Upper Limbs Flashcards
What is subacromial impingement syndrome?
Inflamm and invitation of rotator cuff tendons as they pass through subacromial space resulting in progressive pain and weakness, especially abduction. Most common shoulder path.
Clin signs of SAIS? (3) subacromial impingement syndrome
Neer’s sign and test positive
Hawkins - Kennedy test positive
Painful arc 60-120 degrees abduction.
Clin signs of acromio-clavicular joint involve? (2)
Positive scarf test (cross-body adduction)
Painful arc 120-160 abduction
What causes “frozen shoulder”? (Risk factors)
Diabetes
Hypertension
Hyperthyroid
What is “frozen shoulder”
Adhesive capsulitis. Glenohumeral joint capsule contracted and adherent to humeral head.
Clinical signs of adhesive capsulitis/ frozen shoulder
Arm held to side. Loss arm swing.
Ext rotation and flexion esp affected.
Pain, stiff, decreased ROM
3 stages of adhesive capsulitis or frozen shoulder
- Painful
- Freezing
- Thawing
Clin tests for de quervain’s stenosing tenosynovitis
Finkelstein test positive
Which structures does de quervain’s tenosynovitis affect?
1st dorsal extensor compartment: tendons of extensor pollicis brevis and abductor pollicis longus.
Clinical presentation of de quervain tenosynovitis (5)
Radial wrist pain Local swelling over radial styloid region Crepitations on movement Pain with abduction wrist Grasping and pinching difficulty
Treat de quervain?
- Splint + steroid injection
2. Surgical decompression of extensor compartment 1
What is carpal tunnel syndrome?
Compression of median nerve by flexor retinaculum
3 risk factors for carpal tunnel syndrome
Diabetes
Pregnancy
Rheumatoid arthritis
Clinical presentation of carpal tunnel syndrome (3)
Early morning or nocturnal paraesthesia and thick fingers on radial side wrist
Weak grip
Late sign: Weak thumb abduction (wasting thenar MM.)
Clinical tests (3) for carpal tunnel syndrome
Phalen test
Tinel test
Median nerve compression test
What is tennis elbow?
Lateral epicondylitis. Common extensor tendon fibrosis and tendinosis due to formation of granulation tissue from microtears.
What causes tennis elbow or lat epicondylitis
Repetitive overuse wrist extensors
Clinical test for lateral epicondylitis
Mills test (palpate) (ECRB) Cozens test (pain W/ resisted wrist extension)
Name pathology: picture 3
Dupuytren’s contracture.
What is dupuytren’s contracture?
Common contraction of longitudinal palmar fascia
Where does dupuytren’s contracture most commonly occur?
4th and 5th digits.
Risk factors for dupuytren’s contractures (3)
Diabetes
Smoking
Alcohol
Clin presentation dupuytren’s contracture. Ass pathologies. (5)
Flexion contracture of 4th or 5th digits Hard, puckered nodules in palm Knuckle pads (garod nodes) Contractures medial part of sole of foot (leddharhose disease) Peyronie's abnormality penis
Clin test for dupuytren’s contracture
Hueston’s test: can’t lay palm flat on tabletop
Characteristic hand manifestations in rheumatoid arthritis (8)
Boutonnière deformity (PIP flexed, DIP extended). !
Z deformity of thumb (MCP flex, IP hyperextend) !
Swan neck deformity ( PIP hyperextended, dip flexed) ! - more debilitating, struggle to grip
Finger extensor tenosynovitis or tendon rupture
Symmetrical and bilateral
Spares DIP joints
Radial deviation wrist. !
Ulnar deviation fingers MCP !
What is pathology in picture 4
Acromioclavicular joint dislocation
3 common causes of radial sided wrist pain
Carpometacarpal arthritis
Trigger thumb
De quervain’s tenosynovitis
Characteristic hand presentations of asteoarthritis(7)
Osteoarthritic quintet:
- Heberden nodule: DIP
- Carpal tunnel syndrome
- Carpometacarpal arthritis of thumb
4 Mucinous cyst - Trigger finger
Also:
Bouchard nodule: PIP
DIP involved
Describe erb-duchenne palsy
C5/c6 lesion. Arm is internally rotated with adduction and flexion wrist. “Waiter’s tip”
Describe path picture 5
Erb-duchenne palsy
Waiter’s tip sign
How diagnose clinically rotator cuff tear
Weakness of external rotation
What is kienboch’s disease?
Compromised blood supply to lunate bone in wrist leading to sclerosis
Name the 4 components or stages of rotator cuff syndrome
1 supraspinatus impingement and tendinitis
2 rotator cuff tears
3 biceps tendinitis
4 acromioclavicular osteoarthritis
Clin Sign of long head of biceps rupture
Popeye sign
Most Common cause cubitis varus
Malunited(untreated) supracondylar fracture of humerus. “Gun stock deformity”
What is medial epicondylitis?
Golfer’s elbow. Common flexor tendon injury. Less common than lateral
Possible complication of medial epicondylitis
Ulnar nerve fallout