Upper limb problems

Question 1

what is impingement syndrome

Answer 1

when the tendons of the rotator cuff are compressed in the tight subacromial space during movement, producing pain

Question 2

degrees of painful arc

Answer 2

60-120 abduction

Question 3

causes of impingement

Answer 3

tendonitis, subacromial bursitis, acromioclavicular OA with inferior osteophyte, a hooked acromion and rotator cuff tear

Question 4

where does the pain radiate to in impingement

Answer 4

deltoid and upper arm

Question 5

where may tenderness be felt in impingement

Answer 5

below the lateral edge of the acromion

Question 6

what test recreates the pain of impingement?

Answer 6

Hawkins-Kennedy

Question 7

which movement usually causes a rotator cuff tear

Answer 7

sudden jerk

Question 8

which muscle is usually involved in rotator cuff tear

Answer 8

supraspinatus

Question 9

where can large tears extend to?

Answer 9

subscapularis and infraspinatus

Question 10

sign of supraspinatus problem

Answer 10

weakness of initiation of abduction

Question 11

sign of subscapularis problem

Answer 11

weakness of internal rotation

Question 12

sign of infraspinatus problem

Answer 12

weakness of external rotation

Question 13

characteristics of adhesive capsulitis

Answer 13

progressive pain and stiffness in patients between 40-60 which usually resolves in 18-24m

Question 14

main clinical sign of adhesive capsulitis

Answer 14

loss of external rotation

Question 15

conditions associated with adhesive capsulitis

Answer 15

diabetes, hypercholesterolaemia, Dupuytren’s disease

Question 16

what happens in adhesive capsulitis

Answer 16

the capsule and glenohumeral ligaments become inflamed then thicken and contract

Question 17

characteristics of acute calcific tendonitis

Answer 17

calcium deposition in supraspinatus tendon

Question 18

where is the calcium seen on Xray in acute calcific tendonitis

Answer 18

just proximal to greater tuberosity

Question 19

what is shoulder instability

Answer 19

painful abnormal translational movement or subluxation/recurrent dislocation

Question 20

type of surgery used for recurrent dislocation

Answer 20

Bankart repair - reattaches labrum and capsule to anterior glenoid

Question 21

what does inflammation of the tendon of the long head of biceps cause

Answer 21

anterior shoulder pain with pain on resisted biceps contraction

Question 22

where does the long head of biceps tendon attach

Answer 22

glenoid labrum

Question 23

What is tinel’s test

Answer 23

percussion over the median or ulnar nerve in order to reproduce symptoms of carpal/cubital tunnel syndrome

Question 24

what is phalen’s test

Answer 24

hold the wrists hyperflexed in order to decrease the space in the carpal tunnel and reproduce the symptoms of carpal tunnel syndrome

Question 25

non-operative treatment in carpal tunnel syndrome

Answer 25

wearing splints at night

injection of corticosteroid

Question 26

surgical treatment of carpal tunnel syndrome

Answer 26

carpal tunnel decompression - division of transverse carpal ligament under local anaesthetic

Question 27

muscles which are weak in cubital tunnel syndrome

Answer 27

1st dorsal interosseous and adductor pollicis

Question 28

clinical features of tennis elbow

Answer 28

painful and tender lateral epicondyle and pain on resisted middle finger/wrist extension

Question 29

what may done for arthritis of the radio-capitellar joint which has failed non-operative management

Answer 29

surgical excision of the radial head

Question 30

lifting weight restriction in total elbow replacement

Answer 30

2.5kg

Question 31

how do patients usually present in calcific tendonitis

Answer 31

grey and sweaty - important to rule out septic arthritis

Question 32

which direction of shoulder dislocation is most likely

Answer 32

anterior

Question 33

light bulb sign on X-ray

Answer 33

posterior shoulder dislocation

Question 34

features of traumatic shoulder instability

Answer 34

TUBS - traumatic, unilateral, bankart, surgery

Question 35

features of atraumatic shoulder instability

Answer 35

AMBRI - atraumatic, multidirectional, bilateral, rehabilitation, inferior capsular shift

Question 36

froments sign positive

Answer 36

cubital tunnel syndrome - ulnar nerve compression