week 5: upper limbs Flashcards by Rory Houlihan

whats bones make up the shoulder girdle 3

scapula
clavicle
proximal humerus

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rotator cuff muscles 4

supraspinatous
infraspinatous
teres minor
subscapularis

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supraspinatus, infraspinatus and teres minor attach to the

greater tuberosity

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

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

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

supraspinatus

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in impingement painful abduction is between

60 to 120 deg

inflamed areas of supraspinatus tendon passes through the subacromial space

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3 causes of impingement

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

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pain from impingement radiates to

deltoid and upper arm

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which test recreates pain from impingement

hawkins-kennedy (internal rotation of flexed shoulder)

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treatment for shoulder impingemen t

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

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conservative treatment for shoulder impingement unsuccesfful, what next

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

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how are rotator cuff tears confirmed

MRi

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what can occur from chronic cuff deficiency

arthritis

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another name for adhesive capsulitis

frozen shoulder

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frozen shoulder is characterized by

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

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principal clinical sign of frozen shoulder is

loss of external rotation (+restricted omovements)

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t/f diabetes are prone to adhesive capsulitis

true

assoc with hypercholesterolaemia
and dupuytrens disease

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treatment for frozen shoulder

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

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

subacromial injection steroid + local anaesthetic injection

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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

bankart repair (open/arthroscopic)

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

idiopathic
ehlers-danlos
marfans

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area of pain associated with biceps tendonitis

anterior shoulder pain (+restricted bicep contraction)

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popeye deformity

spontaneous rupture of tendon in patient with bicep tendonitis

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since pain can refer to shoulder, give examples

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

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

flexion | extension

radio-capitallar joint is responsible for

``` supination pronation (along with proximal/distal radioulnar joints) ```

triceps power extension, where does it attach

olecranon process

brachialis/biceps flex the elbow, where do they attach

brach - coronoid process bicep - bicipital tuberosity of the radius

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

``` pronator teres muscle (proximally) prpnator quadratus (distally) ```

t/f common extensor origin is the medial epicondyle

false extensor = lateral flexor=medial

t/f elbow is commonly affected in RA

true

primary OA of elbow is rare t.,f

true | 2ndary due to trauma

tennis elbow is another name for q

lateral epicondylitis

golfers elbow is another name for

medial epicondylitis

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

resisted extension

clinical features of lateral epicondylitis

painful/tender lateral epicondyle | pain on resisted middle finger and wrist extension

treatment for tennis

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

which is more common, medial or lateral epicondylitis

lateral

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

TER

cubital tunnel syndrome affects which nerve

ulnar

where does compression occur in cubital tunnel syndrome

posterior to medial epicondyle funny bone area

2 tests for cubital tunnel syndrome

Tinels | Fromens

causes of compression q

tight band of fascia forming roof of tunnel | tightness at intermuscular septum (at oriigin of flexor carpi ulnaris)

t/f surgery may be usd in cubital tunnel

true | releases any tight structures

what forms the carpal tunnel

carpal bones | flexor retinaculum

which nerve affected in carpal tunnel

median

other than idiopathic, causes of carpal tunnel

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

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

true

presentation of carpal tunnel

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

tinels test is sused to reproduce symptoms, what is this

percussion over median nerve

non-op treatment of carpal

wrist splints at night (prevents flexion) | corticosteroid injection

surgical treatment of carpal

carpal tunnel decompression | division of carpal ligament

dupuytrens contracture

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

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

myofibroblasts | collagen

females more affected in dupuytrens

false | 10:1

difference between fasciectomy and fasciotomy

fasciectomy - full removal fasciotomy - partial

trigger finer

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

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

clicking

most common affected fingers in trigger finger

middlie | ringe

treatment of trigger

steroid injections around tendon | surgery if recurrent/persistent

t/f excision of a1 does not affect function

true | a2 and a4 require

heberdens nodes

stiffness and thckening of bones on finger

mild/mod OA of hand/wrist treatment

removal of osteophytes | excision of any mucous cyst

if sev. OA, ____ may be perfored

arthrodesis

which is more commonly affected, DIP or PIP

DIP - esp postmen. women

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

index | to preserve pinch grip

rarely OA can affect MCP, examples when it does

prev injury gout infection w

which carpo-metacarpal joint is commonly affected by OA

1st trapziometacarpal j at base of thumb

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

fusion

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

true

t/f ra spares the PIPs

false spares DIP - unlike psoriatic arthritis + OA

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

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

drugs used to combat RA

DMARDS

deformities found in RA 5

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

type of surgery which may prevent tendon rupture

tenosynovectomy (tendon sheath)

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

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

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

distal ulna

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

mucus filled tendon synovial joint

common areas for ganglion cyst

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

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

localised pain

describe a ganglion cysr

firm, smooth rubbery should transilluminate

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

palmar surface | around PIP of index, and middle finer

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

true doesnt always happen

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

haemosiderin

t/f excision is recommended in GCTs

true

difference between arthroplasty, arthrodesis

arthrodesis - joint fusion arthroplasty - reshaping through partial/full resection of joint

disadvantages of arthrodesis

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

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

ankle arthritis | MTP joint

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

deformity correction | redistribute load across an arthritic joint

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

rest analgesia anti-inflam medication

which tendons/entheses are not suitable for injection

Achilles extensor knee (rotator cuff, tennis elbow can)

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

synovectomy also used for inflam of tibialis posterior tendon - prevents rupture

tendon tear requiring splintage

achilles

tendon tear requiring surgical repair

quads or patellar tendon | sometimes achilles

2 times tendon transfer would be carried out

tibialis posterior | extensor pollicis longuus

most cases of joint instability can be managed with

physio splints/braces may also be used for additional support

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

early arthritis (of knee/ankle due to load) corrected by growth plate manipulation surgery or osteotomy

most common sites for nerve decompression

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

most at risk of osteomyolitis

chronic patients elderly young immunocompromised

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

local osteolysis | pus

sequestrum

dead fragment of bone

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

true

t/f in acute osteomyelitis an involucrum may be observed

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

in acute, who is usually affected

children

__ __ can co-exist with acute osteomyelitis

septic arthritis

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 ___ |____

pulmonary urinary intervertebral disc (discitis)

t/f TB can cause COM

true

causative organisms of OM

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

most common organism regardless of group in OM

staph aureus

t/f chronic OM cannot be cured by antibiotics alone

true

commonest spot for osteomyelitis q

lumbar spine

presentation of OM

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

endocarditis shd be considered, what would be looked for

clubbing splinter haem ,murmur

treatment for OM

high dose IV AB post CT biopsy

t/f orthopaedic infection shd be resolved with antibiotics

false surgery

pseudotumour

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

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

true

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

rotator cuff tendon subacromial abduction

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

labrum | acetabulum

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?

adductor pollicis

week 5: upper limbs Flashcards

(120 cards)