Upper Limb

Question 1

Specific tests for the hand

Answer 1

Watson scaphoid shift test
Finkelstein test
Phalen's test
Ice cream scoop test (FUSS)
Elson test
Triquetrum-lunate compression test

Question 2

Fracture distal phalanx

Answer 2

Benign

• tuft fracture
• shaft distal to tendon insertions
• mallet with no joint dislocation

Malignant

• Jersey fracture (avulsion FDP)
• fractures with >50% massive haematoma
• large bony mallet with fracture dislocation (long extensor)

Question 3

Displaced fracture of middle phalanx

Answer 3

ALWAYS MALIGNANT

warn of complications with operative or non-operative treatment

Question 4

Proximal phalangeal shaft fracture

Answer 4

Usually malignant

Accept angulation of 30-60d for 5th, 20-40 for ring
ZERO tolerance for rotation 1 degree in metacarpal -> produced 5 degrees in digit

Complications - malunion; rotation and angulation, lump in palm, pseudoclawing, loss of motion

Rx
splinting or operative

Question 5

Head fractures classification

Answer 5

Type 1 - stable with no displacement
Type 2 - unstable unicondylar
Type 3 - unstable bicondylar or comminuted

Question 6

Seymour fracture

Answer 6

Distal phalanx fracture
epiphyseal injury
due to hyperflexion
Mallet deformity (i.e. apex dorsal
FDP

Question 7

Stabilisers of the Elbow

Answer 7

Primary - ulnohumeral joint, anterior MCL, LCL
Secondary - radiohumeral joint, capsule, origin of flexor and extensor tendons
Dynamic - anconeus, brachialis, triceps

Question 8

Simple elbow dislocation

Answer 8

No associated fracture
50-60% of elbow dislocations
universal disruption of LCL and MCL partially or completely torn
Bony congruence

Question 9

Complex fracture elbow dislocation

Answer 9

Transolecranon fracture dislocation
TERRIBLE TRIAD = LCL tear, radial head fracture, coronoid tip fracture
Posterior monteggia

Question 10

Elbow dislocation

Answer 10

Pain and swelling
Physical examination

Radiograph - AP, lateral, oblique views
CT

Closed reduction + splinting [acute stable]
Open reduction, capsular release [chronic dislocation
ORIF [acute complex]

Question 11

Golfer’s elbow

Answer 11

Repetitive strain injury (RSI)
Elbow only affected
NO numbness, tingling, paraesthesia
Pain medial epicondyle +/- below elbow joint anteriorly with possible referral to wrist

Question 12

Cubital tunnel syndrome

Answer 12

RSI
Elbow, ring and little finger affected
Numbness, paraesthesia nad tingling on ring and little finger
Pain on elbow and fingers

Question 13

Supracondylar fracture

Answer 13

Common in children after a fall onto outstretched hand with elbow in extension

Question 14

Lateral condylar fracture

Answer 14

Separation of growth plate in 4-10yos

Lateral elbow pain, swelling, dysfunction

Question 15

Radial head and neck fractures

Answer 15

Radial head => adults
Radial neck => children

Fall on outstretched arm, elbow in valgus

Question 16

Shoulder joint stabilising factors

Answer 16

Adhesive forces fluid friction
glenohumeral suction cupping
negative IAP
ligaments
superior stabilisers - glenoid lip, superior cuff 
Dynamic stabilisers - rotators cuff

Question 17

TUBS

Answer 17

Traumatic anterior shoulder dislocation - 96%

Traumatic, unidirectional, Bankart, Surgery

Question 18

AMBRII

Answer 18

Atraumatic Shoulder Instability - 4%
Atraumatic, bilateral findings, rehabilitation, interval capsule-coracohumeral ligament mechanism repair, inferior capsule tightening

Question 19

Shoulder dislocation

Answer 19

<40 instability

grey hair = cuff tears

Question 20

Shoulder posterior dislocation

Answer 20

79% missed

major violence e.g. epilepsy

Question 21

Non-mechanical pain in the shoulder

Answer 21

Cancer
infection
calcific supraspinatus tendonitis
adhesive capsulitis
inflammatory arthroplasty

Question 22

Non-mechanical pain in the shoulder

Answer 22

Cancer
infection
calcific supraspinatus tendonitis
adhesive capsulitis
inflammatory arthroplasty