lifting 
painful arc 
positive impingment tests
39
Q

What imaging modality is used to clarify rotator cuff tear?

A

US

MRI if required

40
Q

Management options of rotator cuff tear

A

Conservative - rest, physio, steroid and LA injection

Surgery - arthroscopic or open subarchronial decompression and rotator cuff repair

41
Q

What clinical signs suggest biceps rupture?

A

Popeye sign ad extensive bruising

42
Q

What head of the biceps is predominantly affected in biceps tendinopathy?

A

Long head

43
Q

How does biceps tendinopathy occur?

A

Overuse, insatbillty, impingement or trauma

44
Q

Where is the pain in biceps tendinopathy? What is it aggravated by?

A

Pain in anterior shoulder radiatig to elbow

Shouder flexion, forearm pronation and elbow flexion

45
Q

What are the management options for biceps tendinopathy?

A

Conservative - rest and physio

Surgery

46
Q

What is Golfers elbow?

A

Medial epicondylitis
Inflammation of the origin of flexor forearm muscles over the medial epicondyle
Medial elbow pain
Self limiting

47
Q

Which nerve could be compressed in medial epicondylitis?

A

Ulner nerve - could lead to muscle weakness

48
Q

Give treatment options for golfers and tennis elbow.

A 
rest 
physio 
activity modification 
orthotics 
injection or surgical release
49
Q

What is lateral epicondylitis?

A

Tennis Elbow

Inflammation of the origin of extensor forearm muscles over the lateral epicondyle - pain and tender

50
Q

The pain in latera epicondylitis/tennis elbow is worse when..?

A

Worse when stretching the muscles

51
Q

What is DeQuervain’s tenosynovitis?

A

Inflammation of the tendon sheath of APL and EPB

52
Q

What is the most common direction of a shoulder dislocation? How does this occur?

A

Anterior

Fall with shoulder in external rotation or fall onto the back of the shoulder

53
Q

What other directions can a shoulder dislocate in and what causes them?

A

Posterior - fall with shoulder in internal rotation (posterior force on the adducted and internally rotated arm)
Inferior

54
Q

An impaction fracture on the anterior glenoid by the posterior humeral head, can occur in an anterior dislocaton. What is the name of this lesion?

A

Hill-Sachs lesion

55
Q

What is the main x-ray finding in a posterior shoulder dislocation?

A

Light-bulb sign

56
Q

What is the treatment for a shoulder dislocation?

A

Closed reduction under sedation/ anaesthetic
Then placed in a sling for 2-3 weeks
Then physiotherapy

57
Q

How do elbow dislocations occur?

A

FOOSH

58
Q

What is the most common direction of an elbow dislocation?

A

Posterior

59
Q

What is the management of an elbow dislocation?

A

Closed reduction under sedation/ anaesthetic

Then placed in a sling for 2-3 weeks

60
Q

How do interphalangeal joint dislocations occur and in whihc direction to they tend to be?

A

Hyperextension injury or direct axial blow

Almost always posterior

61
Q

Management of an interphalangeal joint dislocation?

A

Closed reduction under digital or metacarpal block

then 2 weeks in neighbour strapping

62
Q

Name the fracture that occurs when the radius fractures with dislocation of the ulna at DRUJ?

A

Galeazzi fracture dislocation

63
Q

Name the fracture that occurs when ulna fractures with dislocation of radial head at elbow?

A

Monteggia fracture dislocation

64
Q

If both the ulna and radius fracture what treatment is required?

A

ORIF

65
Q

What is the treatment for a Galeazzi or Monteggia fracture?

A

ORIF

66
Q

What is a Smith’s fracture?

A

Extra-articular fracture of the distal radius with a fall onto the back of the hand

67
Q

Do polymyositis and dermatomysitis present as proximal or distal muscle weakness? Is it symmetrical or asymmetrical?

A

Proximal muscle weakness

Symmetrical

68
Q

Which muscle are tired in inclusion body myositis? Is it symmetrical or asymmetrical?

A

Disteal muscle weakness

Asymmetrical

69
Q

Polymyalgia rheumatica presents as an ache where?

A

Shoulder and hip girdle

70
Q

What other clinical manifestations of polymyalgia rheumatica are there?

A

Morning stiffness in shoulder and hip girdle (may have decreased ROM)
Fever, weight loss, fatigue and anorexia may occur

71
Q

What clinical findings are seen in fibromyalgia?

A

Excessive tenderness on palpation of soft tissues
at least 11/18 tender points
Inflam markers normal

72
Q

What is the first line treatment for fibromyalgia?

A

Graded exercise programme and atypical analgesia - Gabapentin and pregabalin
No curative treatment

MSK (19 decks)

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