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MSK ( A.S) > Upper Limb > Flashcards

Upper Limb Flashcards

1
Q

the 3 main shoulder problems

A

Frozen shoulder
Rotator cuff disease ( impingement, cuff disease)
Arthritis

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2
Q

Shoulder problem 20-30s

A

Instability

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3
Q

Shoulder problem 30-40s

A

Impingement

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4
Q

Shoulder problems 40- 50s

A

Frozen shoulder

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5
Q

Shoulder problem 50 -60s

A

Cuff disease

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6
Q

Shoulder problem : >60s

A

Arthritis

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7
Q

Intrinsic muscle of shoulder

A 
SITS 
Supraspinatus 
Infraspinatus 
Teres minor 
Sub scapularis
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8
Q

Extrinsic muscle of rotator muscles

A

Deltoid
Trapezium
Pectoralis major
Latissimus major

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9
Q

What type of shoulder instability is more common

A

ANTERIOR!!!!

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10
Q

How is posterior instability normally caused by

A

Epileptic fit

Electrocution

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11
Q

Light bulb sign

A

Posterior dislocation

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12
Q

Treatment of instability

A

Physio
Arthroscopic / open stabilisation

Then 2- 3 sling, Early mobilisation

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13
Q

What is impingement

A

Sub - acromial space has narrowed hitting the nerves

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14
Q

Treatment of impingement

A 
Rest
Pain relief 
Physio 
Corticosteroid injection 
6 months of this then consider surgery : arthroscopic / open sub acromial decompression
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15
Q

Grey hair

A

Cuff disease

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16
Q

Treatment of cuff disease

A 
Rest 
Analgesic 
Sling 
Physio 
Again arthroscopic and open surgery as last resort
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17
Q

Main feature of impingement

A

Pain

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18
Q

Main symptoms of cuff disease

A

Weakness

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19
Q

What common cause of frozen shoulder

A

Sudden - not traumatic

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20
Q

Typical patient with frozen shoulder

A

Females
Gradual severe pain
40 -50s
Assoc with diabetes, endocrine diseases, dupuytrens

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21
Q

What are the stages of frozen shoulder

A

Freezing
Frozen
Thawing

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22
Q

3 stages of frozen shoulder - how long can it takes

A

3-4 years

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23
Q

X-ray of frozen shoulder Is weird

A

Nope - it’s nothing

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24
Q

Treatment of frozen shoulder

A

Analgesics, physio, steroid injectio
Surgery: manipulation under anaesthetic, arthroscopic capsule release

MIND OVER MATTER

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25
Q

What will examination show in glenohumeral OA

A

Asymmetry, wasting, limitation external rotation, global restriction in movement, pain throughout ROM

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26
Q

Ix of glenohumeral arthritis

A

LOSS

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27
Q

What nerve gets compressed in carpal tunnel syndrome

A

Median neuropathy

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28
Q

What nerve gets compressed in cubical tunnel syndrome

A

Ulnar nerve

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29
Q

Typical patient with carpal tunnel

A

Females

>30

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30
Q

Causes of carpal tunnel

A

Pregnancy, hormonal fluctuations, hypothyroidism, diabetes, obesity

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31
Q

Typical patient of cubical tunnel syndrome

A

Males

>30

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32
Q

Causes of cubical syndrome

A

Direct pressure (cyst, tumours0

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33
Q

What is in the carpal tunnel

A 
9 flexor tendons 
1 nerve ( median)
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34
Q

Carpal tunnel syndrome

A 
M: myxoedema 
E : oedema 
D : diabetes 
I : idiopathic 
A : acromegaly 
N: neoplasm

T: trap
R: RA
A : amyloidosis
P : pregnancy

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35
Q

Early symptoms of carpal tunnel

A

Pins and needles
Pain
Clumsiness

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36
Q

Late symptoms of carpal tunnel

A

Numbness

Weakness

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37
Q

Hypothenar atrophy = carpal tunnel

A

Nope - thenar

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38
Q

Ix for carpal tunnel

A

Durkin , tinnel’s, phalens
nerve conduction studies
Electromyogram

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39
Q

Treatment for carpal tunnel

A

Mild - moderate : splintage, physio, steroid

Severe: carpal tunnel decompression

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40
Q

Signs cubical syndrome

A

Hypothenar and interossseous atrophy
Clawing of ring and small finger
Altered sensation

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41
Q

Ix for cubical syndrome

A

Tinnel’s. Phalans, froments

Nerve conduction studies, EMG.

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42
Q

Treatment for cubical test

A

Same as carpal

43
Q

What is a tendon

A

Muscle to bone

44
Q

Tendinopathy

A

Painful tendon

45
Q

Tendonitis

A

Inflammation of tendon

46
Q

Tendonosis

A

Degeneration of the tendon

47
Q

Tenosynovitis

A

Inflammation of fluid filled sheath

48
Q

Enthesopathy

A

Pain at attachment of tendons, ligaments onto bone

49
Q

Intrinsic causes of tendon problems

A

Age, gender, obesity, malignancy

50
Q

Extrinsic causes of tendon problems

A

Trauma / injury, repetitive injury, drugs ( steroids, antibiotics) , sports

51
Q

What is most likely wrong in tendonosis

A

Matrix metalloproteinases ( MMP)

52
Q

Tendonosis is always painful

A

NO, Can be present and not painful

53
Q

Treatment for tendonosis

A

Rest, analgesia, anti inflammatory

Injections

54
Q

Injections of LA for Achilles tendonitis and extensor knee mechanism

A

NOOOOO AS THEY WILL RUPTURE

Only consider in rotator cuff, tennis elbow

55
Q

What surgery methods are there for tendonosis

A

Debridement ( removal of disease tissue)
Decompression
Synovectomy
Tendon transfer using tibialis posterior and extensor policis Longus

56
Q

Inject for upper limb

A 
NOOOOOO 
Only down ( except for Achilles and extensor  knee mechanism)
57
Q

What is the main muscle affected in rotator cuff injury

A

Supraspinatus

58
Q

Intrinsic causes for rotator cuff pathology

A

Degeneration, tendon vascularity

59
Q

Extrinsic causes of rotator cuff pathology

A

Throwing with athletes

Painters who lift over head

60
Q

Clinical findings of rotator cuff pathology

A

Dull achy pain over 4 tendon of the cuff
Cant sleep or reach over head
Painful arc with rotator cuff weakness
Impingement sign with Hawkins, jobes and scarf test

61
Q

Treatment of rotator cuff pathology

A

Rest, physio, steroid and LA injections

Surgery: arthroscopic or open sub acromial decompression, rotator cuff repair

62
Q

1st line ix for rotator cuff pathology

A

US

63
Q

Cause of biceps tendinopathy

A

Overuse, instability trauma

64
Q

Sign of biceps tendinopathy

A

POP EYE

EXTENSIVE BRUISING

65
Q

IX for biceps tendinopathy

A

US

66
Q

Management for biceps tendinopathy

A

Rest and physio

Surgical Repair but risk of neurovascular complication :(

67
Q

Medial epicondylitis

A

Golfers elbow

68
Q

Treatment of golfers elbow and tennis

A

rest, physio, infection of LA and steroid orthotics

Self limiting

69
Q

Lateral epicondylitis

A

Tennis elbow

70
Q

Examples when tennis elbow is worsens

A

Opening a jar

71
Q

All names for de quervains tenosynovitis

A

Blackberry / games thumb / mothers wrist

72
Q

Affects first extensor compartment ( APL and EPB)

A

De quervain’s tenosynovitis

73
Q

General patient with de quervains tenosynovitis

A

Women
30-50
Pregnancy
RA

74
Q

Treatment of de quervains tenosynovitis

A

Splint, rest, physio, analgesics, inject, surgical decompression

75
Q

How does ra cause extensor tendon rupture

A

Autoimmune attack on synovitis -> tendon degeneration -> rupture

76
Q

Feature of extensor tendon rupture

A

Weaknesses wrist extension

Dropped fingers

77
Q

Tx of extensor tendon rupture

A

Tendon transfer

78
Q

Common catch on trigger finger

A

Nodule catches on A1 pulley

79
Q

Tx of trigger finger

A

Observe
Inject
Surgical release

80
Q

What does the knee extensor mechanism consist of?

A

Quad muscles, quad tendon, patella and patella tendon

81
Q

If there is an injury to any part of the knee extensor?

A

Difficulty in straightening the leg

82
Q

Do you inject tendonitis

A

NO

83
Q

Clinical findings of a knee extensor mechanism

A

Palpable gap

No straight leg raise

84
Q

Ix of knee extensor mechanism

A

USS and mri will show a tear

Xr shows effusions or patella out of place

85
Q

Tx of knee extensor mechanism

A

Mainly surgical repair

86
Q

How does tibialis posterior rupture occur

A

Tenosynovitis -> progressive elongation -> rupture

87
Q

What is mucous cyst

A

Outpouching of synovial fluid from DIP

Females more affected

88
Q

Treatment of mucous cyst

A

Nothing

89
Q

What are ganglion

A

Outpouching of synovial cavity in wrist or ankles

Females

90
Q

Treatment for ganglion

A

Nothing

- old used to be hit with a bible

91
Q

What is dupuytrens contracture

A

Thickening and contracture of subdermal fascia leading to fixed flexion deformity of fingers
Usually starts at palmer pits / nodules

92
Q

Causes

A

Genetic, DM, alcohol, smoking, trauma, epilepsy

93
Q

Ix of dupuytrens

A

Table top test

94
Q

Treatment of dupuytrens

A

Stretches, activity modifications

Surgery: segmental fasiectomy, dermofascietomy, amputation

95
Q

What is paronychia

A

Infection within the nail fold mum

96
Q

Cause of Parton chia

A

Nail biting

97
Q

Management of paronchia

A

Elevate
Antibiotics
Incase and drain collection

98
Q

Flexor tendon sheath infection

A

INFECTION WITHIN SHEATH, TRACKING UP PALM AND ARM
VERY PAINFUL
EMERGENCY

99
Q

Ganglion of the popliteal

A

Bakers cyst

100
Q

What is bursitis

A

Inflammation of the synovium lined sacs that protects bony prominences and joints

101
Q

Management of bursitis

A

NSAIDs, analgesics
Antibiotics
Incision and drainage

102
Q

Rheumatoid nodules managment

A

They dont respond to dmards
So just excise if problematic
They will probs come back

103
Q

Dupuytrens is a disease of the flexor tendons

A

NO

MSK ( A.S) (16 decks)

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