upper limb problems Flashcards
what is carpal tunnel syndrome
nerve compression within the carpal tunnel due to swelling within the tunnel
what forms the carpal tunnel
carpal bones
flexor retinaculum
what does the carpal tunnel contain
median nerve
9 flexor tendons
what are the causes of carpal tunnel syndrome
idiopathic (most common)
rheumatoid arthritis
any condition resulting in fluid retention
wrist fracture (Colles fracture)
how does rheumatoid arthritis lead to carpal tunnel syndrome
synovitis results in less space
what conditions would result in fluid retention
pregnancy
diabetes
chronic renal failure
hypothyroidism
what are the symptoms of carpal tunnel syndrome
loss of feeling/movement in median nerve innervated digits
muscle wasting of the thinner eminence = chronic cases
what does the median nerve innervate
thumb and radial 2 1/2 fingers
what are the investigations of carpal tunnel syndrome
tinels test = percuss over the median nerve
Phalen’s test = holding wrists hyper flexed causes symptoms
nerve conduction studies = slow conduction
what is the treatment of carpal tunnel syndrome
nighttime wrist splints
corticosteroid injections
carpal tunnel decompression
what is cubital tunnel syndrome
compression of the ulnar nerve at the elbow behind the medial epicondyle (funny bone area)
what are the causes of cubital tunnel syndrome
tight ban of fascia forming at the roof of the tunnel = Osborne’s fascia
tightness at inter-muscular septum
what are the symptoms of cubital tunnel syndrome
numbness/loss of movement in ulnar 1 1/2 fingers = pinky
weakness in abduction of index finger
weakness in adductor pollicis
what are the investigations of cubital tunnel syndrome
nerve conduction test
what bones make up the shoulder griddle
scapula
clavicle
proximal humerus
what bones make up the shoulder joint
humeral head
scapular glenoid
what 4 muscles make up the rotator cuff
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
where does the supraspinatus attach to
proximal = supraspinatus fossa of scapula
distal = greater tubercle of humerus
what is the supraspinatus innervated by
suprascapular nerve
what is the main action of the supraspinatus
abducts arm
where does the infraspinatus attach to
proximal = infraspinatus fossa of scapula
distal = greater tubercle of humerus
what is the infraspinatus innervated by
suprascapular nerve
what is the main action of the infraspinatus
externally rotates the arm
where does the teres minor attach
proximal = middle part of lateral border of scapula
distal = greater tuberosity of humerus
what is the innervation of teres minor
axillary nerve
what is the main action of teres minor
externally rotates the arm
where does the subscapularis attach
proximal = subscapular fossa of scapula
distal = lesser tuberosity of humerus
what is the innervation of subscapularis
upper and lower subscapular nerves
what is the main action of subscapularis
internally rotates the arm
what is the function of the deltoid
abducts the arm
what is the innervation of the deltoid
axillary nerve
where does the deltoid attach
proximal = clavicle, acromion, spine of scapula
distal = deltoid tuberosity on lateral aspect of humerus
what is the function of the biceps brachii
flexes elbow
supinates forearm
what is the innervation of the biceps brachii
musculocutaneous nerve
what is the biceps brachii attached to
proximal
short head = caracoid process
long head = labrum/glenoid
distal = tuberosity of radius
what is the most common shoulder condition in a young adult
instability (dislocation)
what is the most common shoulder condition in an elderly person
OA
what are the most common shoulder conditions in a middle aged person
frozen shoulder
rotator cuff tear
what is impingement syndrome
tendons of the rotator cuff are compressed in the tight subacromial space during movement
what is commonly affected in impingement syndrome
supraspinatus
what are the causes of impingement syndrome (3)
OA with inferior osteophyte
bursitis
hooked acromion
what are the symptoms of impingement syndrome
Painful arc between 60-120 degree
Pain radiates to deltoid and upper arm
Tenderness below the lateral edge of the acromion
+ve hawkins-kennedy test
what is the hawkins-kennedy test
internally rotating arm. positive if causes pain
what are the investigations of impingement syndrome
US or MRI if mobility is poor
X-ray = calcification
what is the treatment of impingement syndrome
pain relief
subacromial steroid injections (up to 3)
subacromial decompression surgery
what usually causes a rotator cuff tear
>40 = sudden jerk movement young = significant injury
what is usually affected in a rotator cuff tear
supraspinatus
large tear may extend into subscapularis or infraspinatus
what are the symptoms of rotator cuff tear
weakness of initiation of abduction, internal and external rotation
passive movement > active movement
wasting of the supraspinatus
what are the investigations of rotator cuff tear
US
MRI if very stiff
what is the treatment of rotator cuff tear
physio
subacromial steroid injections
surgery
what is frozen shoulder also known as
adhesive capsulitis
what is frozen shoulder
progressive pain and stiffness of the shoulder with unknown cause
who is affected by frozen shoulder
40-60 yr old patients
what are the symptoms of frozen shoulder
sudden onset pain and stiffness
loss of external rotation +/- loss of other movements
what are the investigations of frozen shoulder
rely on history as x-ray is normal
what is the aim of treatment of frozen shoulder
Non-operative with the aim to relive pain and prevent further stiffening
what is the treatment of frozen shoulder
physio + pain relief
resolves after 18-40months
what is acute calcific tendonitis
calcium deposits in the supraspinatus tendon proximal to the greater tuberosity
what is the symptoms of acute calcific tendonitis
acute onset of severe shoulder pain
what is the investigation of acute calcific tendonitis
X-ray
what is the treatment of acute calcific tendonitis
subacromial steroid or local anaesthetic injection
self-limiting until calcification reabsorbs
what is biceps tendonitis
inflammation of the tendon of the long head of the biceps
what is the symptoms of biceps tendonitis
anterior shoulder pain
pain on resisted biceps contraction
popeye deformity
what is a popeye deformity
spontaneous rupture of the biceps tendon which will prove relief of pain in biceps tendonitis
what is the treatment of biceps tendonitis
surgical division of the tendon +/- attachment to the proximal humerus
what are the two types of instability
traumatic
atraumatic
what is the cause of instability
traumatic = trauma
posterior traumatic = fits
atraumatic = generalised ligament laxity
give examples of conditions that could result in atraumatic instability
idiopathic generalised laxity
Marfans
elhers-danos
give examples of conditions that could result in posterior traumatic instability
epileptic fits
alcoholic fits
electrocution
what are the symptoms of instability
subluxation/dislocation
postitive apprehension test
winging
dyskinesia
what are the investigations of instability
X-ray
MRI arthrogram = if had multiple dislocations
what is the treatment of instability
reduction & rest
surgery = recurrent dislocation
what are the compartments of the arm
posterior compartment
anterior compartment
what muscles are located in the anterior compartment of the arm
biceps brachii
brachialis
coracobrachialis
what is the innervation of the anterior compartment of the arm
musculocutaneous nerve
what is the action of the anterior compartment of the arm
flexion of the arm and forearm
what is the attachment of the biceps brachii
proximal
long head = supraglenoid tubercle of scapula
short head = tip of coracoid process
distal = radial tuberosity
what is the action of the biceps brachii
flexion of the arm and forearm
supinates forearm
what is the attachment of the coracobrachialis
proximal = tip of coracoid process distal = middle 1/3 of medial surface pf humerus
what is the attachment of the brachialis
proximal = distal 1/2 of anterior humerus distal = coronoid process and tuberosity of ulna
what muscle is located in the posterior compartment of the arm
triceps brachii
what is the nerve supply of the posterior compartment of the arm
radial nerve
what is the action of the posterior compartment of the arm
extension of arm and forearm
what are the 3 heads of the triceps brachii
long head
lateral head
medial head
where does the long head of the triceps brachii attach
proximal = infraglenoid tubercle of scapula distal = proximal end of olecranon of ulna
where does the lateral head of the triceps brachii attach
proximal = posterior surface of humerus, SUPERIOR to the radial groove distal = proximal end of olecranon of ulna
where does the medial head of the triceps brachii attach
proximal = posterior surface of humerus, INFERIOR to the radial groove distal = proximal end of olecranon of ulna
what is the treatment of cubital tunnel syndrome
may need surgical release of any tight structures
describe the passage of the ulnar nerve in the elbow
passes posterior to the medial epicondyle and enters an arch formed by the two heads of the flexor carpi ulnaris under the acute ligament
what is tennis elbow also known as
lateral epicondylitis
describe the pathology of tennis elbow
the common extensor can become painful which can give rise to tennis elbow
where does the common extensor arise from
the lateral epicondyle
what causes tennis elbow
repetitive strain injury
degenerative enthesopathy
micro tears
what is the treatment of tennis elbow
rest
self-limiting
where does the common flexor arise from
the medial epicondyle
describe the pathology of golfer’s elbow
the common flexor can be come painful which can give rise to medial epicondylitis
what is golfer’s elbow also known as
medial epicondylitis
what causes golfer’s elbow
repetitive strain injury
degenerative enthesopathy
what is the treatment of golfer’s elbow
rest
self-limiting
what must NEVER be given as a treatment in golfer’s elbow
steroid injections
why must steroid injections never be given in golfer’s elbow
risk of injury to the ulnar nerve
what is a mucous cyst
outputting of synovial fluid from a DIP joint affected by OA
what is the treatment of a mucous cyst
asymptomatic = leave alone symptomatic = excise
what is dupuytren’s contracture
proliferative connective tissue disease where the palmar fascia undergoes hyperplasia forming nodules, cords, and bands
what cells are produced in dupuytren’s contracture
myofibroblast cells
collagen type 3
what are the symptoms of dupuytren’s contracture
painless, gradual progression
palpable nodules/puckering
what fingers are affected in dupuytren’s contracture
pinky and ring
what is the treatment of dupuytren’s contracture
stretching
activity modification
surgery
amputation
what is trigger finger
tendonitis of a flexor tendon to a digit resulting in nodular enlargement
what are the symptoms of trigger finger
pain
clicking sensation on movement
finger locked in flexed position
what is the treatment of trigger finger
resolves spontaneously
steroid injection
recurrent = surgery
what is DeQuervain’s tendonitis
spontaneous inflammation the sheath which surrounds the two tendons involved in moving the thumb
what are the symptoms of DeQuervain’s tendonitis
pain
swelling
redness
what is the treatment of DeQuervain’s tendonitis
rest + splint
steroid injection
decompression surgery
what is paronychia
infection within the nail fold
what is he treatment of paronychia
incise and drain +/- antibiotics
what is a flexor tendon sheath infection
infection within the sheath tracking up the palm +/- arm
what is the symptoms of lexor tendon sheath infection
extreme pain causing limited movement
what is the treatment of lexor tendon sheath infection
wash out tendon sheath
