Upper Limb Problems Flashcards
what is carpal tunnel syndrome
compression of the MEDIAN nerve in the carpal tunnel
Sx and signs of carpal tunnel syndrome
Tingling/pain in thumb, index and middle finger.
Relief brought about by ‘flicking’ or ‘ shaking’ the wrist
Pain common at NIGHT
Clumsiness/Weakness
Dysaethesia
Wasted Thenar eminence seen
Decreased sensation over lateral 3 1/2 digits
what does dysaethesia mean
a painful, persistent sensation induced by a gentle touch of the skin
Ix for Carpal tunnel syndrome
Tinel’s test - tapping over carpal tunnel to cause Sx
Phalen’s test - hyper flex the wrist for a 1min to cause Sx
Nerve conduction study not needed if history and examination are conclusive.
US may be useful but not done routinely.
Tx for carpal tunnel syndrome
non-op
corticosteroid infection
splint
op open carpal tunnel release arthroscopic endoscopic carpal tunnel release mini-open carpal tunnel release
indications for surgery in carpal tunnel syndrome
failed conservative treatment
constant numbness
weakness
what fingers are affected in carpal tunnel syndrome
thumb, index and middle fingers
what are causes of cubital tunnel syndrome
OA
RA
what is cubital tunnel syndrome
compression of ULNAR nerve
symptoms of cubital tunnel syndrome
pain paraesthesia numbness weak pinch clawing of ring + little finger
fingers affected in cubital tunnel syndrome
little finger and lateral half of ring finger
Tx of cubital tunnel syndrome
splint
neurolysis
surgery - anterior subcutaneous transposition
Ix for cubital tunnel syndrome
nerve conduction studies
US - identifies where the compression is
what is shoulder impingement
syndrome where the tendons of the rotator cuff (predominantly supraspinatus) are compressed in the tight subacromial space during movement producing pain
what are physical signs of shoulder impingement
painful arc - pain disappears once the patient hand reaches the top
Hawkins–Kennedy Test
Loss of ROM
DDx for shoulder impingement
Frozen shoulder
Rotator cuff tear
Shoulder instability
what is a pain arc
pain on abduction from 50-120 degrees
what is calcific tendonitis
build up of calcium in the rotator cuff