Upper Limb

Question 1

What forms the shoulder girdle?

Answer 1

Scapula
Clavicle
Proximal humerus
Deltoid
Rotator cuff muscles

Question 2

What muscles in the rotator cuff attach to the greater tuberosity and are posterior?

Answer 2

Supraspinatus
Infraspinatus
Teres minor

Question 3

What rotator cuff muscle is anterior and attaches to the lesser tuberosity?

Answer 3

Subscapularis

Question 4

What rotator cuff muscle initiates abduction?

Answer 4

Supraspinatus

Question 5

What rotator cuff muscles are responsible for external rotation?

Answer 5

Infrapsinatus

Teres minor

Question 6

What rotator cuff muscle is responsible for internal rotation?

Answer 6

Subscapularis

Question 7

What occurs in impingement syndrome?

Answer 7

Tendons of supraspinatus are compressed in the subacromial space

Question 8

Give some causes of impingement syndrome

Answer 8

Tendonitis
AC osteoarthritis
Rotator cuff tear

Question 9

Give some clinical features of impingement syndrome

Answer 9

Painful arc
Painful deltoid
+ve Hawkins-Kennedy test

Question 10

How is impingement syndrome treated?

Answer 10

NSAIDs
Physiotherapy
Steroid injection
Subacromial decompression surgery

Question 11

What muscle is most commonly affected in rotator cuff tears?

Answer 11

Supraspinatus

Question 12

Give some causes of a rotator cuff tear

Answer 12

Sudden jerk injury

Tendon degeneration

Question 13

What is the main clinical feature of a rotator cuff tear?

Answer 13

Weakness in initiating abduction

Question 14

What occurs in adhesive capsulitis?

Answer 14

Progressive pain and stiffness of shoulder resolving after 18-24 months

Question 15

Give some causes for adhesive capsulitis

Answer 15

Triggering injury
Diabetes
High cholesterol
Dupuytren’s

Question 16

What is the main sign of adhesive capsulitis?

Answer 16

Loss of external rotation

Question 17

How is adhesive capsulitis treated?

Answer 17

Physiotherapy
Analgesia
Intra-articular injections

Question 18

Where is calcium deposited in acute calcific tendonitis?

Answer 18

Supraspinatus tendon

Question 19

How is acute calcific tendonitis treated?

Answer 19

Subacromial steroid injection

Question 20

How is shoulder instability commonly treated?

Answer 20

Bankart repair

Question 21

What occurs in carpal tunnel syndrome?

Answer 21

Swelling within the carpal tunnel compresses the median nerve

Question 22

Give some secondary causes of carpal tunnel syndrome

Answer 22

Rheumatoid arthritis
Pregnancy
Diabetes
Chronic renal failure
Hypothyroidism
Colles fracture

Question 23

What are the clinical features of carpal tunnel syndrome?

Answer 23

Paraesthesia in median nerve innervated fingers
Weakness of thumb
+ve Tinel’s/Phalen’s test

Question 24

How is carpal tunnel syndrome treated?

Answer 24

Non-surgical - wrist spint/steroid injection

Surgical - division of transverse carpal ligament

Question 25

What occurs in cubital tunnel syndrome?

Answer 25

Compression of ulnar nerve behind medial epicondyle

Question 26

What tight fascia is formed in cubital tunnel syndrome?

Answer 26

Osborne's fascia

Question 27

What fingers are affected by cubital tunnel syndrome?

Answer 27

Little finger | Medial 1/2 of ring finger

Question 28

What two joints does the elbow consist of?

Answer 28

Humero-ulnar | Radio-capitallar

Question 29

The elbow is flexed by the biceps brachii and the brachialis. True/false?

Answer 29

True

Question 30

What causes tennis elbow?

Answer 30

Repetitive strain injury to due repeated resisted wrist extension

Question 31

What is the main symptom of tennis elbow?

Answer 31

Pain on resisted middle finger/wrist extension

Question 32

Tennis elbow affects the medial/lateral epicondyle

Answer 32

Lateral

Question 33

How is tennis elbow treated?

Answer 33

Rest, physiotherapy, NSAIDs Steroid injection Brace

Question 34

What occurs in Dupuytren's contracture?

Answer 34

Hyperplasia of the palmar fascia forming nodules and cords causing MCP/PIP contractures

Question 35

There is proliferation of what cells and production of what type collagen in Dupuytren's?

Answer 35

Proliferation of myofibroblasts | Production of type III collagen

Question 36

What is Dupuytren's associated with?

Answer 36

Alcoholism | Diabetes

Question 37

What fingers are most commonly affected by Dupuytren's?

Answer 37

Ring | Little

Question 38

How is Dupuytren's treated?

Answer 38

Fasciectomy | Fasciotomy

Question 39

What occurs in trigger finger

Answer 39

Tendonitis of flexor tendon causes nodular enlargement over A1 pulley

Question 40

What are the symptoms of trigger finger?

Answer 40

Painful clicking sensation | Finger locked in flexion

Question 41

How is trigger finger treated?

Answer 41

Steroid injection | Surgical division of A1 pulley

Question 42

Swelling of DIPs in osteoarthritis is called what?

Answer 42

Hebreden's nodes

Question 43

Swelling of PIPs in osteoarthritis is called what?

Answer 43

Bouchard's nodes

Question 44

How is mild to moderate DIP osteoarthritis treated?

Answer 44

Removal of osteophytes/mucous cyst

Question 45

How is severe DIP osteoarthritis treated?

Answer 45

Arthrodesis

Question 46

Osteoarthritis of the PIP on the index finger is treated with what?

Answer 46

Arthrodesis

Question 47

Osteoarthritis of the PIPs on all fingers apart from index is treated with what?

Answer 47

Arthroplasty

Question 48

What occurs in rheumatoid arthritis?

Answer 48

Inflammation within joints and tendon sheath causes articular cartilage erosion leading to joint instability and tendon rupture

Question 49

What are the symptoms of rheumatoid arthritis?

Answer 49

Ulnar deviation Swan-neck deformity Boutonniere deformity Z-shaped tumb

Question 50

How is rheumatoid arthritis treated?

Answer 50

DMARDs Tenosynovectomy Soft tissue releases

Question 51

What occurs in a ganglion cyst?

Answer 51

Mucinous filled cysts form adjacent to a tendon/synovial joint

Question 52

How are ganglion cysts treated?

Answer 52

Needle aspiration | Surgical excision