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MSK SB > Upper Limb Problems > Flashcards

Upper Limb Problems Flashcards

1
Q

what is carpal tunnel syndrome

A

compression of the MEDIAN nerve in the carpal tunnel

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2
Q

Sx and signs of carpal tunnel syndrome

A

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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3
Q

what does dysaethesia mean

A

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

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4
Q

Ix for Carpal tunnel syndrome

A

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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5
Q

Tx for carpal tunnel syndrome

A

non-op
corticosteroid infection
splint

op
open carpal tunnel release
arthroscopic
endoscopic carpal tunnel release
mini-open carpal tunnel release
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6
Q

indications for surgery in carpal tunnel syndrome

A

failed conservative treatment
constant numbness
weakness

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7
Q

what fingers are affected in carpal tunnel syndrome

A

thumb, index and middle fingers

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8
Q

what are causes of cubital tunnel syndrome

A

OA

RA

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9
Q

what is cubital tunnel syndrome

A

compression of ULNAR nerve

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10
Q

symptoms of cubital tunnel syndrome

A 
pain
paraesthesia
numbness
weak pinch
clawing of ring + little finger
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11
Q

fingers affected in cubital tunnel syndrome

A

little finger and lateral half of ring finger

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12
Q

Tx of cubital tunnel syndrome

A

splint
neurolysis

surgery - anterior subcutaneous transposition

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13
Q

Ix for cubital tunnel syndrome

A

nerve conduction studies

US - identifies where the compression is

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14
Q

what is shoulder impingement

A

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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15
Q

what are physical signs of shoulder impingement

A

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

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16
Q

DDx for shoulder impingement

A

Frozen shoulder
Rotator cuff tear
Shoulder instability

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17
Q

what is a pain arc

A

pain on abduction from 50-120 degrees

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18
Q

what is calcific tendonitis

A

build up of calcium in the rotator cuff

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19
Q

symptoms of calcific tendonitis

A

extremely painful
subacromial impingement
30-60 y/o

20
Q

Tx for calcific tendonitis

A

NSAIDs + Analgesia
Physio
Steroid injections
Surgical excision

21
Q

what are causes of shoulder instability

A

trauma - bankart/hill sachs lesions

atraumatic

22
Q

what are bankart/hill sachs lesions

A

B - complication of anterior shoulder dislocation.

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

23
Q

two surgical Tx options in traumatic shoulder instability

A

bankart repair

LATARJET

24
Q

what surgical Tx is used in atraumatic shoulder instability

A

inferior capsular shift

25
Q

what can sulcus sign be a sign of

A

Multidirectional Instability of the Shoulder (MDSI)

Inferior instability

26
Q

where is the compression about in cubital tunnel

A

compression around the elbow

27
Q

what are common causes of shoulder pain/problems

A 
Rotator cuff tear
Sub-acromial bursitis
Acromioclavicular disease
Frozen shoulder
OA/RA of shoulder
Recurrent dislocation
Referred pain
28
Q

symptoms of shoulder arthritis

A 
pain
swelling
stiffness
deformity
loss of function
29
Q

signs/Mx of arthritis sternoclavicular joint

A

(rare)
swelling/pain at SCjt

Mx - physio, injection

30
Q

acromioclavicular joint arthritis

A

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

31
Q

Mx of ACjt arthritis

A

injection

excision

32
Q

signs of glenohumeral joint OA

A

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

33
Q

surgical options for OA in upper limb

A

hemiarthroplasty, resurfacing, total shoulder arthroplasty and reverse shoulder arthroplasty

34
Q

if the glenohumeral joint has arthritis where is the pain felt

A

pain is centered in the back of the shoulder

35
Q

where is arthritis of ACjt felt

A

on the top of the shoulder

sometimes radiates to side of neck

36
Q

shoulder replacement complication

A 
infection
instability
stiffness
nerve damage
loosening
37
Q

pathogenesis of cuff tear arthropathy

A

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

38
Q

how does reverse geometry shoulder replacement work

A 
reverses ball - socket
increases lever arm of deltoid
lengthens deltoid
resurfaces joint 
prevents upward migration
39
Q

Tx for radiocapitellar OA at the elbow

A

Radial head is only secondary stabiliser (so not vital)

  • excise
  • replace
40
Q

surgery options for RA

A

synovectomy
tendon realignment
replacement
fusion

41
Q

what is Scapholunate advanced collapse (SLAC)

A

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

42
Q

what can cause SLAC

A

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

43
Q

what are the features of SLAC

A

radioscaphoid malalignment, progressive chondromalacia, and osteoarthritis

44
Q

what is SNAC

A

scaphoid nonunion advanced collapse

45
Q

what can be done to treat SNAC or SLAC

A

total wrist arthrodesis

46
Q

what does OA of base of thumb cause

A

subluxation of CMC jt

MSK SB (15 decks)

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