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CORTEX > week 5: upper limbs > Flashcards

week 5: upper limbs Flashcards

1
Q

whats bones make up the shoulder girdle 3

A

scapula
clavicle
proximal humerus

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2
Q

rotator cuff muscles 4

A

supraspinatous
infraspinatous
teres minor
subscapularis

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3
Q

supraspinatus, infraspinatus and teres minor attach to the

A

greater tuberosity

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4
Q

most common problems of shoulders fro young, middlle aged and elderly

A

young - instability
middle - grey hair = cuff tear/frozen shoulder
old - OA

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5
Q

impingement is where the tendons of the rotator cuff are compressed, which tendon is usually affected

A

supraspinatus

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6
Q

in impingement painful abduction is between

A

60 to 120 deg

inflamed areas of supraspinatus tendon passes through the subacromial space

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7
Q

3 causes of impingement

A

tendonitis subacromial bursitis
acromioclaviccular OA + inferior osteophyte
hooked acromion cuff tear

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8
Q

pain from impingement radiates to

A

deltoid and upper arm

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9
Q

which test recreates pain from impingement

A

hawkins-kennedy (internal rotation of flexed shoulder)

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10
Q

treatment for shoulder impingemen t

A

conservative - NSAIDS, analgesis, physio, subacromial injection (3 may be required)

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11
Q

conservative treatment for shoulder impingement unsuccesfful, what next

A

subacromial decompression surgery -creates more space for tendon to pass through

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12
Q

how are rotator cuff tears confirmed

A

US

MRi

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13
Q

what can occur from chronic cuff deficiency

A

arthritis

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14
Q

another name for adhesive capsulitis

A

frozen shoulder

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15
Q

frozen shoulder is characterized by

A

progressive pain->stiffness in patients 40-60, resolves after 18-24nth

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16
Q

principal clinical sign of frozen shoulder is

A

loss of external rotation (+restricted omovements)

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17
Q

t/f diabetes are prone to adhesive capsulitis

A

true

assoc with hypercholesterolaemia
and dupuytrens disease

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18
Q

treatment for frozen shoulder

A

pain relief
physio
intra-articular (gleno-humerol) injections for pain maybe
tearing of capsule considered if still problematic

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19
Q

acute calcific tendonitis is characterised by calcium deposits in supraspinatus tendon and is sore af. treatment

A

subacromial injection steroid + local anaesthetic injection

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20
Q

traumatic instability can lead to recurrent dislocations, what type of repair can stabilise the shoulder, by reattaching the labrum and capsule to the a. glenoid

A

bankart repair (open/arthroscopic)

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21
Q

atraumatic instability can occur in patients with generalised ligamentous laxity, name 3 causes

A

idiopathic
ehlers-danlos
marfans

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22
Q

area of pain associated with biceps tendonitis

A

anterior shoulder pain (+restricted bicep contraction)

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23
Q

popeye deformity

A

spontaneous rupture of tendon in patient with bicep tendonitis

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24
Q

since pain can refer to shoulder, give examples

A

angina pectoris
diaphragmatic irritation (biliary colic, hepatic/subphrenic abscess)
neck problems too

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25
Q

the humero-ulnar joint is responsible for what type of movements

A

flexion

extension

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26
Q

radio-capitallar joint is responsible for

A 
supination 
pronation (along with proximal/distal radioulnar joints)
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27
Q

triceps power extension, where does it attach

A

olecranon process

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28
Q

brachialis/biceps flex the elbow, where do they attach

A

brach - coronoid process

bicep - bicipital tuberosity of the radius

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29
Q

supination is performed by biceps + supinator muscles, whereas pronation is performed by contraction of

A 
pronator teres muscle (proximally) 
prpnator quadratus (distally)
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30
Q

t/f common extensor origin is the medial epicondyle

A

false
extensor = lateral
flexor=medial

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31
Q

t/f elbow is commonly affected in RA

A

true

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32
Q

primary OA of elbow is rare t.,f

A

true

2ndary due to trauma

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33
Q

tennis elbow is another name for q

A

lateral epicondylitis

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34
Q

golfers elbow is another name for

A

medial epicondylitis

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35
Q

tennis elbow is due too repetitive strain through performing ___ ___ of the wrist

A

resisted extension

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36
Q

clinical features of lateral epicondylitis

A

painful/tender lateral epicondyle

pain on resisted middle finger and wrist extension

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37
Q

treatment for tennis

A

self-limiting
rest from exacerbating activities
NSAIDS, physio, steroids, brace
rarely surgery

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38
Q

which is more common, medial or lateral epicondylitis

A

lateral

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39
Q

an albow severely affected by ra or oa which isnt managable conservatively can be treated with

A

TER

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40
Q

cubital tunnel syndrome affects which nerve

A

ulnar

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41
Q

where does compression occur in cubital tunnel syndrome

A

posterior to medial epicondyle

funny bone area

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42
Q

2 tests for cubital tunnel syndrome

A

Tinels

Fromens

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43
Q

causes of compression q

A

tight band of fascia forming roof of tunnel

tightness at intermuscular septum (at oriigin of flexor carpi ulnaris)

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44
Q

t/f surgery may be usd in cubital tunnel

A

true

releases any tight structures

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45
Q

what forms the carpal tunnel

A

carpal bones

flexor retinaculum

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46
Q

which nerve affected in carpal tunnel

A

median

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47
Q

other than idiopathic, causes of carpal tunnel

A

RA (synovitis - less space)
fractures
conditions causing fluid retention (pregnancy, diabetes, chronic renal failure,hypothyroidism

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48
Q

t/f in pregnancy related carpal tunnel, symptoms subside after birth

A

true

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49
Q

presentation of carpal tunnel

A

parathesiae of thumb+radial 2.5 fingers, worse at night
clumsiness
muscle wasting

50
Q

tinels test is sused to reproduce symptoms, what is this

A

percussion over median nerve

51
Q

non-op treatment of carpal

A

wrist splints at night (prevents flexion)

corticosteroid injection

52
Q

surgical treatment of carpal

A

carpal tunnel decompression

division of carpal ligament

53
Q

dupuytrens contracture

A

connective tissue disorder
hyperplasia of palmar fascia
nodules formed and leads to progressive contractures at MCP/PIP js

54
Q

proliferation of ___ cell and the production of abnormal ____ is what causes dupuytrens

A

myofibroblasts

collagen

55
Q

females more affected in dupuytrens

A

false

10:1

56
Q

difference between fasciectomy and fasciotomy

A

fasciectomy - full removal

fasciotomy - partial

57
Q

trigger finer

A

tendonitis of a flexor tendon, usually distal to a fascial pulley over a metacarpal neck

58
Q

movement of finger in trigger finger produces a ____ sensation, the nodule catches on and then passes underneath the pulley q

A

clicking

59
Q

most common affected fingers in trigger finger

A

middlie

ringe

60
Q

treatment of trigger

A

steroid injections around tendon

surgery if recurrent/persistent

61
Q

t/f excision of a1 does not affect function

A

true

a2 and a4 require

62
Q

heberdens nodes

A

stiffness and thckening of bones on finger

63
Q

mild/mod OA of hand/wrist treatment

A

removal of osteophytes

excision of any mucous cyst

64
Q

if sev. OA, ____ may be perfored

A

arthrodesis

65
Q

which is more commonly affected, DIP or PIP

A

DIP - esp postmen. women

66
Q

if OA inPIP joint affected i ___ finger, arthrodesis may be required

A

index

to preserve pinch grip

67
Q

rarely OA can affect MCP, examples when it does

A

prev injury
gout
infection
w

68
Q

which carpo-metacarpal joint is commonly affected by OA

A

1st
trapziometacarpal j

at base of thumb

69
Q

Joints btween trapzeium, trapezoid, and scaphoid can be affected by primary OA. if sev symptoms what may be required

A

fusion

70
Q

the hands are the site where RA causest the most problems t/f

A

true

71
Q

t/f ra spares the PIPs

A

false

spares DIP - unlike psoriatic arthritis + OA

72
Q

RA of hands can be split into 3 stages, what are these

A

1- synovitis and tenosynovitis - inflame within js and tendon sheath (swelling + pain)

2 - joint erosion - pannus (invasion into terminal vessels results in soft tissue ischemia + stretching of surrounding structures)

3 - j instability + tendon rupture - can progress to subluxation and chronic tenosynovitis - predisposes to extensor tendon ruptures

73
Q

drugs used to combat RA

A

DMARDS

74
Q

deformities found in RA 5

A

volar MCPJ subluxation
ulnar deviation
swan neck (hyperextension at PIPj, with flexion at DIPj)
boutonnier (flexion at PIPj, hyperextension at DIPj)
z-shaped thumb

75
Q

type of surgery which may prevent tendon rupture

A

tenosynovectomy (tendon sheath)

76
Q

t/f in extensor tendon rupture of wrist/fingers direct surgical repair is possible

A

false

repair of diseased tendon will fail, instead tendon transfers or joint fusions may preserve function

77
Q

in DRUJ arthritis, resection of the ___ ___ may be required

A

distal ulna

78
Q

a ganglion cyst is a common ___ __ cyst found adjacent to a ___ or ___ ___

A

mucus filled
tendon
synovial joint

79
Q

common areas for ganglion cyst

A

DIPJ
Wrist
also occur in foot, aankle and kneee (bakers - popliteal fossa)

80
Q

ganglion cysts can cause ___ ___ or irritation, most however are removed for cosmetic reasons

A

localised pain

81
Q

describe a ganglion cysr

A

firm, smooth
rubbery
should transilluminate

82
Q

giant cell tumours of the tendon sheath are the most common soft tissue swellings after ganglios, where would u find them

A

palmar surface

around PIP of index, and middle finer

83
Q

t/f a GCT can cause pain, nerve damage and erode into bone

A

true

doesnt always happen

84
Q

GCT are multinucleate giant cells, but what gives their brown appearance

A

haemosiderin

85
Q

t/f excision is recommended in GCTs

A

true

86
Q

difference between arthroplasty, arthrodesis

A

arthrodesis - joint fusion

arthroplasty - reshaping through partial/full resection of joint

87
Q

disadvantages of arthrodesis

A

fusion

loss of function
incr in pressure in surrounding areas may lead to arthritis change

88
Q

arthrodesis is good for end stage ____ __, wrist arthritis and arthritis of the first ___ ___ of the foot (hallux rigidus)

A

ankle arthritis

MTP joint

89
Q

osteotomy is a surgical realingment of a bone, when would this be used

A

deformity correction

redistribute load across an arthritic joint

90
Q

vast majority of soft tissue inflam problems settle with ___ ,____ and ___ ___

A

rest
analgesia
anti-inflam medication

91
Q

which tendons/entheses are not suitable for injection

A

Achilles
extensor knee

(rotator cuff, tennis elbow can)

92
Q

inRA affecting the extensor tendons of the wrist, what may be performed

A

synovectomy

also used for inflam of tibialis posterior tendon - prevents rupture

93
Q

tendon tear requiring splintage

A

achilles

94
Q

tendon tear requiring surgical repair

A

quads or patellar tendon

sometimes achilles

95
Q

2 times tendon transfer would be carried out

A

tibialis posterior

extensor pollicis longuus

96
Q

most cases of joint instability can be managed with

A

physio

splints/braces may also be used for additional support

97
Q

angular deformity of long bones of the lower limb may result in

A

early arthritis (of knee/ankle due to load)

corrected by growth plate manipulation surgery or osteotomy

98
Q

most common sites for nerve decompression

A

median nerve at wrist
ulnar at elbow (post. medial epicondyle)
brachial plexus at shoulder

99
Q

most at risk of osteomyolitis

A

chronic patients
elderly
young
immunocompromised

100
Q

Once infected, enzymes from leucocytes cause ____ ___ and ___ forms which impairs local blood flow making the infection very difficult to eradicate.

A

local osteolysis

pus

101
Q

sequestrum

A

dead fragment of bone

102
Q

once a sequestrum is made, antibiotics alone wll not cure the infection

A

true

103
Q

t/f in acute osteomyelitis an involucrum may be observed

A

false

chronic only - live bone formd around dead bone (sequestrum)

104
Q

in acute, who is usually affected

A

children

105
Q

__ __ can co-exist with acute osteomyelitis

A

septic arthritis

106
Q

In adults the infection tends to be in the axial skeleton (spine or pelvis) with haematogenous spread from ____ or ___ infections s, or from infection of the ___ |____

A

pulmonary
urinary
intervertebral disc (discitis)

107
Q

t/f TB can cause COM

A

true

108
Q

causative organisms of OM

A

staph aureus
Entero sp.
Group A/B strep
HAem. influe

109
Q

most common organism regardless of group in OM

A

staph aureus

110
Q

t/f chronic OM cannot be cured by antibiotics alone

A

true

111
Q

commonest spot for osteomyelitis q

A

lumbar spine

112
Q

presentation of OM

A

insidious onset back pain- constant, unremitting
muscle spasms/tenderness
fever/systemic upset
neurological deficit in sev.

113
Q

endocarditis shd be considered, what would be looked for

A

clubbing
splinter haem
,murmur

114
Q

treatment for OM

A

high dose IV AB post CT biopsy

115
Q

t/f orthopaedic infection shd be resolved with antibiotics

A

false

surgery

116
Q

pseudotumour

A

inflam granuloma produced in response to metal wear pparticles in conext of J replacement

117
Q

tibial osteotomy may be considered as alternative option to J replacement for knee arthritis in young t/f

A

true

118
Q

shoulder impingment affects the ___ ___ ___ as it passes throught the ____ space during shoulder ____.

A

rotator cuff tendon
subacromial
abduction

119
Q

hip impingement is when the ___ surround the ___ becomes squashed by the femoral neck

A

labrum

acetabulum

120
Q

Froment’s test may form part of your examination of the ulnar nerve. A positive test reflects ulnar nerve dysfunction. Weakness of which muscle will give rise to a positive Froment’s test?

A

adductor pollicis

CORTEX (7 decks)

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