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othopaedics > elbow, hand, wrist pathologies > Flashcards

elbow, hand, wrist pathologies Flashcards

1
Q

what is epicondylitis of the elbow

A

inflammatory process at the forearm extensor origin on the humeral supracondylar ridge either medial or lateral

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2
Q

other name for lateral and medial epicondylitis

A

lateral= tennis elbow

medial=golf elbow

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3
Q

epidemiology of epicondylitis

A

40-50 years

more common in men

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4
Q

difference between lateral and medial epicondulitis pain

A

lateral: pain in lateral epicondylitis worsened with resisted wrist extension
medial: pain in medial epicondylitis with resisted wrist flexion

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5
Q

treatment for epicondylitis

A 
activity modify
brace
physio
injections
surgical release- usually self-limiting
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6
Q

symptoms of ulnar nerve entrapment

A

-ulnar nerve pain and weakness
-waste hypothenar eminence and intrinsic muscles
-elbow pain and nerve intrapment
clumsier
-loss sensation to medial one and half fingers
-night pain
-worse with elbow flexion

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7
Q

management of ulnar nerve entrapment

A

splint elbow in extension

ulnar nerve decompression

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8
Q

2 causes or locations for ulnar nerve entrapment

A

cubital tunnel syndrome- between 2 heads of FCU, paraesthesia to ulna hand, night pain, worse elbow flexion
Guyon’s canal: in wrist,

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9
Q

what is the ulnar claw paradox

A

closer to the paw the worser the claw
ie the lesser the claw the higher up the lesion is as FDP will be affected meaning there is less flexion in the claw
-due to loss of lumbricals

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10
Q

carpal tunnel syndrome symptoms

A 
pain 
paraesthesia
night pain
clumsiness
nocturnal dyaesthesia
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11
Q

exam of carpal tunnel syndrome

A

thenar wasting
weak APB on exam
median nerve altered sensation

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12
Q

what part of the hand sensory is spared in carpal tunnel syndrome and why

A

thenar eminence sensation often spared (palmar cutaneous branch) goes over the carpal tunnel

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13
Q

reversible causes of carpal tunnel syndrome9

A 
pregnancy
RA
diabetes
hypothyroid
obesity
colles fracture
cushing
amyloidosis
SLE
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14
Q

treatment for carpal tunnel and 1 yr success rate for conservative

A

reversible self-limiting 80% improve in a yr
nocturnal splint
NSAID
surgical decompression

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15
Q

what joints does dupuytren’s contractures affect

A

MCPJ
PIPJ
painless contractures

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16
Q

what causes dup contractures

A

abnormal thickeing of palmar aponeuosis and shortening

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17
Q

risk factors for dup contractures 5

A 
male >50
smoking
dm
alcoholism
epilepsy
ring> little finger
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18
Q

treatment of dup contractures

A

injectable collagenase
surgical resection
fasciectomy

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19
Q

what is trigger finger

A

stenosing tenosynovitis

narrow tendon sheath means flexor tendon catches

20
Q

symptoms of trigger finger

A
  • finger becomes caught in flexion
  • pain and popping flexing finger
  • thickening of ganglion
21
Q

difference trigger to duputyren contracture

A

with trigger finger can extend passively

but cant with dup

22
Q

who is more affected by trigger finger 3

A

middle aged women- menopause
DM
RA

23
Q

which 3 fingers are most affected

A

ring, middle finger and thumb

24
Q

management of trigger finger

A

injections

but if >2 injections and no change then do a flexor pully release

25
Q

de quervian tenosynovitis- what is it?

A

inflammation of extensor tendons underneath the extensor retinaculum
repetitive strain injury

26
Q

where/ when is the pain in de quervian tenosynovitis

A
  • pain over radial styloid
  • first dorsal compartment of wrist when gripping
  • resisted thumb extension
27
Q

symptoms of de quervian tenosynvoitis

A

swelling and tenderness

pain

28
Q

test for de quervian tenosynovitis

A

worse with finkelstein’s test- deviate hand ulnar with thumb across palm

29
Q

treatment de quervian

A 
rest 
splint
physio
injection
surgical release
30
Q

most common places to find OA in the hand

A

more common in DIP of fingers and CMCJ of thumb

31
Q

where is herbeden and bouchard nodules and z thumb

A

Herbeden=dipj

bouchard=pipj

32
Q

treatment base of thumb OA surgical

A

trapezium excision

33
Q

2 main types of hand infections

A

flexor sheath infection

paronychia-nail bed

34
Q

flexor sheath infection- Kanavel’s cardinal signs 5

A
  • fusiform sausage swelling
  • flexed posture
  • tender along tendon sheath
  • pain on passive extension
  • swollen, flexed, pain extending, pain palpation
35
Q

treatment for flexor sheath infeciton

A

iv antibiotics

surgical washout

36
Q

common organism in paronychia

A

s.aureus

37
Q

treatment for paronychia

A

release of pus under pressure by probing the nail fold or formal incision and drainage under digital nerve block

38
Q

what is mallet finger

A

injury to extensor tendon ie torn from DIPJ insertion so terminal phalanx assumes a flexed posture- splint

39
Q

what is radicular pain

A

pain that follows a dermatome ie spinal path root

40
Q

signs for carapl tunnel syndrome

A

ok sign loss

tinel sign and phalen

41
Q

signs of a higher median nerve palsy and what specific nerve affected

A

loss of OK sign
loss sensation radial 3.5 digits
anterior interosseous
ulnar deviation

42
Q

high radial nerve palsy sign

A

wrist drop
lost wrist extension
lost mcp, thumb ad finger extension
sensory loss over 1st dorsum space

43
Q

low radial nerve palsy signs

A

elbow extension spared

lost thumb and finger extension

44
Q

what nerve specifically is affected in radial nerve palsy

A

dorsal interosseous nerve

45
Q

what causes a high radial nerve palsy versus a lower radial nerve palsy

A 
#humerus=high
elbow dislocate=low
46
Q

2 tests for carpal tunnel syndrome

A

tinel’s test: tapping

Phalen’s test

othopaedics (21 decks)

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