Upper Limb Pathology Flashcards
In trigger finger, which pulley most commonly has a nodular enlargement distal to it?
A1
In trigger finger which fingers are most commonly affected?
Middle and ring finger
In OA, what are the two types of nodes that can be seen and where do they form?
Heberden’s nodes - DIP joints
Bouchard’s nodes - PIP joints
In RA, what hand joints tend to be spared?
DIP joints
Briefly, what are the 3 stages of natural history of RA?
synovitis and tenosynovitis
erosion of the joints
joint instability and tendon rupture
What are the 5 hand deformities of RA?
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
What is a ganglion cyst?
mucinous filled cysts found adjacent to a tendon or synovial joint
With rotator cuff tear, what are the symptoms?
weakness
muscle wasting
night pain
In carpal tunnel syndrome, which nerve is compressed?
Median nerve
What is the most common cause of carpal tunnel syndrome?
Tendinitis (often caused by RA)
What else can cause carpal tunnel syndrome?
Diabetes causing polyneuropathy trauma neoplasm idiopathic developmental degenrative
What are the symptoms of carpal tunnel syndrome?
Numbness (3 fingers supplied by median nerve)
altered sensation = dyasthesia
pain
night awakening
What investigations are used in carpal tunnel syndrome?
Nerve conduction studies
PV
X-ray
Give conservative treatments for carpal tunnel syndrome.
Corticosteroid injection
Splint
workplace task modification
What are the indications for decompression in carpal tunnel sydrome?
Failed conservative treatment
constant numbness
weakness
What are the 2 kinds of carpal tunnel release operative treatments?
Endoscopic or mini
standard open carpal tunnel release or arthroscopic
What can cause cubital tunnel syndrome?
Acute or delayed trauma
OA
RA
Anconeus epitrochlearis
What nerve is compressed and stretched in cubital tunnel syndrome? What are the symptoms of cubital tunnel syndrome?
Ulnar nerve pain paraesthesia - 1.5 fingers supplied by ulnar nerve numbness weak pinch
What are the treatment options for cubital tunnel syndrome?
Splint
Neurolysis
Anterior transposition
What does the patient present with in cubital tunnel syndrome?
Pain
Paraesthesia
Numbness
Weak pinch
Colles Fracture
Dorsal angulation of radius with associated ulner styloid fracture
Elderly with osteoporosis - FOOSH
Radia buckel fracture
children with soft bones (un-fused growth plates and un-ossified carpal bones) - FOOSH
Scaphoid fracture
Pain in anatomical snuff box
Young males - FOOSH
How many x-ray views are required in a suspected scaphoid fracture?
4
What complication may occcur from a scaphoid fracture?
Proximal scaphoid blood supply may be disrupted leading to ANV or non-union
This may lead to early wrist OA
What nerve is commonly injured in surgical neck of humerus fractures?
Axillary nerve (regimental badge area loss of sensation)
What x-ray view is required in suspected posterior shoulder dislocation?
Oblique view
In a posterior shoulder dislocation, what is the typical sign seen on x-rays?
lightbulb sign
In a supracondylar fracture, what sign can be seen on x-rays?
Visible posterior fat pads - always pathological.
Is seeing the anterior fat pad in the elbow always pathological?
No it is a normal sign
What artery could be damaged in a supracondylar fracture?
Brachial artery
What does a Bennet’s fracture involve?
The articular surfaces of the 1st MC base
Tendinopathy
Disease of a tendon
Tendinitis
Tendon injuries that involve larger scale acute injuries accompanied by inflammation
Tendonosis
Chronic tendon injury with damage to a tendon at cellular level
Tenosynovitis
Inflammation of the tendon sheath
Enthesopathy
Inflammation of the tendon origin or insertion into bone
What is the clinical presentation of a rotator cuff tear?
achy pain shoulder tenderness difficulty sleeping on affected side, reaching overhead and on lifting painful arc positive impingment tests
What imaging modality is used to clarify rotator cuff tear?
US
MRI if required
Management options of rotator cuff tear
Conservative - rest, physio, steroid and LA injection
Surgery - arthroscopic or open subarchronial decompression and rotator cuff repair
What clinical signs suggest biceps rupture?
Popeye sign ad extensive bruising
What head of the biceps is predominantly affected in biceps tendinopathy?
Long head
How does biceps tendinopathy occur?
Overuse, insatbillty, impingement or trauma
Where is the pain in biceps tendinopathy? What is it aggravated by?
Pain in anterior shoulder radiatig to elbow
Shouder flexion, forearm pronation and elbow flexion
What are the management options for biceps tendinopathy?
Conservative - rest and physio
Surgery
What is Golfers elbow?
Medial epicondylitis
Inflammation of the origin of flexor forearm muscles over the medial epicondyle
Medial elbow pain
Self limiting
Which nerve could be compressed in medial epicondylitis?
Ulner nerve - could lead to muscle weakness
Give treatment options for golfers and tennis elbow.
rest physio activity modification orthotics injection or surgical release
What is lateral epicondylitis?
Tennis Elbow
Inflammation of the origin of extensor forearm muscles over the lateral epicondyle - pain and tender
The pain in latera epicondylitis/tennis elbow is worse when..?
Worse when stretching the muscles
What is DeQuervain’s tenosynovitis?
Inflammation of the tendon sheath of APL and EPB
What is the most common direction of a shoulder dislocation? How does this occur?
Anterior
Fall with shoulder in external rotation or fall onto the back of the shoulder
What other directions can a shoulder dislocate in and what causes them?
Posterior - fall with shoulder in internal rotation (posterior force on the adducted and internally rotated arm)
Inferior
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?
Hill-Sachs lesion
What is the main x-ray finding in a posterior shoulder dislocation?
Light-bulb sign
What is the treatment for a shoulder dislocation?
Closed reduction under sedation/ anaesthetic
Then placed in a sling for 2-3 weeks
Then physiotherapy
How do elbow dislocations occur?
FOOSH
What is the most common direction of an elbow dislocation?
Posterior
What is the management of an elbow dislocation?
Closed reduction under sedation/ anaesthetic
Then placed in a sling for 2-3 weeks
How do interphalangeal joint dislocations occur and in whihc direction to they tend to be?
Hyperextension injury or direct axial blow
Almost always posterior
Management of an interphalangeal joint dislocation?
Closed reduction under digital or metacarpal block
then 2 weeks in neighbour strapping
Name the fracture that occurs when the radius fractures with dislocation of the ulna at DRUJ?
Galeazzi fracture dislocation
Name the fracture that occurs when ulna fractures with dislocation of radial head at elbow?
Monteggia fracture dislocation
If both the ulna and radius fracture what treatment is required?
ORIF
What is the treatment for a Galeazzi or Monteggia fracture?
ORIF
What is a Smith’s fracture?
Extra-articular fracture of the distal radius with a fall onto the back of the hand
Do polymyositis and dermatomysitis present as proximal or distal muscle weakness? Is it symmetrical or asymmetrical?
Proximal muscle weakness
Symmetrical
Which muscle are tired in inclusion body myositis? Is it symmetrical or asymmetrical?
Disteal muscle weakness
Asymmetrical
Polymyalgia rheumatica presents as an ache where?
Shoulder and hip girdle
What other clinical manifestations of polymyalgia rheumatica are there?
Morning stiffness in shoulder and hip girdle (may have decreased ROM)
Fever, weight loss, fatigue and anorexia may occur
What clinical findings are seen in fibromyalgia?
Excessive tenderness on palpation of soft tissues
at least 11/18 tender points
Inflam markers normal
What is the first line treatment for fibromyalgia?
Graded exercise programme and atypical analgesia - Gabapentin and pregabalin
No curative treatment
