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MSK Pathology > Compressive Neuropathies, Elbow and Hand > Flashcards

Compressive Neuropathies, Elbow and Hand Flashcards

1
Q

What forms the carpal tunnel of the wrist?

A

carpal bones

flexor retinaculum

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2
Q

Any swelling within the confines of the carpal tunnel may cause what?

A

medial nerve compression

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3
Q

What can carpal tunnel syndrome occur secondary to?

A

RA (synovitis leads to less space)

Many conditions which involve fluid retention eg pregnancy, diabetes, CKD, hypothyroid

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4
Q

Which fracture may cause carpal tunnel syndrome?

A

colles fracture

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5
Q

Is carpal tunnel more common in men or women?

A

women (8 times more)

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6
Q

How will patients present with carpal tunnel syndrome?

A

numbness in median nerve innervated digits (thumb and radial 2.5 fingers, worse at night
weakness of thumb
clumsiness

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7
Q

What may be seen on examination in carpal tunnel syndrome?

A

muscle wasting of thenar eminence

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8
Q

Which tests can be done in Carpal Tunnel?

A

Tinel’s test (decreases space in carpal tunnel)

Phalen’s test (holds wrists hyper flexed)

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9
Q

What confirm diagnosis of carpal tunnel?

A

nerve conduction studies - see slowing of conduction across wrist

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10
Q

Treatment of carpal tunnel syndrome?

A

wrist splints to prevent flexion

surgical carpal tunnel decompression (very commonly performed)

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11
Q

Which nerve is compressed in cubital tunnel syndrome and where?

A

ulnar nerve

at albow behind medial epicondyle (funny bone area)

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12
Q

Which muscles may be weak in cubital tunnel syndrome?

A

1st dorsal interosseus and adductor pollicis

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13
Q

What test can assess muscle weakness in cubital tunnel syndrome?

A

Froment’s test

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14
Q

What may be the cause of compression in cubital tunnel syndrome?

A

tight band of fascia forming the root of the tunnel (Osborne’s fascia)

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15
Q

What confirm diagnosis of cubital tunnel syndrome?

A

nerve conduction studies

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16
Q

What may give rise to either type of epicondylitis?

A

common extensor and flexor origins’ attachment (enthesis) can become painful (enthesopathy)

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17
Q

Which is the elbow commonly affected by, OA or RA?

A

RA

18
Q

Is tennis elbow lateral or medial?

A

lateral

19
Q

Is golf elbow lateral or medial?

A

medial

20
Q

Injection for golfer’s elbow poses a risk of injury to which nerve?

A

ulnar

21
Q

What is Dupytrens contracture?

A

connective tissue disorder
specialized palmar fascia undergoes hyperplasia
Nodules/cords formed
Leads to contractures at MCP and PIP joints

22
Q

What is the pathology of Dupytrens?

A

proliferation of myofibroblast cells and production of abnormal collagen (type 3 instead of type 1)

23
Q

Contractures most commonly affect which fingers?

A

ring and pinky

24
Q

Who are more likely to have Dupytrens, men or women?

A

men (10:1)

25
Q

What can dupytrens be a features of?

A

alcoholic cirrhosis
side effect of phenytoin therapy
Peyronie’s disease
Ledderhose disease

26
Q

Is dupytrens less common in diabetics?

A

no, more common

27
Q

What is an indication for surgery in Dupytrens?

A

contracture at PIP joint

28
Q

What surgery is done in Dupytrens?

A

fasciectomy or fasciotomy

29
Q

What is trigger finger?

A

tendonitis of flexor tendon resulting in nodular enlargement of affected tendon

30
Q

Movement o finger in trigger finger produces what?

A

clicking sensation

31
Q

Which fingers are most commonly affected in trigger finger?

A

middle and ring

32
Q

In whom is DIP OA very common?

A

post menopausal women

33
Q

What are seen on examination of DIPs with OA?

A

Heberden’s nodes

34
Q

What are seen on examination of PIPs with OA?

A

Bouchard’s nodes

35
Q

Which joint is extremely commonly affected by OA in women over 40?

A

trapziometacarpal joint at base of thumb

36
Q

OA of the radio carpal join is normally due to what?

A

trauma

37
Q

Name the 3 stages of disease of the hand by RA.

A
  1. synovitis and tenosynovitis
  2. erosion of joint
  3. joint instability and tendon rupture
38
Q

List the 5 hand deformities caused by RA.

A

Volar MCP joint xubluxation
Ulnar deviation
Swan neck deformity (hyperextension at PIP with flexion of DIP)
Boutonnier deformity (flexion at PIP with hyperextension at DIP)
Z thumb

39
Q

What are ganglion cysts?

A

common mucinous filled cysts adjacent to tendon or synovial joint

40
Q

What is a ganglion cyst in the knee?

A

Baker’s cyst

41
Q

What do ganglion cysts feel like?

A

firm, smooth, rubbery, should transilluminate

MSK Pathology (17 decks)

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