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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
Management of medial epicondylitis
physiotherapy rest NSAIDs
26
Why is intra-articular steroids not used in medial epicondylitis
Due to risk of damage to ulnar nerve
27
Which type of arthritis is common in elbow
RA
28
Primary / secondary OA is more common in elbow
Secondary OA is more common in elbow
29
What is cubital tunnel syndrome
compression of the ulnar nerve at the elbow behind the medial epicondyle
30
Name A-D
A - Medial epicondyle B - Retinaculum C - Olecranon D - ulnar nerve
31
Causes of cubital tunnel syndrome
tight band of Osborne's fascia (cubital retinaculum) tightness at the intermuscular septum Tightness between the 2 heads of flexor carpi ulnas
32
Symptoms of cubital tunnel syndrome
paraesthesiae in the ulnar 1½ finger Night symptoms - caused by sleeping with the arm in flexion
33
Clinical signs of cubital syndrome
Tinel’s test over the cubital tunnel - usually positive Weakness of ulnar nerve innervated muscles 1st dorsal interosseous, abduction index finger and adductor pollicis
34
Investigations for ulnar nerve injury
Froment's test Tinel's test
35
What is froment's test what does it test for
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
36
Management of Cubital syndrome
NSAIDs, activity modification nighttime elbow extension splinting Surgery if refractory
37
Injury mechanism of olecranon fracture
Falling onto elbow
38
Symptoms of olecranon fracture
Pain localised to posterior elbow
39
Clinical signs of olecranon fracture
Inability to extend elbow Palpable defect indicating displaced fracture
40
What does inability to extend elbow suggest in olecranon fracture
Triceps brachii function is compromised - since olecranon is triceps brachii insertion point
41
Investigations for olecranon fracture
- X-ray - AP and lateral - CT
42
Management for olecranon fracture
ORIF for comminuted fracture Tension band (conservative if transverse fracture)
43
Most common type of elbow dislocation
Posterior
44
Mechanism of injury of elbow dislocation
Fall on outstretched hand
45
Types of elbow dislocation
Posterior Anterior Lateral Medial Divergent
46
Investigations for elbow dislocation
Xray - AP and lateral
47
Management for uncomplicated elbow dislocation
closed reduction under sedation short period in sling (1‐3 weeks)
48
How long should patients be in a sling for elbow dislocation
1-3 weeks
49
What complications may occur in elbow dislocation
Fracture of radial head, humeral epicondyles or coronoid process of the ulna Causing bony fragments to be entrapped and limit motion
50
Management for elbow dislocation with associated fracture
ORIF +/- screws
51
What is a supracondylar fracture
Fracture at distal humerus right above the condyles
52
Injury mechanism of supracondylar fracture
Fall on outstretched hand
53
Supracondylar fracture is most commonly seen in
Children
54
Which neurovascular structures are likely to be damaged in supracondylar fractures
Brachial artery Median nerve
55
Signs of supracondylar fracture
Refusal to move elbow unable to make the “OK” sign
56
Why would a patient with supracondylar fracture be unable to make the OK sign
Due to anterior interosseous branch of median nerve damage - loss of flexor pollicis longus and flexor digitorum profundus (lateral 2)
57
Function of flexor pollicis longus
flexes the IP joint and MCP joint of the thumb
58
Innervation of flexor pollicis longus
Anterior interosseous branch of median nerve
59
Function of flexor digitorum profundus
the only muscle that can flex the DIP of the finger (except thumb) assist flexion of wrist assist flexion of MCP
60
Innervation of flexor digitorum profundus
Index + middle finger - anterior interosseous branch of median nerve Little + ring finger - ulnar nerve
61
Investigations for supracondylar fracture
Xray - AP and lateral
62
What may be seen on xray for supracondylar fracture
Posterior fat pad sign
63
Management of undisplayed supracondylar fracture
Splint
64
Management of displaced supracondylar fracture
Closed reduction + pinning with wires Open reduction if cannot perform closed reduction Surgery if indicated
65
When is surgery indicated in supracondylar fracture
If radial pulse cannot be felt If there is nerve injury (cannot make OK sign)
66
Function of anterior compartment of the forearm
Flexion at wrist Flexion at fingers Pronation
67
which muscles of the anterior compartment of the forearm is not supplied by the median nerve? and which nerve innervates these muscles
Flexor carpi ulnas Medial part of flexor digitorum profundus Ulnar nerve
68
What are the superficial muscles in the anterior forearm
Flexor carpi ulnaris Palmaris longus Flexor carpi radialis Pronator teres
69
Name A-I
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
All superficial muscles of the anterior forearm attach proximally by ___ to ____
Attach proximally by common flexor tendon to medial epicondyle of the humerus Medial epicondyle = common flexor origin
71
Attachment point for palmaris longus
Origin: medial epicondyle Attachment: Palmar aponeurosis
72
Function of palmaris longus
Flexion at the wrist
73
Is palmaris longus present in all population
No, absent in 15%
74
Attachment point for pronator teres
Origin: medial epicondyle and coronoid process of ulna Attachment: Mid-shaft of the radius
75
Function of pronator teres
Pronation of the forearm
76
What are the wrist flexor muscles
Palmaris longus Flexor carpi radialis Flexor carpi ulnaris
77
Attachment point for flexor carpi radialis
Origin: Medial epicondyle Attachment: Base of 2nd and 3rd metacarpals (metacarpals on the radial side)
78
Function of flexor carpi radialis
Flexion and ABDUCTION at the wrist
79
Attachment of flexor carpi ulnaris
origin: medial epicondyle and olecranon of ulna Attachment: pisiform carpal bone
80
Function of flexor carpi ulnaris
Flexion and ADDUCTION at the wrist
81
What muscle is part of the intermediate compartment of anterior forearm
Flexor digitorum superficialis
82
Name A-G
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
Attachment point for flexor digitorum superficialis
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
Innervation of flexor digitorum superficialis
Median nerve
85
Function of flexor digitorum superficialis
Flexion of the MCP and PIP joints at the 4 fingers Flexion of the wrist
86
What are the muscles of the deep compartment of anterior forearm
Flexor digitorum profundus Flexor pollicis longus Pronator quadratus
87
Difference between origins of deep muscles and superficial muscles of the anterior forearm
Superficial muscles (including flexor digitorum superficialis) all originate from the medial epicondyle (common flexor origin) whereas the deep muscles do not
88
Attachment of flexor digitorum profundus
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
Function of flexor digitorum profundus
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
Innervation of flexor digitorum profundus
Medial half = little and ring fingers = Ulnar nerve Lateral half = Middle and index fingers = anterior interosseous branch of median nerve
91
Attachment of flexor pollicis longus
Origin: anterior surface of the radius and interosseous membrane Attachment: Base of distal phalanx of the thumb
92
Function of flexor pollicis longus
flexes the IP and MCP of thumb
93
Innervation of flexor pollicis longus
Anterior interosseous branch of median nerve
94
Attachment of pronator quadratus
Origin: Anterior surface of the ulna Attachment: Anterior surface of the radius
95
Innervation of pronator quadratus
Anterior interosseous branch of median nerve
96
Function of pronator quadratus
Pronates the forearm
97
Name A -C
A - Flexor pollicis longus B - Pronator quadratus C - Flexor digitorum profundus
98
Both flexor digitorum superficialis and profundus split in to 4 tendons at the wrist then
Passes through the carpal tunnel to attach to the phalanges of digits
99
Name A-I
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
Attachment of flexor retinaculum
On the ulnar side - pisiform and hamate bone On the radial side - scaphoid and trapezium bone
101
Main function of posterior compartment of forearm
Extension at wrist and fingers
102
Arterial supply of posterior compartment of the forearm
Posterior interosseous artery - branch of ulnar artery
103
The muscles of the posterior compartment of the forearm are all innervated by
Radial nerve
104
Where is the common origin of the superficial posterior forearm muscles
Common extensor tendon on the lateral epicondyle of humerus
105
What are the superficial posterior forearm muscles
Brachioradialis Extensor carpi radialis longus Extensor carpi radialis brevis Extensor digitorum Extensor digiti minimi Extensor carpi ulnaris Anconeus
106
Name A - G
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
Attachment of brachioradialis
Origin: supracondylar ridge of humerus Attachment: Lateral surface of distal end of radius
108
Function of brachioradialis
Flexion of semi-pronated forearm e.g. when drinking from a cup
109
Attachment of extensor carpi radialis longus
Origin: lateral supracondylar ridge Attachment: joins with the tendon of ECRB to attach to dorsal aspect of base of 2nd metacarpal
110
Attachment of extensor carpi radialis brevis
Origin: Lateral epicondyle Attachment: joins with the tendon of ECRL to attach to dorsal aspect of base of 3rd metacarpal
111
Function of ECRL
Extension of the wrist Abducts the hand at wrist
112
Function of ECRB
Extension of wrist Abducts the hand at wrist
113
Innervation of ECRL
Radial nerve
114
Innervation of ECRB
Deep branch of radial nerve
115
Attachment of extensor digitorum
Origin: Lateral epicondyle Attachment: Splits into 4 tendons and insert into the extensor hood of the 4 fingers
116
Function of extensor digitorum
Extension of medial 4 digits at DIP, PIP and MCP joints
117
Innervation of extensor digitorum
Deep branch of radial nerve
118
Attachment of extensor digiti minimi
Origin: Lateral epicondyle Attachment: joints with the extensor digitorum tendon and insert into extensor hood of little finger
119
Function of extensor digiti minimi
Extend the little finger at MCP DIP PIP joints
120
Attachment of extensor carpi ulnaris
Origin: Lateral epicondyle Attachment: dorsal aspect of Base of 5th metacarpal
121
Function of extensor carpi ulnaris
Extension of hand at wrist joint Adduction of hand at wrist joint
122
What are the deep muscles of posterior forearm
Supinator Extensor indicis Abductor pollicis longus Extensor pollicis brevis Extensor pollicis longus
123
Function of supinator muscle
Supinates the forearm
124
Innervation of supinator muscle
Deep branch of radial nerve
125
Attachment of extensor indices
Origin: Posterior surface of distal 1/3 of ulna and interosseous membrane Attachment: Extensor hood of 2nd digit
126
Function of extensor indices
Extends the index finger
127
Innervation of extensor indices
Posterior interosseous branch of radial nerve
128
Attachment of abductor pollicis longus
Origin: Posterior surface of ulna and interosseous membrane Attachment: dorsal aspect of base of 1st metacarpal
129
Function of abductor pollicis longus
Abducts the thumb Extends the thumb at carpometacarpal joint (base of thumb)
130
Innervation of abductor pollicis longus
Posterior interosseous branch of radial nerve
131
Attachment of extensor pollicis brevis
origin: Posterior surface of distal 1/3 of radius and interosseous membrane Attachment: Dorsal aspect of base of proximal phalanx of thumb
132
Function of extensor pollicis brevis
Extends the thumb at MCP and CMC joints
133
Innervation of extensor pollicis brevis
Posterior interosseous branch of radial nerve
134
Attachment of extensor pollicis longus
Origin: Posterior surface of middle 1/3 of ulna and interosseous membrane Attachment: Dorsal aspect of base of distal phalynx of thumb
135
Function of extensor pollicis longus
Extend the thumb at CMC, MCP, IP joints (all joints of thumb)
136
Muscle bellies of which muscle of the posterior compartment of the forearm can be found at the anterior compartment
Supinator Brachioradialis
137
Name A-E
A- supinator B- Abductor pollicis longus C- extensor pollicis brevis D- extensor pollicis longus E- Extensor indicis
138
Name A-J
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
Carpal tunnel is formed by
Flexor retinaculum - anterior Carpal bones - posterior
140
Contents of the carpal tunnel
4x tendons of flexor digitorum superficialis 4x tendons of flexor digitorum profundus 1x tendon of flexor pollicis longus
141
Name A-E
A- flexor retinaculum B- Flexor digitorum superficialis C- Flexor digitorum profundus D- Flexor pollicis longus E- Median nerve
142
Radius and ulna are connected by
Proximal and distal radioulnar joints
143
Because radius and ulna are connected by 2 joints they form a
ring
144
The ring structure of radius and ulna means that
If there is a fracture of one bone, there is usually an injury of the other
145
Patterns of radius and ulna shaft fractures
Monteggia Galeazzi Nightstick fracture
146
Describe Monteggia pattern of radius and ulna shaft fracture
Fracture of proximal 1/3 of ulna + dislocation of proximal head of radius
147
Describe Galeazzi pattern of radius and ulna shaft fracture
Fracture of distal 1/3 of radius + dislocation of distal radioulnar joint
148
Describe nightstick fracture
Isolated fracture of the ulnar shaft
149
Clinical signs of radius and ulna shaft fracture
Deformity Change in neurovascular function (radial, ulnar, median nerves; radial and ulnar arteries)
150
Investigations for radius and ulna shaft fracture
Xray - AP and lateral
151
Management for radius and ulna shaft fracture
Cast ORIF
152
Mechanism of injury for distal radius fracture
Fall on outstretched hand
153
Patterns of distal radius fractures
Colles Smith Barton's
154
Describe Colles fracture
Fracture of distal radius with posterior displacement of distal fragment
155
Describe Smith's fracture
Fracture of distal radius with anterior displacement of distal fragment
156
Describe Barton's fracture
Intra-articular fracture of the distal radius with dislocation of the radiocarpal joint
157
Symptoms of distal radius fracture
Wrist pain Wrist swelling Deformity
158
Investigations of distal radius fracture
Xray- AP, lateral, oblique CT - to evaluate intra-articular involvement MRI - to evaluate soft tissue injury
159
Management of distal radius fracture
Cast ORIF Manipulation under anaesthetics + K wires
160
Complication of distal radius fracture
Carpal tunnel syndrome - esp Colles Heal in poor position -> impaired grip strength

Y2 MSK (19 decks)

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