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pain syndromes > Pain Syndromes > Flashcards

Pain Syndromes Flashcards

1
Q

Cubital Bursitis

A

Pain the front of the elbow (antecubital area)

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2
Q

Cubital Bursitis (bicipitalradial bursa)

A

NSAIDs

Bursae injection

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3
Q

Cubital Tunnel Syndrome

A

Ulnar nerve entrapment at the elbow

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4
Q

Confirmation of Cubital Tunnel Syndrome

A

EMG

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5
Q

Untreated Cubital tunnel Syndrome

A

May develop weakness in the hand
Atrophy of the hand muscles
Permanent flexion contractures of the fingers

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6
Q

Cubital tunnel Syndrome Treatment

A

NSAIDS
Steroid injections
Surgery

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7
Q

Cubital Tunnel Presentation

A

Produces pain and numbness from the inside back of the elbow down to the wrist and into the inside fourth and fifth finger
May lead to small muscle wasting of the hand and the ulnar side of the forearm

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8
Q

Pronator Teres Syndrome

A

Compression of the median nerve proximal to the carpal tunnel by the pronator teres muscle resulting in pain in the forearm

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9
Q

Pronator Teres Syndrome Presentation

A
  1. “tiredness” in the foream
  2. Clumsiness and weakness of the hand muscles (index/middle finger)
  3. Pain and numbness in the hand in the same pattern as carpal tunnel syndrome.
  4. Symptoms worsened by repetitive pronation and supination
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10
Q

Pronator Teres Syndrome

A

Negative Tinel’s Sign

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11
Q

Cause of Pronator Teres Syndrome

A

The syndrome is caused by inflammation of the muscle of the forearm responsible for rotating the hand from palm up to palm down position.

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12
Q

Cause of Pronator teres Syndrome

A

Activities such as repetitive elbow movements in chopping wood, rowing a boat, etc

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13
Q

Test for pronator teres syndrome

A

The pronator test is placing the elbow on a table and turning the palm down. The patient is instructed to resist the examiner rotating the palm upwards. If pain is produced in the forearm during this process, there is a positive pronator sign.

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14
Q

Treatment of pronator teres syndrome

A 
NSAIDS
Rest of the arm and elbow
Avoidance of the repetitive triggering activity
Steroid injections
Surgery is rarely required.
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14
Q

Lateral epicondylitis presentation

A

Provoked pain of the lateral proximal forearm and lateral elbow with resisted wrist extension

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15
Q

Anterior interosseous nerve

A

Motor nerve only

Branch of median nerve

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16
Q

Anterior interosseous nerve

A

Innervates deep muscles of he forearm:

FPL (thumb), FDP to the( index and middle fingers), pronator quadratus

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17
Q

Anterior interosseous nerve Presentation

A

No motor function of the three muscles

Unable to make the “O” sign

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18
Q

Posterior Interosseous nerve

A

Purely motor nerve that branches from the radial nerve

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19
Q

Posterior Interosseous nerve

A

Consider in patients with weakness of the finger extensors

Severe cases may show radial deviation of the wrist with wrist extension

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20
Q

Posterior Interosseous Nerve presentation

A

Inability to extend thumb and other fingers

Lack of sensory disturbance

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21
Q

What are early signs of Posterior Interosseous nerve

A

Provocative pain of the lateral proximal forearm with resisted extension of the middle finger
Consider in patients with weakness of the finger extensors

22
Q

What does it innervate Posterior Interosseous nerve

A 
Innervates the finger
Ulnar wrist extensors
Thumb extensor
Abductor muscles 
Extensor muscles of the forearm and hand
Spares the radial wrist extensor
23
Q

Where can it get entrapped and was is it described as( Posterior Interosseous Nerve)

A

Arcade of Frohse (part of the supinator muscle)

Described as a finger drop

24
Q

Carpal tunnel syndrome

A

Sensory deficits 1st-4th finger
Decrease in muscle strength
Worsened by repetitive wrist flexion

25
Q

Thoracic outlet syndrome

A
  1. Shoulder pain
  2. Pallor or coldness of the hand
  3. Negative Adsons test
26
Q

Radial Nerve palsy (Wrist drop)

A 
Weakness:
1. Wrist
2. Finger extensors
3. Brachioradialis muscle
Preserved Triceps strength
27
Q

Diff dx for Inability to extend the fingers in the setting of RA

A
  1. Extensor tendon rupture
  2. MCP joint dislocation
  3. Posterior interosseous Nerve compression
28
Q

Presentation of extensor tendon rupture due to poorly controlled RA

A

Weakness of the middle through small finger extensors

Intact thumb abductors and wrist extensors

29
Q

Extensor tendon rupture presentation

A

Inability to extend fingers in the order of 5th, 4th and 3rd

Lack of sensory disturbance

30
Q

Piriformis Muscle

A

Muscle externally rotate the extended thigh and assists in abduction of flexed thigh

31
Q

What is piriformis syndrome

A

Compression or irritation of the sciatic nerve by the piriformis muscle

32
Q

Symptoms of Piriformis Syndrome

A 
Sciatica- radiating pain down the leg
Deep, boring pain in the buttock
Tight and painful hamstrings
Radiating pain in the calf
Tightness and decreased mobility in the hip
Pain in the hip
Low back pain
Generally one sided pain
33
Q

Maneuver for piriformis syndrome

A

FADIR test: illicits buttock pain

  1. Passive flexion
  2. Adduction
  3. Internal rotation of the right hip with the patient in the supine position
34
Q

Activities that exacerbate piriformis syndrome

A

Sitting

Activities that adduct and internally rotate the hip

35
Q

Meralgia Paresthetica

A

Compression of lateral femoral cutaneous nerve (L2-L3)
Purely sensory defect
Burning pain with hyperesthesia and numbness of anterolateral thigh
Obese, pregnant, diabetics, trauma, tight clothes

36
Q

Ischial Bursitis:

A

“Weaver’s bottom”
Trauma or prolonged sitting
Pain when sitting or lying down
Pain may radiate down back of thigh

37
Q

Ischial Bursitis:

A

Bursa is superficial to the ischial tuberosity and separtates the gluteus maximus from the tuberosity

38
Q

Tarsal Tunnel Syndrome

A

Posterior tibial nerve is compressed at or near the flexor retinaculum
Flexor retinaculum is located posterior and inferior to the medial malleolus

39
Q

Tarsal Tunnel Syndrome Presentation

A

Medial ankle pain
Numbness, burning pain, and paresthesias of the toes and sole extend proximally to the area over the medial malleolus
Pain with eversion and dorsiflexion

40
Q

Tarsal Tunnel Syndrome sign

A

+Tinel’s sign-percussion posterior to the medial malleolus

41
Q

Peroneal Tendon Injury

A

Cause of lateral ankle pain

42
Q

Fx rule out in Peroneal Tendon Injury

A

Fibular Fx

43
Q

Peroneal Tendon Maneuvers

A

Active dorsiflexion and eversion of the foot against resistance

44
Q

Peroneal Tendon Injury treatment

A 
Protection
Rest
Ice
Compression
Medication
Physical therapy
Ankle taping
Lateral Heel wedges
45
Q

Common peroneal nerve compression

A

Difficulty with foot dorsiflexion or foot drop

46
Q

Tibialis posterior tendon (TPT)

A

Medial ankle pain

47
Q

Maneuvers Tibialis posterior tendon (TPT)

A

Plantar flexion
Inversion of the foot
Stabilization of the medial longitudinal arch

48
Q

Maneuvers that exacerbate tibialis posterior tendon (TPT) pain

A

Standing on tiptoe
Inability to repeat raises on tiptoe
Varus deviation of the heel

49
Q

Sign tibialis posterior tendon (TPT) pain

A

Too many toes signs

50
Q

Anterior Tibialis tendon rupture

A

Swelling of the anterior ankle

Mild foot drop

51
Q

Straight leg raising maneuver

A

+pain radiating below the knee with leg elevation 10-60 degrees

52
Q

SI or hip joint pathology maneuver

A

FABER test:

  1. Flexion
  2. Abduction
  3. External rotation

pain syndromes (1 decks)

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