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Y2 MSK > Upper limb problems II > Flashcards

Upper limb problems II Flashcards

1
Q

Elbow joint is a type of

A

Hinge type synovial joint

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2
Q

Articulations of the elbow joint

A

Trochlear notch of ulna + trochlea of humerus
Head of radius + capitulum of humerus

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3
Q

All synovial joints have

A

Outer fibrous joint capsule

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4
Q

Describe the joint capsule of elbow joint

A

Joint capsule thickened medially and laterally to form collateral ligaments

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5
Q

What are the ligaments of the elbow

A

Lateral collateral ligament (radial ligament)
Annular ligament
Medial ligament (ulnar ligament)

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6
Q

The lateral collateral ligament originates from

A

Lateral epicondyle of humerus

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7
Q

The medial ligament originates from

A

Medial epicondyle of humerus

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8
Q

Name A-D

A

A- radial collateral ligament (lateral collateral)
B - Annulus ligament
C - Joint capsule
D - Ulnar collateral ligament (medial collateral)

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9
Q

What are the bursae of the elbow

A

Intratendinous bursa
Subtendinous bursa
Subcutaneous (olecranon) bursa

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10
Q

Name A - C

A

A - Subtendinous bursa
B - Intratendinous bursa
C - Olecranon bursa (subcutaneous)

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11
Q

What happens to the radius and ulna during pronation

A

Radius moves over ulna

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12
Q

What is lateral epicondylitis (tennis elbow)

A

condition that causes pain around the outside of the elbow

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13
Q

Cause of lateral epicondylitis

A

Repetitive extension of wrist causing strain and injury

Degenerative tendonitis of the extensor tendon originating on lateral epicondyle

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14
Q

What are the forearm muscles for extension of the wrist

A

Extensor carpi radialis longus
Extensor carpi radialis brevis
Extensor carpi ulnaris

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15
Q

The extensors of the wrist all originate from (common extensor origin)

A

Lateral epicondyle of humerus

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16
Q

What is the pathology in lateral epicondylitis

A

Micro-tears in the common extensor origin (lateral epicondyle)

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17
Q

Symptoms of lateral epicondylitis

A

pain and tenderness over the lateral epicondyle
pain on opening a jar

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18
Q

Clinical signs of lateral epicondylitis

A

pain on resisted middle finger and wrist extension

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19
Q

Management for lateral epicondylitis

A

rest
physiotherapy
NSAIDs
steroid injections
Elbow clasp (brace)
Surgery in recurrent cases

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20
Q

What is medial epicondylitis (golfer’s elbow)

A

a consequence of repeated strain or degeneration of the common flexor tendon (common flexor tendonitis)

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21
Q

What are the muscles that origin from the medial epicondyle

A

Palmar longus
Pronator teres
Flexor carpi radialis
Flexor carpi ulnaris
Flexor digitorum superficialis

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22
Q

Which type of epicondylitis is more common

A

Lateral epicondylitis

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23
Q

Symptoms of medial epicondylitis

A

Pain and tenderness on medial epicondyle
Pain opening a jar

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24
Q

Clinical signs of medial epicondylitis

A
  1. Flex elbow to 90° in supination
  2. pain produced when wrist flexed against resistance
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25
Q

Management of medial epicondylitis

A

physiotherapy
rest
NSAIDs

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26
Q

Why is intra-articular steroids not used in medial epicondylitis

A

Due to risk of damage to ulnar nerve

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27
Q

Which type of arthritis is common in elbow

A

RA

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28
Q

Primary / secondary OA is more common in elbow

A

Secondary OA is more common in elbow

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29
Q

What is cubital tunnel syndrome

A

compression of the ulnar nerve at the elbow behind the medial epicondyle

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30
Q

Name A-D

A

A - Medial epicondyle
B - Retinaculum
C - Olecranon
D - ulnar nerve

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31
Q

Causes of cubital tunnel syndrome

A

tight band of Osborne’s fascia (cubital retinaculum)
tightness at the intermuscular septum
Tightness between the 2 heads of flexor carpi ulnas

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32
Q

Symptoms of cubital tunnel syndrome

A

paraesthesiae in the ulnar 1½ finger
Night symptoms - caused by sleeping with the arm in flexion

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33
Q

Clinical signs of cubital syndrome

A

Tinel’s test over the cubital tunnel - usually positive
Weakness of ulnar nerve innervated muscles 1st dorsal interosseous, abduction index finger and adductor pollicis

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34
Q

Investigations for ulnar nerve injury

A

Froment’s test
Tinel’s test

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35
Q

What is froment’s test what does it test for

A

Tests for adductor pollicis function which would show ulnar nerve injury

thumb flexes at the IP joint while pinching a piece of paper to compensate for a weak adductor pollicis muscle

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36
Q

Management of Cubital syndrome

A

NSAIDs,
activity modification
nighttime elbow extension splinting
Surgery if refractory

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37
Q

Injury mechanism of olecranon fracture

A

Falling onto elbow

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38
Q

Symptoms of olecranon fracture

A

Pain localised to posterior elbow

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39
Q

Clinical signs of olecranon fracture

A

Inability to extend elbow
Palpable defect indicating displaced fracture

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40
Q

What does inability to extend elbow suggest in olecranon fracture

A

Triceps brachii function is compromised - since olecranon is triceps brachii insertion point

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41
Q

Investigations for olecranon fracture

A
  • X-ray - AP and lateral
  • CT
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42
Q

Management for olecranon fracture

A

ORIF for comminuted fracture
Tension band (conservative if transverse fracture)

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43
Q

Most common type of elbow dislocation

A

Posterior

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44
Q

Mechanism of injury of elbow dislocation

A

Fall on outstretched hand

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45
Q

Types of elbow dislocation

A

Posterior
Anterior
Lateral
Medial
Divergent

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46
Q

Investigations for elbow dislocation

A

Xray - AP and lateral

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47
Q

Management for uncomplicated elbow dislocation

A

closed reduction under sedation
short period in sling (1‐3 weeks)

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48
Q

How long should patients be in a sling for elbow dislocation

A

1-3 weeks

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49
Q

What complications may occur in elbow dislocation

A

Fracture of radial head, humeral epicondyles or coronoid process of the ulna
Causing bony fragments to be entrapped and limit motion

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50
Q

Management for elbow dislocation with associated fracture

A

ORIF +/- screws

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51
Q

What is a supracondylar fracture

A

Fracture at distal humerus right above the condyles

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52
Q

Injury mechanism of supracondylar fracture

A

Fall on outstretched hand

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53
Q

Supracondylar fracture is most commonly seen in

A

Children

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54
Q

Which neurovascular structures are likely to be damaged in supracondylar fractures

A

Brachial artery
Median nerve

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55
Q

Signs of supracondylar fracture

A

Refusal to move elbow
unable to make the “OK” sign

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56
Q

Why would a patient with supracondylar fracture be unable to make the OK sign

A

Due to anterior interosseous branch of median nerve damage
- loss of flexor pollicis longus and flexor digitorum profundus (lateral 2)

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57
Q

Function of flexor pollicis longus

A

flexes the IP joint and MCP joint of the thumb

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58
Q

Innervation of flexor pollicis longus

A

Anterior interosseous branch of median nerve

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59
Q

Function of flexor digitorum profundus

A

the only muscle that can flex the DIP of the finger (except thumb)
assist flexion of wrist
assist flexion of MCP

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60
Q

Innervation of flexor digitorum profundus

A

Index + middle finger - anterior interosseous branch of median nerve

Little + ring finger - ulnar nerve

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61
Q

Investigations for supracondylar fracture

A

Xray - AP and lateral

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62
Q

What may be seen on xray for supracondylar fracture

A

Posterior fat pad sign

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63
Q

Management of undisplayed supracondylar fracture

A

Splint

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64
Q

Management of displaced supracondylar fracture

A

Closed reduction + pinning with wires
Open reduction if cannot perform closed reduction
Surgery if indicated

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65
Q

When is surgery indicated in supracondylar fracture

A

If radial pulse cannot be felt
If there is nerve injury (cannot make OK sign)

66
Q

Function of anterior compartment of the forearm

A

Flexion at wrist
Flexion at fingers
Pronation

67
Q

which muscles of the anterior compartment of the forearm is not supplied by the median nerve? and which nerve innervates these muscles

A

Flexor carpi ulnas
Medial part of flexor digitorum profundus

Ulnar nerve

68
Q

What are the superficial muscles in the anterior forearm

A

Flexor carpi ulnaris
Palmaris longus
Flexor carpi radialis
Pronator teres

69
Q

Name A-I

A

A - Biceps Brachii
B - Brachialis
C - Brachioradialis
D - Triceps brachii
E - Pronator teres
F - Flexor carpi radialis
G - Palmaris longus
H - Flexor carpi ulnaris
I - flexor digitorum superficialis

70
Q

All superficial muscles of the anterior forearm attach proximally by ___ to ____

A

Attach proximally by common flexor tendon to medial epicondyle of the humerus
Medial epicondyle = common flexor origin

71
Q

Attachment point for palmaris longus

A

Origin: medial epicondyle
Attachment: Palmar aponeurosis

72
Q

Function of palmaris longus

A

Flexion at the wrist

73
Q

Is palmaris longus present in all population

A

No, absent in 15%

74
Q

Attachment point for pronator teres

A

Origin: medial epicondyle and coronoid process of ulna
Attachment: Mid-shaft of the radius

75
Q

Function of pronator teres

A

Pronation of the forearm

76
Q

What are the wrist flexor muscles

A

Palmaris longus
Flexor carpi radialis
Flexor carpi ulnaris

77
Q

Attachment point for flexor carpi radialis

A

Origin: Medial epicondyle
Attachment: Base of 2nd and 3rd metacarpals (metacarpals on the radial side)

78
Q

Function of flexor carpi radialis

A

Flexion and ABDUCTION at the wrist

79
Q

Attachment of flexor carpi ulnaris

A

origin: medial epicondyle and olecranon of ulna
Attachment: pisiform carpal bone

80
Q

Function of flexor carpi ulnaris

A

Flexion and ADDUCTION at the wrist

81
Q

What muscle is part of the intermediate compartment of anterior forearm

A

Flexor digitorum superficialis

82
Q

Name A-G

A

A - pronator teres
B - Flexor digitorum superficialis
C - palmaris longus
D - Flexor carpi radialis
E - flexor carpi ulnaris
F - Flexor retinaculum
G - palmar aponeurosis

83
Q

Attachment point for flexor digitorum superficialis

A

Origin: Medial epicondyle and coronoid process of ulna and shaft of radius
Attachment: splits into 4 tendons at the wrist and attach to MIDDLE phalanges of the 4 digits except thumb

84
Q

Innervation of flexor digitorum superficialis

A

Median nerve

85
Q

Function of flexor digitorum superficialis

A

Flexion of the MCP and PIP joints at the 4 fingers
Flexion of the wrist

86
Q

What are the muscles of the deep compartment of anterior forearm

A

Flexor digitorum profundus
Flexor pollicis longus
Pronator quadratus

87
Q

Difference between origins of deep muscles and superficial muscles of the anterior forearm

A

Superficial muscles (including flexor digitorum superficialis) all originate from the medial epicondyle (common flexor origin) whereas the deep muscles do not

88
Q

Attachment of flexor digitorum profundus

A

Origin: Ulna and its interosseous membrane
Attachment: Splits into 4 tendons at the wrist and attach to DISTAL phalanges of the 4 fingers except thumb

89
Q

Function of flexor digitorum profundus

A

the ONLY muscle that can flex the DIP joints of the 4 fingers
assist Flexion of MCP of the 4 fingers
assist Flexion at wrist

90
Q

Innervation of flexor digitorum profundus

A

Medial half = little and ring fingers = Ulnar nerve
Lateral half = Middle and index fingers = anterior interosseous branch of median nerve

91
Q

Attachment of flexor pollicis longus

A

Origin: anterior surface of the radius and interosseous membrane
Attachment: Base of distal phalanx of the thumb

92
Q

Function of flexor pollicis longus

A

flexes the IP and MCP of thumb

93
Q

Innervation of flexor pollicis longus

A

Anterior interosseous branch of median nerve

94
Q

Attachment of pronator quadratus

A

Origin: Anterior surface of the ulna
Attachment: Anterior surface of the radius

95
Q

Innervation of pronator quadratus

A

Anterior interosseous branch of median nerve

96
Q

Function of pronator quadratus

A

Pronates the forearm

97
Q

Name A -C

A

A - Flexor pollicis longus
B - Pronator quadratus
C - Flexor digitorum profundus

98
Q

Both flexor digitorum superficialis and profundus split in to 4 tendons at the wrist then

A

Passes through the carpal tunnel to attach to the phalanges of digits

99
Q

Name A-I

A

A - Flexor digitorum superficialis
B - Flexor digitorum profundus
C - palmar carpal ligament
D - flexor retinaculum
E - flexor digitorum superficialis
F - Flexor digitorum profundus
G - flexor pollicis longus
H - Pronator quadratus
I - palmaris longus tendon

100
Q

Attachment of flexor retinaculum

A

On the ulnar side - pisiform and hamate bone
On the radial side - scaphoid and trapezium bone

101
Q

Main function of posterior compartment of forearm

A

Extension at wrist and fingers

102
Q

Arterial supply of posterior compartment of the forearm

A

Posterior interosseous artery - branch of ulnar artery

103
Q

The muscles of the posterior compartment of the forearm are all innervated by

A

Radial nerve

104
Q

Where is the common origin of the superficial posterior forearm muscles

A

Common extensor tendon on the lateral epicondyle of humerus

105
Q

What are the superficial posterior forearm muscles

A

Brachioradialis
Extensor carpi radialis longus
Extensor carpi radialis brevis
Extensor digitorum
Extensor digiti minimi
Extensor carpi ulnaris
Anconeus

106
Q

Name A - G

A

A - anconeus
B - flexor carpi ulnaris (anterior)
C - Extensor digiti minimi
D - Extensor carpi ulnaris
E - Extensor carpi radialis longus
F - Extensor carpi radialis brevis
G - Extensor digitorum

107
Q

Attachment of brachioradialis

A

Origin: supracondylar ridge of humerus
Attachment: Lateral surface of distal end of radius

108
Q

Function of brachioradialis

A

Flexion of semi-pronated forearm e.g. when drinking from a cup

109
Q

Attachment of extensor carpi radialis longus

A

Origin: lateral supracondylar ridge
Attachment: joins with the tendon of ECRB to attach to dorsal aspect of base of 2nd metacarpal

110
Q

Attachment of extensor carpi radialis brevis

A

Origin: Lateral epicondyle
Attachment: joins with the tendon of ECRL to attach to dorsal aspect of base of 3rd metacarpal

111
Q

Function of ECRL

A

Extension of the wrist
Abducts the hand at wrist

112
Q

Function of ECRB

A

Extension of wrist
Abducts the hand at wrist

113
Q

Innervation of ECRL

A

Radial nerve

114
Q

Innervation of ECRB

A

Deep branch of radial nerve

115
Q

Attachment of extensor digitorum

A

Origin: Lateral epicondyle
Attachment: Splits into 4 tendons and insert into the extensor hood of the 4 fingers

116
Q

Function of extensor digitorum

A

Extension of medial 4 digits at DIP, PIP and MCP joints

117
Q

Innervation of extensor digitorum

A

Deep branch of radial nerve

118
Q

Attachment of extensor digiti minimi

A

Origin: Lateral epicondyle
Attachment: joints with the extensor digitorum tendon and insert into extensor hood of little finger

119
Q

Function of extensor digiti minimi

A

Extend the little finger at MCP DIP PIP joints

120
Q

Attachment of extensor carpi ulnaris

A

Origin: Lateral epicondyle
Attachment: dorsal aspect of Base of 5th metacarpal

121
Q

Function of extensor carpi ulnaris

A

Extension of hand at wrist joint
Adduction of hand at wrist joint

122
Q

What are the deep muscles of posterior forearm

A

Supinator
Extensor indicis
Abductor pollicis longus
Extensor pollicis brevis
Extensor pollicis longus

123
Q

Function of supinator muscle

A

Supinates the forearm

124
Q

Innervation of supinator muscle

A

Deep branch of radial nerve

125
Q

Attachment of extensor indices

A

Origin: Posterior surface of distal 1/3 of ulna and interosseous membrane
Attachment: Extensor hood of 2nd digit

126
Q

Function of extensor indices

A

Extends the index finger

127
Q

Innervation of extensor indices

A

Posterior interosseous branch of radial nerve

128
Q

Attachment of abductor pollicis longus

A

Origin: Posterior surface of ulna and interosseous membrane
Attachment: dorsal aspect of base of 1st metacarpal

129
Q

Function of abductor pollicis longus

A

Abducts the thumb
Extends the thumb at carpometacarpal joint (base of thumb)

130
Q

Innervation of abductor pollicis longus

A

Posterior interosseous branch of radial nerve

131
Q

Attachment of extensor pollicis brevis

A

origin: Posterior surface of distal 1/3 of radius and interosseous membrane
Attachment: Dorsal aspect of base of proximal phalanx of thumb

132
Q

Function of extensor pollicis brevis

A

Extends the thumb at MCP and CMC joints

133
Q

Innervation of extensor pollicis brevis

A

Posterior interosseous branch of radial nerve

134
Q

Attachment of extensor pollicis longus

A

Origin: Posterior surface of middle 1/3 of ulna and interosseous membrane
Attachment: Dorsal aspect of base of distal phalynx of thumb

135
Q

Function of extensor pollicis longus

A

Extend the thumb at CMC, MCP, IP joints (all joints of thumb)

136
Q

Muscle bellies of which muscle of the posterior compartment of the forearm can be found at the anterior compartment

A

Supinator
Brachioradialis

137
Q

Name A-E

A

A- supinator
B- Abductor pollicis longus
C- extensor pollicis brevis
D- extensor pollicis longus
E- Extensor indicis

138
Q

Name A-J

A

A- Brachioradialis
B- Extensor carpi radialis longus
C- Extensor carpi radialis brevis
D- Anconeus
E- Extensor digitorum
F- Extensor digiti minimi
G- Extensor carpi ulnaris
H- Abductor pollicis longus
J- Extensor pollicis brevis
I- Extensor retinaculum

139
Q

Carpal tunnel is formed by

A

Flexor retinaculum - anterior
Carpal bones - posterior

140
Q

Contents of the carpal tunnel

A

4x tendons of flexor digitorum superficialis
4x tendons of flexor digitorum profundus
1x tendon of flexor pollicis longus

141
Q

Name A-E

A

A- flexor retinaculum
B- Flexor digitorum superficialis
C- Flexor digitorum profundus
D- Flexor pollicis longus
E- Median nerve

142
Q

Radius and ulna are connected by

A

Proximal and distal radioulnar joints

143
Q

Because radius and ulna are connected by 2 joints they form a

A

ring

144
Q

The ring structure of radius and ulna means that

A

If there is a fracture of one bone, there is usually an injury of the other

145
Q

Patterns of radius and ulna shaft fractures

A

Monteggia
Galeazzi
Nightstick fracture

146
Q

Describe Monteggia pattern of radius and ulna shaft fracture

A

Fracture of proximal 1/3 of ulna + dislocation of proximal head of radius

147
Q

Describe Galeazzi pattern of radius and ulna shaft fracture

A

Fracture of distal 1/3 of radius + dislocation of distal radioulnar joint

148
Q

Describe nightstick fracture

A

Isolated fracture of the ulnar shaft

149
Q

Clinical signs of radius and ulna shaft fracture

A

Deformity
Change in neurovascular function (radial, ulnar, median nerves; radial and ulnar arteries)

150
Q

Investigations for radius and ulna shaft fracture

A

Xray - AP and lateral

151
Q

Management for radius and ulna shaft fracture

A

Cast
ORIF

152
Q

Mechanism of injury for distal radius fracture

A

Fall on outstretched hand

153
Q

Patterns of distal radius fractures

A

Colles
Smith
Barton’s

154
Q

Describe Colles fracture

A

Fracture of distal radius with posterior displacement of distal fragment

155
Q

Describe Smith’s fracture

A

Fracture of distal radius with anterior displacement of distal fragment

156
Q

Describe Barton’s fracture

A

Intra-articular fracture of the distal radius with dislocation of the radiocarpal joint

157
Q

Symptoms of distal radius fracture

A

Wrist pain
Wrist swelling
Deformity

158
Q

Investigations of distal radius fracture

A

Xray- AP, lateral, oblique
CT - to evaluate intra-articular involvement
MRI - to evaluate soft tissue injury

159
Q

Management of distal radius fracture

A

Cast
ORIF
Manipulation under anaesthetics + K wires

160
Q

Complication of distal radius fracture

A

Carpal tunnel syndrome - esp Colles
Heal in poor position -> impaired grip strength

Y2 MSK (19 decks)

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