Upper Limb Problems Flashcards by S B

what is carpal tunnel syndrome

compression of the MEDIAN nerve in the carpal tunnel

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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

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what does dysaethesia mean

a painful, persistent sensation induced by a gentle touch of the skin

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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.

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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

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indications for surgery in carpal tunnel syndrome

failed conservative treatment
constant numbness
weakness

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what fingers are affected in carpal tunnel syndrome

thumb, index and middle fingers

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what are causes of cubital tunnel syndrome

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what is cubital tunnel syndrome

compression of ULNAR nerve

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symptoms of cubital tunnel syndrome

pain
paraesthesia
numbness
weak pinch
clawing of ring + little finger

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fingers affected in cubital tunnel syndrome

little finger and lateral half of ring finger

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Tx of cubital tunnel syndrome

splint
neurolysis

surgery - anterior subcutaneous transposition

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Ix for cubital tunnel syndrome

nerve conduction studies

US - identifies where the compression is

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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

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what are physical signs of shoulder impingement

painful arc - pain disappears once the patient hand reaches the top
Hawkins–Kennedy Test
Loss of ROM

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DDx for shoulder impingement

Frozen shoulder
Rotator cuff tear
Shoulder instability

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what is a pain arc

pain on abduction from 50-120 degrees

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what is calcific tendonitis

build up of calcium in the rotator cuff

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symptoms of calcific tendonitis

extremely painful
subacromial impingement
30-60 y/o

Tx for calcific tendonitis

NSAIDs + Analgesia
Physio
Steroid injections
Surgical excision

what are causes of shoulder instability

trauma - bankart/hill sachs lesions

atraumatic

what are bankart/hill sachs lesions

B - complication of anterior shoulder dislocation.

H-S - posterolateral humeral head compression fracture, typically secondary to recurrent anterior shoulder dislocations

two surgical Tx options in traumatic shoulder instability

bankart repair

LATARJET

what surgical Tx is used in atraumatic shoulder instability

inferior capsular shift

what can sulcus sign be a sign of

Multidirectional Instability of the Shoulder (MDSI) Inferior instability

where is the compression about in cubital tunnel

compression around the elbow

what are common causes of shoulder pain/problems

``` Rotator cuff tear Sub-acromial bursitis Acromioclavicular disease Frozen shoulder OA/RA of shoulder Recurrent dislocation Referred pain ```

symptoms of shoulder arthritis

``` pain swelling stiffness deformity loss of function ```

signs/Mx of arthritis sternoclavicular joint

(rare) swelling/pain at SCjt Mx - physio, injection

acromioclavicular joint arthritis

(very common) often overlaps with impingement may be due to trauma

Mx of ACjt arthritis

injection | excision

signs of glenohumeral joint OA

pain crepitus (grinding) loss of movement - esp external rotation

surgical options for OA in upper limb

hemiarthroplasty, resurfacing, total shoulder arthroplasty and reverse shoulder arthroplasty

if the glenohumeral joint has arthritis where is the pain felt

pain is centered in the back of the shoulder

where is arthritis of ACjt felt

on the top of the shoulder | sometimes radiates to side of neck

shoulder replacement complication

``` infection instability stiffness nerve damage loosening ```

pathogenesis of cuff tear arthropathy

Rotator cuff centres humeral head on glenoid If torn, deltoid pulls head upwards Abnormal forces on gleaned leads to OA Anatomic shoulder replacement will fail

how does reverse geometry shoulder replacement work

``` reverses ball - socket increases lever arm of deltoid lengthens deltoid resurfaces joint prevents upward migration ```

Tx for radiocapitellar OA at the elbow

Radial head is only secondary stabiliser (so not vital) - excise - replace

surgery options for RA

synovectomy tendon realignment replacement fusion

what is Scapholunate advanced collapse (SLAC)

pattern of wrist malalignment that has been attributed to post-traumatic or spontaneous osteoarthritis of the wrist

what can cause SLAC

non-united scaphoid fracture or untreated scapholunate dissociation and rotatory subluxation of the scaphoid bone

what are the features of SLAC

radioscaphoid malalignment, progressive chondromalacia, and osteoarthritis

what is SNAC

scaphoid nonunion advanced collapse

what can be done to treat SNAC or SLAC

total wrist arthrodesis

what does OA of base of thumb cause

subluxation of CMC jt