Upper limb Flashcards
1
Q
signs of shoulder impingement
A
painful arc
Hawkins sign
decreased ROM
pain on movement, not usually at night
2
Q
Bigliani grade 3 acromion = ____
can cause shoulder ___
A
slopes closer to humerus
impingement
3
Q
management of shoulder arthritis is ___
A
conservative
Sx is risky and not as reliable as lower limb Sx
4
Q
Hill-Sachs lesion =
A
dent in back of humerus head as impacts on front of glenoid
5
Q
TUBS (shoulder instability) =
Rx =
A
Traumatic Unilateral dislocation with Bankart/Hill-Sachs lesions
Bankart repair - anchor and suture labrum back to bone
6
Q
AMBRI (shoulder instability) =
A
Atraumatic Multidirectional Bilateral Rehab Inferior capsular shift
7
Q
carpal tunnel syndrome is compression of ____
Ix =
Rx =
A
median nerve
nerve conduction
night splints, Sx decompression
8
Q
cubital tunnel syndrome is compression of ___
A
ulnar nerve
9
Q
3 sites where ulnar nerve can be compressed =
A
FCU tendon heads
cubital tunnel
intermscular fibrous bands above elbow
10
Q
in upper limb trauma get at least __ views on xray
A
2
11
Q
where >2 views are needed in upper limb trauma = (2)
A
C1-2 = AP, lateral and odontoid peg (teeth parted) Scaphoid = AP, lateral and 2 obliques
12
Q
appearance of haematoma in # on xray =
A
lucency crossing bone
13
Q
avulsion fractures mechanism =
A
tendons pull bone off
14
Q
appearance of avulsion fractures on xray
mimic =__+__+__ = all ___
A
incompletely corticated fragment sesamoid bones accessory ossification centres old non-united #s all completely corticated
15
Q
normal alignment of acromioclavicular joint on imaging
A
inferior border of clavicle has a straight line to inferior border acromium
16
Q
alignment of humero-capitellar joint on imaging
used to spot __
A
anterior border of humerus should go through middle of capitellum
supracondylar #
17
Q
in lateral wrist ___ should look like a cup
A
lunate
18
Q
if there is an elbow effusion a displaced ___ can be seen posterior to ____ = ___ sign
is always abnormal if present
A
fat pad
distal humerus
posterior fat pad
19
Q
in children: fracture that causes usually smoothly curved metaphyses to be bumpy on imaging =
A
buckle
20
Q
3 types of # seen in kids
A
buckle
plastic bowing
greenstick
21
Q
Little leaguers elbow =
A
medial epicondyle of humerus avulsed due to flexor tendons
22
Q
bony rings where you would expect to fin >1 fracture
A
spinal canal
pelvis
forearm
lower leg
23
Q
extra articular fracture of the distal radius with dorsal angulation and impaction =
mechanism of injury =
A
Colles #
FOOSH
24
Q
50% of Colles # also have a ___ #
A
ulnar styloid
25
hand is displaced ___ in a Colles #
backwards
26
pain in anatomical snuff box after FOOSH =
scaphoid #
27
best view on imaging for posterior shoulder dislocation =
oblique view
28
involving articular surface of 1st MC base - tendons pull thumb distal to # = displacement =
Bennett's #
29
age commonly affected by supraspinatus tendonitis
35-65 yo
30
age typically affected by frozen shoulder
| more common in ___
40-60yo
| diabetics
31
if shoulder pain can be localised with one finger it is ___ and is likely to be ___ pathology
superficial
| ACJ OA/pathology
32
if shoulder pain is generalised it is likely to be from ___ structures eg __/__
deeper
subacromial
GHJ
33
Scarf test puts P on
ACJ
34
Hawkins is for __ pain - impingement as rotate ___ upwrds
subacromial
| greater tuberosity
35
sternoclavicular joint arthritis is ___
| Rx =
rare
| physio, injection (rarely excision)
36
ACJ arthritis is __ and often overlaps with ___
| Rx =
common
impingement
injection / excision
37
causes of GHJ arthitis
idiopathic (most common)
previous Sx
instability
cuff tear
38
distinctive candle drip osteophyte of ___ =
humerus
| GHJ OA
39
OA of GHJ causes decrease of ROM esp __
external rotation
40
if rotator cuff is torn ___ pulls humeral head __
deltoid
| superiorly
41
new Rx for cuff tear
reverse geometry replacement
42
fossa olecrani is a feature of
elbow OA
43
if elbow replaced wt limit is
5kg / 1kg repeatedly
44
Sx options for RA
synovectomy
tendon realign
replace
fuse
45
SLAC =
scapholunate advanced collapse (=> wrist instability)
46
SNAC
scaphoid non-union advanced collapse
47
total wrist arthrodesis stops __ movement but preserves ___
flexion/extension
| sup+pronation
48
base of thumb OA is usually the __ joint affected in OA => ___ subluxation and pain esp in __
2nd
CMCJ
pinch
49
volar plate of PIPJ becomes attenuated, small ligs and lumbrical tendons move dorsally =
swan neck deformity
50
PIPJ flexion and DIPJ hyperextension = ___ deformity
Boutonniere
51
outpouching of synovial fluid from DIPJ OA
mucous cyst
52
Rx of mucous cyst
usually leave alone
| rarely = Sx
53
possible complications of mucous cyst
pain
fluctuate/ discharge
deform nail = a ridge
54
outpouchings of synovial cavity, filled with synovial fluid, fluctuate, usually painless/"tight" and resolve with time
affect the hand
ganglion cyst
55
in trigger finger tendon swells and catches on __ pulley so there is pain over the ___ and finger is stuck in ___
A1
MC head
flexion
56
Rx for trigger finger
spontaneous resolution >
splint >
steroid and LA injection (can repeat up to 3x - usually curative)
Sx to divide A1 pulley
57
spontaneous, very painful, swollen and red
| +ve Finklesteins test - thumb in fist and ulnar deviate => v painful =
Dequervains tenosynovitis
58
Rx for Dequervains tenosynovitis =
NSAIDs, splint, rest, steroid injection, decompression Sx
59
thickening and contracture of subdermal fascia => fixed flexion =
Dupuytrens contracture
60
high incidence of Dupuytrens contracture in which population
N Europeans
61
dupuytrens contracture usually starts as __/___ and starts ___+__
palmar pit/nodule
| painless and gradual
62
Dupuytrens diathesis is ass with __+__
Lederhosen's
| Peyronies
63
risk factors for development of Dupuytrens contractures
```
northern european
DM
alcohol/cirrhosis
smoking
epilepsy
trauma
knuckle pads; Ledderhose; Peyronie’s; frozen shoulder
```
64
Dupuytrens affecting __ joint is likely to do well
| ___ is unlikely to ever fully flex as capsule thickens
MCPJ = good
| PIPJ
65
Rx for Dupuytrens contracture
```
activity modification >
fasciectomy
dermofasciectomy
collagenase injection (stretch next day and itll snap easily)
percutaneous needle fasciotomy
```
66
paronychia =
nail fold infection
67
Rx of paronychia
elevate
abx
incise and drain
68
```
flexor tendon sheath infection:
occurence rate?
is a Sx _____
can____ the palm and arm
very ___
limited passive and active ___
may cause _____
```
```
rare
Sx emergency
track up
painful
extension
tracking lymphangitis
```
69
Rx for flexor tendon sheath infection
incision above and below and wash out sheath
70
If pressure from a subungual haematoma is causing pain then Rx =
trephine (bore a hole in nail)
71
if the tip of the finger/ nail has been severed Rx =
dressing
72
if the finger has been severed halfway through the length of the nail Rx =
repair nail bed and stabilise bone
73
if there is less than 5mm of nail bed left after finger has been severed then Rx =
ablate
74
If MCPJ needs immobilised then do in ___ because this is when the capsule is ___ so don't lose ROM
flexion
| tight
75
If PIPJ needs immobilised then do in ___ because this is when the capsule is ___ so don't lose ROM
extension
| tight
76
is easier to see rotational of the fingers if you ask the ptnt to ___
flex them
77
Boxer's # =
fracture of one of the MC in the hand usually after a drunken swipe
minimally displaced and no rotation
78
Rx for Boxer's (MC) #
buddy strap and mobilise early
79
Mallet finger is caused by
extensor digitorum tendon of the fingers becoming unattached or having an avulsion fracture that causes the DIPJ to become flexed permanently
80
s+s of Mallet finger
can't extend DIPJ
| tender and bruised
81
Rx of mallet finger
splint 24/7 for 6 wks
fix if large avulsion #
is chronic/ present late = dermatotenodesis
82
Rx of early and late presentation of PIPJ dislocation
```
early = pull to reduce and buddy strap
late = fusion
```
83
Bennett's # causes the fragment of thumb base attached to hand lig.s to ___ and the rest ___
stay in place
| displaces
84
can tell if someone has a tendon injury if when they lie their hand volarly ___
fingers dont naturally flex
85
tendons present at the distal 1/3 of fingers =
FDP
86
tendons present in the proximal 2/3 of fingers and tip of distal palm
fds + fdp in same sheath
87
in the middle of the palm the tendons are/ arent in a sheath
arent
88
at the base of the palm lies the ____ ligament
transvere carpal
89
to test FDP tendon =
hold just below DIPJ straight and flex DIPJ
90
to test FDS
hold other fingers and ask ptnt to flex PIPJ - it acts independently whereas FDP work together
91
Rx of tendon injuries of the hand =
Sx repair
| mobilise early so no stiffness
92
eschar =
thick leathery inelastic skin post burn
93
mutilating injuries of the hand = ___ early and leave ____ for ___wks to decrease infection risk
debribe
| uncovered 2-3wks
94
chronic tendon injury with damage to tendon ECM =
tendonosis
95
predominant cells in tendon =
| 90% is __
fibroblasts
| type 1 collagen
96
arrangement of fibres in a tendon =
| ___>__>___> fascicle
microfibrils
subfibrils
fibrils
fascicle
97
fascicles in tendons are separated by ___ and covered by ___
separated by endotenon
| covered in epitenon
98
blood supply to tendons = _+_+_
perimyseum
periosteal tendon insertion
paratenon
99
histological degeneration of collagen and ECM =
tendonosis
100
tendonosis is caused by increased ___ most likely
| these increse with __+__
MMPs
| age and repetitive strain
101
tendonosis can be __ and usually occur where there is a ___
painless
| poor blood supply
102
most tendon injuries settle with _+_+_
rest, analgesia and anti-inflammatories
103
cortisone/anaesthetic can be used in _+_ tendon problems but NOT __ or ____
rotator cuff and tennis/golfer's elbow = fine
| NOT achilles or extensor knee mechanism
104
Rx for achilles tear =
splint/cast
105
__+___ tendon problems can be treated with decompression
supraspinatus tendonitis
| subacromial tendonitis
106
synovectomy is used to prevent rupture in ___+__
RA of extensor wrist tendons and tibialis posterior
107
tendon transfer can be used to treat __+__ tendons
tibialis posterior and extensor pollicis longus
108
most common rotator cuff muscle to be injured =
supraspinatus
109
s+s for rotator cuff tear
```
achy pain down arm that gradually increases
difficulty sleeping on affected side
+ve impingement signs
hard to reach overhead+lift
painful arc/weakness
```
110
Rx for rotator cuff tear
```
conservative = rest physio and injections
Sx = repair and subacromial decompression
```
111
gold standard test for rotator cuff tear =
| ___ scan can also detect ___
US - dynamic scan can also detect impingement
112
biceps tendinopathy tends to occur where ___ passes through ___ on ____
long head
bicipital groove
anterior humerus
113
s+s of biceps tendinopathy
anterior shoulder pain
elbow pain that is worse on shoulder flexion, forearm pronation and elxbow flexion
click/snaps with shoulder movement if subluxed
114
scan for biceps tendinopathy =
US
115
popeye sign + extensive bruising =
biceps tendon rupture
116
Rx for biceps tendinopathy
conservative
| Sx (high risk of neurovasc complications)
117
s+s of leteral epiconylitis (Tennis)
pain and tender and lat epicondyle greater when muscles stretched
pain with resisted extension of middle finger
Mills test +ve
118
Mills test for lateral epicondylitis =
palpate ptnt’s lateral epicondyle with thumb while passively pronating forearm, flexing wrist and extending elbow
+ve test = reproduction of pain near the lateral epicondyle
119
lateral epicondylitis is non ___
non-inflammatory
120
avoid injections for medial epicondylitis (Golfers) because ___
is near the path of the ulnar nerve
121
s+s of medial epicondylitis (Golfers)
pain greater on wrist flexion and pronation, also greater on grasping
some ass with ulnar neuropathy
122
Rx of medial and lateral epicondylitis
usually conservative
| Sx release is last resort
123
```
DeQuervains Tenosynovitis affects ___ containing __+___
pain over ____
F:M
age
ass with __+__
```
```
1st extensor compartment
APL and EPB
radial styloid process
F>M
30-50yo
preg and RA
```
124
test for DeQuervains Tenosynovitis
Finklesteins test - thumb in fist and ulnar deviate hand => pain
125
__+__ DeQuervains Tenosynovitis to rull out CMC OA
US xray
126
Rx for DeQuervains Tenosynovitis
splint rest physio
analgesia
injections
Sx decompress
127
s+s of hand extensor mechanism rupture =
weak wrist extension and dropped finger
128
hand extensor mechanism rupture Rx =
tendon transfer
129
EPL rupture is ass with __+__
RA
| post colles #
130
hand extensor mechanism rupture is ass with __ which causes an AI attack on __ and leads to tendon __
RA
synovium
transfer
131
Rx of EPL rupture that is causing loss of function
tendon transfer
132
___ can prevent RA causing a hand extensor mechanism rupture
synovectomy
133
development of trigger finger:
| stenosing ___ > ____ metaplasia >nodule ____ > catches on ____ > triggering
tenosynovitis
fibrocartilaginous
FDS tendon
A1 pulley
