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MSK (mine) > upper limb problems > Flashcards

upper limb problems Flashcards

1
Q

what is carpal tunnel syndrome

A

nerve compression within the carpal tunnel due to swelling within the tunnel

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2
Q

what forms the carpal tunnel

A

carpal bones

flexor retinaculum

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3
Q

what does the carpal tunnel contain

A

median nerve

9 flexor tendons

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4
Q

what are the causes of carpal tunnel syndrome

A

idiopathic (most common)
rheumatoid arthritis
any condition resulting in fluid retention
wrist fracture (Colles fracture)

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5
Q

how does rheumatoid arthritis lead to carpal tunnel syndrome

A

synovitis results in less space

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6
Q

what conditions would result in fluid retention

A

pregnancy
diabetes
chronic renal failure
hypothyroidism

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7
Q

what are the symptoms of carpal tunnel syndrome

A

loss of feeling/movement in median nerve innervated digits

muscle wasting of the thinner eminence = chronic cases

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8
Q

what does the median nerve innervate

A

thumb and radial 2 1/2 fingers

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9
Q

what are the investigations of carpal tunnel syndrome

A

tinels test = percuss over the median nerve
Phalen’s test = holding wrists hyper flexed causes symptoms
nerve conduction studies = slow conduction

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10
Q

what is the treatment of carpal tunnel syndrome

A

nighttime wrist splints
corticosteroid injections
carpal tunnel decompression

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11
Q

what is cubital tunnel syndrome

A

compression of the ulnar nerve at the elbow behind the medial epicondyle (funny bone area)

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12
Q

what are the causes of cubital tunnel syndrome

A

tight ban of fascia forming at the roof of the tunnel = Osborne’s fascia
tightness at inter-muscular septum

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13
Q

what are the symptoms of cubital tunnel syndrome

A

numbness/loss of movement in ulnar 1 1/2 fingers = pinky
weakness in abduction of index finger
weakness in adductor pollicis

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14
Q

what are the investigations of cubital tunnel syndrome

A

nerve conduction test

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15
Q

what bones make up the shoulder griddle

A

scapula
clavicle
proximal humerus

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16
Q

what bones make up the shoulder joint

A

humeral head

scapular glenoid

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17
Q

what 4 muscles make up the rotator cuff

A

Supraspinatus 
Infraspinatus
Teres minor
Subscapularis

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18
Q

where does the supraspinatus attach to

A

proximal = supraspinatus fossa of scapula

distal = greater tubercle of humerus

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19
Q

what is the supraspinatus innervated by

A

suprascapular nerve

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20
Q

what is the main action of the supraspinatus

A

abducts arm

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21
Q

where does the infraspinatus attach to

A

proximal = infraspinatus fossa of scapula

distal = greater tubercle of humerus

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22
Q

what is the infraspinatus innervated by

A

suprascapular nerve

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23
Q

what is the main action of the infraspinatus

A

externally rotates the arm

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24
Q

where does the teres minor attach

A

proximal = middle part of lateral border of scapula

distal = greater tuberosity of humerus

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25
Q

what is the innervation of teres minor

A

axillary nerve

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26
Q

what is the main action of teres minor

A

externally rotates the arm

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27
Q

where does the subscapularis attach

A

proximal = subscapular fossa of scapula

distal = lesser tuberosity of humerus

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28
Q

what is the innervation of subscapularis

A

upper and lower subscapular nerves

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29
Q

what is the main action of subscapularis

A

internally rotates the arm

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30
Q

what is the function of the deltoid

A

abducts the arm

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31
Q

what is the innervation of the deltoid

A

axillary nerve

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32
Q

where does the deltoid attach

A

proximal = clavicle, acromion, spine of scapula

distal = deltoid tuberosity on lateral aspect of humerus

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33
Q

what is the function of the biceps brachii

A

flexes elbow

supinates forearm

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34
Q

what is the innervation of the biceps brachii

A

musculocutaneous nerve

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35
Q

what is the biceps brachii attached to

A

proximal
short head = caracoid process
long head = labrum/glenoid

distal = tuberosity of radius

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36
Q

what is the most common shoulder condition in a young adult

A

instability (dislocation)

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37
Q

what is the most common shoulder condition in an elderly person

A

OA

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38
Q

what are the most common shoulder conditions in a middle aged person

A

frozen shoulder

rotator cuff tear

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39
Q

what is impingement syndrome

A

tendons of the rotator cuff are compressed in the tight subacromial space during movement

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40
Q

what is commonly affected in impingement syndrome

A

supraspinatus

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41
Q

what are the causes of impingement syndrome (3)

A

OA with inferior osteophyte
bursitis
hooked acromion

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42
Q

what are the symptoms of impingement syndrome

A

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

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43
Q

what is the hawkins-kennedy test

A

internally rotating arm. positive if causes pain

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44
Q

what are the investigations of impingement syndrome

A

US or MRI if mobility is poor

X-ray = calcification

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45
Q

what is the treatment of impingement syndrome

A

pain relief
subacromial steroid injections (up to 3)
subacromial decompression surgery

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46
Q

what usually causes a rotator cuff tear

A 
>40 = sudden jerk movement
young = significant injury
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47
Q

what is usually affected in a rotator cuff tear

A

supraspinatus

large tear may extend into subscapularis or infraspinatus

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48
Q

what are the symptoms of rotator cuff tear

A

weakness of initiation of abduction, internal and external rotation
passive movement > active movement
wasting of the supraspinatus

49
Q

what are the investigations of rotator cuff tear

A

US

MRI if very stiff

50
Q

what is the treatment of rotator cuff tear

A

physio
subacromial steroid injections
surgery

51
Q

what is frozen shoulder also known as

A

adhesive capsulitis

52
Q

what is frozen shoulder

A

progressive pain and stiffness of the shoulder with unknown cause

53
Q

who is affected by frozen shoulder

A

40-60 yr old patients

54
Q

what are the symptoms of frozen shoulder

A

sudden onset pain and stiffness

loss of external rotation +/- loss of other movements

55
Q

what are the investigations of frozen shoulder

A

rely on history as x-ray is normal

56
Q

what is the aim of treatment of frozen shoulder

A

Non-operative with the aim to relive pain and prevent further stiffening

57
Q

what is the treatment of frozen shoulder

A

physio + pain relief

resolves after 18-40months

58
Q

what is acute calcific tendonitis

A

calcium deposits in the supraspinatus tendon proximal to the greater tuberosity

59
Q

what is the symptoms of acute calcific tendonitis

A

acute onset of severe shoulder pain

60
Q

what is the investigation of acute calcific tendonitis

A

X-ray

61
Q

what is the treatment of acute calcific tendonitis

A

subacromial steroid or local anaesthetic injection

self-limiting until calcification reabsorbs

62
Q

what is biceps tendonitis

A

inflammation of the tendon of the long head of the biceps

63
Q

what is the symptoms of biceps tendonitis

A

anterior shoulder pain
pain on resisted biceps contraction
popeye deformity

64
Q

what is a popeye deformity

A

spontaneous rupture of the biceps tendon which will prove relief of pain in biceps tendonitis

65
Q

what is the treatment of biceps tendonitis

A

surgical division of the tendon +/- attachment to the proximal humerus

66
Q

what are the two types of instability

A

traumatic

atraumatic

67
Q

what is the cause of instability

A

traumatic = trauma
posterior traumatic = fits
atraumatic = generalised ligament laxity

68
Q

give examples of conditions that could result in atraumatic instability

A

idiopathic generalised laxity
Marfans
elhers-danos

69
Q

give examples of conditions that could result in posterior traumatic instability

A

epileptic fits
alcoholic fits
electrocution

70
Q

what are the symptoms of instability

A

subluxation/dislocation
postitive apprehension test
winging
dyskinesia

71
Q

what are the investigations of instability

A

X-ray

MRI arthrogram = if had multiple dislocations

72
Q

what is the treatment of instability

A

reduction & rest

surgery = recurrent dislocation

73
Q

what are the compartments of the arm

A

posterior compartment

anterior compartment

74
Q

what muscles are located in the anterior compartment of the arm

A

biceps brachii
brachialis
coracobrachialis

75
Q

what is the innervation of the anterior compartment of the arm

A

musculocutaneous nerve

76
Q

what is the action of the anterior compartment of the arm

A

flexion of the arm and forearm

77
Q

what is the attachment of the biceps brachii

A

proximal
long head = supraglenoid tubercle of scapula
short head = tip of coracoid process

distal = radial tuberosity

78
Q

what is the action of the biceps brachii

A

flexion of the arm and forearm

supinates forearm

79
Q

what is the attachment of the coracobrachialis

A 
proximal = tip of coracoid process
distal = middle 1/3 of medial surface pf humerus
80
Q

what is the attachment of the brachialis

A 
proximal = distal 1/2 of anterior humerus 
distal = coronoid process and tuberosity of ulna
81
Q

what muscle is located in the posterior compartment of the arm

A

triceps brachii

82
Q

what is the nerve supply of the posterior compartment of the arm

A

radial nerve

83
Q

what is the action of the posterior compartment of the arm

A

extension of arm and forearm

84
Q

what are the 3 heads of the triceps brachii

A

long head
lateral head
medial head

85
Q

where does the long head of the triceps brachii attach

A 
proximal = infraglenoid tubercle of  scapula 
distal = proximal end of olecranon of ulna
86
Q

where does the lateral head of the triceps brachii attach

A 
proximal = posterior surface of humerus, SUPERIOR to the radial groove 
distal = proximal end of olecranon of ulna
87
Q

where does the medial head of the triceps brachii attach

A 
proximal = posterior surface of humerus, INFERIOR to the radial groove 
distal = proximal end of olecranon of ulna
88
Q

what is the treatment of cubital tunnel syndrome

A

may need surgical release of any tight structures

89
Q

describe the passage of the ulnar nerve in the elbow

A

passes posterior to the medial epicondyle and enters an arch formed by the two heads of the flexor carpi ulnaris under the acute ligament

90
Q

what is tennis elbow also known as

A

lateral epicondylitis

91
Q

describe the pathology of tennis elbow

A

the common extensor can become painful which can give rise to tennis elbow

92
Q

where does the common extensor arise from

A

the lateral epicondyle

93
Q

what causes tennis elbow

A

repetitive strain injury
degenerative enthesopathy
micro tears

94
Q

what is the treatment of tennis elbow

A

rest

self-limiting

95
Q

where does the common flexor arise from

A

the medial epicondyle

96
Q

describe the pathology of golfer’s elbow

A

the common flexor can be come painful which can give rise to medial epicondylitis

97
Q

what is golfer’s elbow also known as

A

medial epicondylitis

98
Q

what causes golfer’s elbow

A

repetitive strain injury

degenerative enthesopathy

99
Q

what is the treatment of golfer’s elbow

A

rest

self-limiting

100
Q

what must NEVER be given as a treatment in golfer’s elbow

A

steroid injections

101
Q

why must steroid injections never be given in golfer’s elbow

A

risk of injury to the ulnar nerve

102
Q

what is a mucous cyst

A

outputting of synovial fluid from a DIP joint affected by OA

103
Q

what is the treatment of a mucous cyst

A 
asymptomatic = leave alone
symptomatic = excise
104
Q

what is dupuytren’s contracture

A

proliferative connective tissue disease where the palmar fascia undergoes hyperplasia forming nodules, cords, and bands

105
Q

what cells are produced in dupuytren’s contracture

A

myofibroblast cells

collagen type 3

106
Q

what are the symptoms of dupuytren’s contracture

A

painless, gradual progression

palpable nodules/puckering

107
Q

what fingers are affected in dupuytren’s contracture

A

pinky and ring

108
Q

what is the treatment of dupuytren’s contracture

A

stretching
activity modification
surgery
amputation

109
Q

what is trigger finger

A

tendonitis of a flexor tendon to a digit resulting in nodular enlargement

110
Q

what are the symptoms of trigger finger

A

pain
clicking sensation on movement
finger locked in flexed position

111
Q

what is the treatment of trigger finger

A

resolves spontaneously
steroid injection
recurrent = surgery

112
Q

what is DeQuervain’s tendonitis

A

spontaneous inflammation the sheath which surrounds the two tendons involved in moving the thumb

113
Q

what are the symptoms of DeQuervain’s tendonitis

A

pain
swelling
redness

114
Q

what is the treatment of DeQuervain’s tendonitis

A

rest + splint
steroid injection
decompression surgery

115
Q

what is paronychia

A

infection within the nail fold

116
Q

what is he treatment of paronychia

A

incise and drain +/- antibiotics

117
Q

what is a flexor tendon sheath infection

A

infection within the sheath tracking up the palm +/- arm

118
Q

what is the symptoms of lexor tendon sheath infection

A

extreme pain causing limited movement

119
Q

what is the treatment of lexor tendon sheath infection

A

wash out tendon sheath

MSK (mine) (17 decks)

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