Elbow and arm orthopaedics, trauma and upper limb compessive neuropathies Flashcards Preview

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Flashcards in Elbow and arm orthopaedics, trauma and upper limb compessive neuropathies Deck (43):
1

What is carpal tunnel syndrome?

Compression of the median nerve as it passes through the carpal tunnel

2

What forms the carpal tunnel?

The carpal bones and the flexor retinaculum at the wrist

3

What passes through the carpal tunnel?

Median nerve

9 flexor tendons

4

What can carpal tunnel syndrome be secondary to?

Rheumatoid arthritis (synovitis > less space)

Pregnancy

Diabetes

Chronic renal failure

Hypothyroidism

5

Which fracture in particular can predispose to carpal tunnel syndrome?

Colles fracture

6

How does carpal tunnel syndrome present?

Parathesiae in the median nerve innervated digits (thumb and radial 2½ fingers)

Worse at night

Loss of sensation

Weakness of thumb

Clumsiness in areas of hand supplied by median nerve

7

What signs on examination would indicate carpal tunnel syndrome?

In severe cases, thenar muscle wasting

Symptoms reproduced by Tinels test

Symptoms reproduced by Phalen’s test, holding the wrists hyper‐flexed (which decreases space in the carpal tunnel)

8

What test can confirm the diagnosis of carpal tunnel syndrome?

Nerve conduction testing
Shows slowed conduction across the wrist

9

What is the non-surgical treatment avaliable for carpal tunnel syndrome?

Wearing splints at night

Injection of corticosteroid

10

What is the surgical treatment of carpal tunnel syndrome?

Carpal tunnel decompression involves division of the transverse carpal ligament under local anaesthetic

11

What is cubital tunnel syndrome?

Compression of the ulnar nerve at the elbow behind the medial epicondyle

12

How does cubital tunnel syndrome usually present?

Paraesthesiae in the ulnar 1½ fingers

13

What is Osborne's fascia?

A tight band of fascia forming the roof of the cubital tunnel

14

What can cause cubital tunnel syndrome?

Osborne's fascia

Tightness at the intermuscular septum as the nerve passes through or between the two heads at the origin of flexor carpi ulnaris

15

What test on examination is indicative of cubital tunnel syndrome?

Froment's

16

What does Froment's test involve?

Ask the patient to grip an object e.g. a piece of paper between thumb and index finger to test strength of adductor pollicis

In a positive test, the weakness of adductor pollicis will mean the patient compensates by flexing flexor pollicus longus of the thumb to maintin grip strength

17

What is the repetitive strain injury in Tennis elbow/lateral epicondylitis?

Resisted extension at the wrist

18

What are the two ways that tennis elbow can occur?

Repetitive strain injury

Degenerative enthesopathy (inflammation of the origin or insertion of a tendon or ligament into bone)

19

What is tennis elbow?

Lateral epicondylitis

20

What is the pathology in tennis elbow?

 Micro‐tears in the common extensor origin

21

How does tennis elbow present?

 Painful and tender lateral epicondyle and pain on resisted middle finger and wrist extension

22

What is the conservative treatment of tennis elbow?

Rest from the activities that exacerbate the pain

Physiotherapy

NSAIDs

Steroid injections

Use of a brace (known as an elbow clasp)

23

What is the surgical treatment for tennis elbow?

Division and/or excision of some fibres of the common extensor origin

24

What is golfers elbow?

Medial epicondylitis - repetitve strain or degeneration of the common flexor origin

25

Which is more common: tennis elbow or golfers elbow?

Tennis elbow - lateral epicondylitis

26

What is the risk associated with steroid injection to treat golfers elbow?

Risk of ulnar nerve damage

27

How can arthritic change at the radio-capitellar joint that has not responded to conservative management be treated?

Surgical excision of the radial head

28

How can arthritic change at the humero-ulnar joint that has not responded to conservative management be treated?

Total elbow replacement

29

How does radial nerve injury due to humeral shaft fracture present?

Wrist drop

Loss of sensation in 1st dorsal web space

30

How are most cases of humeral shaft fracture treated?

Non-operatively with a functional humeral brace which compresses the fragments into acceptable alignment and provides some stability

31

What is the treatment for intra-articular fractures of the distal humerus?

Ppen reduction, internal fixation (ORIF)

Anatomic reduction and rigid fixation to minimize loss of function

32

How do olecranon fractures occur?

Usually occur with a fall onto the point of the elbow with contraction of the triceps muscle

33

How are olecranon fractures usually managed?

ORIF to restore triceps function and restore the articular surface

34

How can a simple transverse avulsion fracture of the olecranon be treated?

Tension band wiring which compresses the tension side of the fractures

35

How do radial head and neck fractures usually occur?

Fall on an outstretched hand

36

How might an undisplaced radial head or neck fracture present?

Lateral elbow pain on supination / pronation

'Fat pad' on lateral xray (a triangle like a sail anterior to the distal humerus)

37

How are minimally or undisplaced radial head or neck fractures treated?

Sling

Early elbow exercises to minimise stiffness

38

How can restricted range of movement following radial head/neck fracture be assisted, or differentiated from a mechanical block?

Aspiration of hemarthrosis

Injection of local anaesthetic

39

When is ORIF performed in radial head/neck fractures?

If the fragment is large enough or excision if not amenable to fixation

40

In what direction do most elbow dislocations occur and how?

In the posterior direction after a fall onto the outstretched hand

41

What is the treatment for uncomplicated elbow dislocations?

Neurovascular assessment

Closed reduction under sedation

1-3 weeks in sling

Elbow exercises

42

What fractures are associated with elbow dislocation?

Radial head

Humeral epicondyles

Coronoid process of the ulna

43

How are epicondyle fractures fixed?

With a screw