upper limb

Question 1

what happens in rotator cuff impingement?

Answer 1

the tendons of the rotator cuff (mainly supraspinatous) are compressed in the tight subacromial space during movement

Question 2

approximately, when in abduction does painful arc syndrome occur?

Answer 2

60-120 degrees

Question 3

name some causes of rotator cuff impingement ?

Answer 3

hooked acromion rotator cuff tear
tendonitis subacromial bursitis
acromioclavicular OA

painting /overhead work
athelets-throwing, swimming

Question 4

what is this?
shoulder pain (radiating to deltoid and upper arm)
tenderness on later edge of acromion
Hawkin’s _kennedy test positive

Answer 4

rotator cuff impingment

Question 5

treatment for rotator cuff impingement?

Answer 5

1. conservative- NSAIDS, analgesics, physio, steroid injection
2. surgery- subacromial decompression to create for space for tendon to pass through

Question 6

classic history of a sudden jerk in patient >40 with pain and weakness

Answer 6

rotator cuff tear

Question 7

how do you confirm rotator cuff tears?

Answer 7

Ultrasound or MRI

Question 8

treatment for rotator cuff tear?

Answer 8

non surgery-physio

surgery-subacromial decompression

Question 9

what is adhesive capsulitis?

Answer 9

frozen shoulder

Question 10

progressive pain and stiffness of shoulder in 40-60 year olds and loss of external rotation

Answer 10

frozen shoulder

Question 11

how do you treat frozen shoulder/

Answer 11

physio and analgesics

steroids injections can help in the painful phase

Question 12

what is acute calcific tendonitis?

Answer 12

acute onset of severe shoulder pain characterized by calcium deposition in supraspinatus tendon

Question 13

where do you see calcific tendonitis?

Answer 13

proximal to greater tuberosity of humerus on XRAY

Question 14

treatment for calcific tendonitis?

Answer 14

subacromial steroid injection and local anaesthetic gives great relief

Question 15

what are the 2 types of shoulder instability?

Answer 15

traumatic

atraumatic

Question 16

what is traumatic dislocation?

Answer 16

patients experience traumatic anterior shoulder dislocation.

most of these settle after reduction and physio

for recurrent dislocations, the Bankart repair can stabilize the shoulder

Question 17

what is atraumatic dislocation?

Answer 17

patients tend to have generalised lax ligaments, dislocations can be multidirectional

Question 18

what causes anterior shoulder pain with pain on resisted biceps contraction?

Answer 18

inflammation of long head of biceps (biceps tendonitis)

Question 19

name things which can cause referred pain to the shoulder

Answer 19

neck
angina
diaphragmatic irritation-biliary colic, hepatic abscess

Question 20

lateral epicondylitis?

Answer 20

tennis elbow

Question 21

what causes tennis elbow

Answer 21

repetitive strain

lost of restricted extension of the wrist

Question 22

painful and tender over lateral epicondyle

Answer 22

tennis elbow

Question 23

treatment for tennis elbow?

Answer 23

rest from activity
physio
NSAIDs
steroid injections
use of a brace
ultrasound therapy maybe
surgery in rare cases/for athletes

Question 24

medial epicondylitis

Answer 24

golfer elbow

Question 25

cause of golfer elbow

Answer 25

repetitive strain or degeneration of the common flexor origin

Question 26

which arthritis is more common in the elbow/

Answer 26

RA

Question 27

what is Dupuytren's contracture?

Answer 27

connective tissue disorder where the palmar fascia undergoes hyperplasia

Question 28

normal fascia bands form nodules and cords progressing to contractures

Answer 28

Dupuytren's contracture

Question 29

who is more affected by Dupuytren's contracture?

Answer 29

``` men people with diabetes people with liver cirrhosis Peyronie's disease Ledderhose disease ```

Question 30

pathology of Dupuytren's contracture?

Answer 30

proliferation of myofibroblast cells and production of abnormal collegen

Question 31

what body part does Peyronie's disease affect?

Answer 31

penis

Question 32

what body part does Ledderhose disease affect?

Answer 32

feet

Question 33

when do people with Dupuytren's contracture get surgery?

Answer 33

when its affecting their function

Question 34

what is trigger finger?

Answer 34

tendonitis of a flexor tendon to a digit

Question 35

how to treat trigger finger?

Answer 35

steroid injection around tendon within the sheath surgery offered inn recurrent cases

Question 36

Heberden's nodes

Answer 36

bony thickenings from OA in distal interphalangeal joints

Question 37

Bouchard's nodes

Answer 37

bony swellings from OA in proximal interphalangeral joints

Question 38

Boutonniere deformity swan neck deformity Z shaped thumb ulnar deviation volar MCPJ subluxation

Answer 38

RA in hands

Question 39

3 stages of RA in the hand?

Answer 39

1. synovitis and tenosynovitis 2. erosions of joint 3. joint instability and tendon rupture

Question 40

what are ganglion cysts?

Answer 40

mucinous filled cysts found adjacent to a tendon or synovial joint

Question 41

firm, smooth, rubbery, should transilluminate

Answer 41

ganglion cyst

Question 42

how to treat a ganglion cyst?

Answer 42

if swelling is causing localized discomfort, surgical excision

Question 43

second most common soft tissue swelling of hand?

Answer 43

giant cell tumour of tendon sheath

Question 44

where do you normally find giant cell tumour of tendon sheath?

Answer 44

palmar surface

Question 45

what is the danger of a giant cell tumour of tendon sheath?

Answer 45

can envelope digital nerve or artery and erode bone.