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upper limb conditions Flashcards

1
Q

impingement syndrome

A

where tendons of rotator cuff are compressed in the tight subacromial space during movement producing pain

supraspinatus = commonest

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2
Q

impingement syndrome presentation

A

30-40s
painful arc
pain radiates to deltoid + upper arm
tenderness may be felt lateral edge of acromion

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3
Q

special test for rotator cuff impingement

A

arc

Hawkins-Kenedy test - internally rotating flexed shoulder

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4
Q

management of impingement

A

resolves in most cases
NSAIDs, physio
subacromial steroid injections - up to 3

surgery = subacromial decompression - create more space for tendon, open or arthroscopic

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5
Q

causes of rotator cuff tears

A

acute injury - FOOSH
degenerative changes
overhead activities - playing tennis, construction

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6
Q

rotator cuff tear presentation

A

acute or gradual
shoulder pain - disrupt sleep

weakness + pain with specific movement relating to side of tear
–> supraspinatus = abduction

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7
Q

rotator cuff tear investigation

A

US or MRI

x-ray for exclusion of bony pathology - OA

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8
Q

rotator cuff tear management

A

degenerative = conservative

active/young = surgery if physio fails
-> arthroscopic rotator cuff repair

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9
Q

adhesive capsulitis (frozen shoulder)

A

inflam + fibrosis in joint capsule leads to adhesions (scar tissue) - adhesions bind the capsule + cause it to tighten around the joint + restrict movement

primary - no trigger
secondary - trauma, surgery, immobilisation

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10
Q

risk factors for adhesive capsulitis

A

middle aged, diabetes, thyroid problems

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11
Q

test for acromioclavicular OA

A

scarf test

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12
Q

adhesive capsulitis (frozen shoulder) presentation

A

3 phases -

  1. painful - may be worse at night
  2. stiff - esp external rotation
  3. thawing - gradual improvement in stiffness -> normal

lasts 1-3yrs

  • 6ish months in each phase
  • 50% have persistent symptoms
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13
Q

diagnosis of adhesive capsulitis

A

CLINICAL

US, CT, MRI show thickened joint capsule
- x-ray to exclude OA

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14
Q

adhesive capsulitis management

A

conserv = NSAIDs, physio, intra-articular steroid injections, hydrodilation (injecting fluid to stretch capsule)

surgery (resistant/severe)

  • manipulation under anaesthesia - forcefully stretching capsule
  • arthroscopy - cut adhesions
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15
Q

most common type of shoulder dislocation

A

anterior (90%)

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16
Q

cause of anterior shoulder dislocations

A

arm forced backward whilst abducted + extended

fall with shoulder in external rotation

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17
Q

causes of posterior shoulder dislocation

A

seizures
electric shocks

fall in internal rotation, direct blow anteriorly

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18
Q

what else must be assessed for in shoulder dislocations?

A

fractures

vascular damage - pulses, cap refil, palor

nerve damage - loss of sensation in regimental patch area (axillary nerve

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19
Q

posterior shoulder dislocation on xray

A

hard to see

“light bulb” sign

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20
Q

complications of shoulder dislocations

A

Bankart lesions - tear to anterior part of labrum

fractured humeral head (Hill-Sachs lesion)

axillary nerve damage - anterior dislocation

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21
Q

how would you check for axillary nerve damage?

A

loss of sensation in “regimental badge” area

motor weakness in deltoid + teres minor muscles

(comes from C5 + C6)

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22
Q

shoulder dislocation investigations

A

apprehension (recurrent subluxs)

x-ray - not always before, always after to confirm reduction + check for fractures

magnetic resonance arthrography (MRI with contrast injected into shoulder joint)
-> Bankart + Hill-Sachs lesions

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23
Q

why is important to reduce dislocations ASAP

A

muscle spasms occur over time making it harder to relocate + increasing risk of neurovascular damage

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24
Q

ulnar nerve damage checks

A

sensation to pinkie + half ring finger on both sides of hand

ability to abduct all fingers

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25
radial nerve damage checks
sensation between thumb + index finger and DORSAL surface of hand ability to extend wrist
26
median nerve damage checks
sensation between thumb + index PALMAR surface ability to to bring thumb and pinkie together
27
what sport is associated with lateral epicondylitis?
tennis (elbow) the tendon that inserts to the lateral epicondyle acts to extend the writst
28
what sport is associated with medial epicondylitis?
Golfer's elbow tendon that inserts into medial epicondyle acts to flex the wrist
29
management of epicondylitis
``` analgesia, physio orthotics (elbow braces) steroid injections - avoid nerves platelet rich plasma (PRP) injections extracorpeal shockwave therapy ```
30
cubital tunnel syndrome pathophysio
compression of ulnar nerve behind medial epicondyle (funny bone area) -> can be due to tight band of fascia forming roof (Osbourne's fascia) or tightness at intermuscular septum
31
cubital tunnel syndrome presentation
parathesia in ulnar fingers = pinkie + half of ring finger
32
cubital tunnel syndrome investigations
Tinel's test over cubital tunnel Froment's test - paper between thumb + fist nerve conduction studies to confirm diagnosis
33
what 2 tendons are primarily affects in De Quervains tenosynovitis?
abductor pollicis longus (APL) extensor pollicis brevis (EPB) --> both act to abduct thumb + wrist
34
notable cause of de querbains tenosynovitis in babies
parents repetively lifting newborns in a way that stresses tendons of the thumb -> sometimes referred to as "mummy thumb"
35
de quervains tenosynovitis
swelling + inflammation of tendon sheaths in the wrist repetitive strain injury causes pain on radial side of wrist
36
de quervains tenosynovitis pathophysio
APL + EPB pass under the extensor retinaculum which wraps across the back of the wrist repetitive movement of APL + EPB under extensor retinaculum results in inflammation + swelling of tendon sheaths
37
de quervains tenosynovitis presentation
``` symptoms at radial aspect of the wrist - near base of thumb >pain - radiate forearm > aching, burning > weakness, numbness > tenderness ```
38
special tests for de quervains tenosynovitis
finklesteins = examiner flexes patients thumb into palms causing wrist to adduct (pos = pain) eichoff's = fist with thumb inside, wrist abducting
39
de quervains tenosynovitis management
rest, analgesia, physio splints steroid injections surgery (rarely) - cut extensor retinaculum
40
carpal tunnel syndrome risk factors
``` obesity menopause rheumatoid arthritis diabetes acromegaly hypothyroidism ```
41
what is the carpal tunnel made up of / what does it contain?
between carapal bones + flexor retinaculum contains = median nerve + flexor tendons of forearm
42
what motor function does the median nerve supply?
to 3 thenar muscles (bulge at base of thumb responsible for its movements) - abductor pollicis brevis - abduction - opponens pollicis - opposition (reaching across palm to touch fingertips) - flexor pollicis brevis - flexion - adduct pollicis - adduction (**innervated by ulnar**)
43
is palmar sensation of thumb, index + middle finger affected in carpal tunnel syndrome?
yes | palmar DIGITAL cutaneous branch of median nerve passes through tunnel
44
carpal tunnel syndrome presentation
gradual onset symptoms - initially intermittent - often worse at night - shake hand to relieve sensory (palmar thumb half) - numbness, paraesthesia - burning, pain motor (thenar, thumb movements) - weak thumb movements - weak grip strength - difficult with fine movements - wasting of thenar muscles
45
carpal tunnel syndrome special tests
phalens - flexing hands, putting backs of hands together tinel's - tapping over carpal tunnel positive = triggering of symptoms - numbness/paraesthesia
46
carpal tunnel syndrome management
- rest, altered activities - wrist splints that maintain a neutral position of the wrist that can be worn at night (min 4 weeks) - steroid injections - surgery - cut flexor retinaculum
47
which fingers are most commonly affected in trigger finger?
middle + ring finger
48
risk factor for trigger finger (stenosing tenosynovitis)
40s, 50s women diabetes
49
which pulley is most commonly affected in trigger finger?
first annular pulley (A1) at MCP joint
50
trigger finger (stenosing tenosynovitis) pathophysio
thickening of tendon or tightening of sheath that tendons pass through -> prevents tendon from smoothly runnign through - pain,stiffnes + catching symptoms nodule can get stuck at entrance to pulley - causing finger to lock/stuck in bent position --> may release with painful pop/click
51
trigger finger (stenosing tenosynovitis) presentation
movement of finger produces clicking sensation - may be painful finger may lock in position - patient may have to forcibly manipulate finger to regain extension (with PAIN)
52
trigger finger management
most resolve spontaneously - rest, analgesia splinting steroid injections surgery to release A1 pulley - division of A1 does not affect function
53
dupuytren's pathophysio
fascia of hand becomes thickened + tight leading to finger contractures (flexed, can't fully extend) proliferation of myofibroblasts + production of abnormal type 3 collagen contracture = shortening of soft tissue that leads to restricted movement
54
most common finger affected by dupuytren's
ring + pinkie
55
dupuytren's risk factors
``` age family history - autosomal dominant pattern male manual labour (vibrating tools) diabetes (esp type 1) epilepsy smoking + alcohol ``` high prevalence in scandinavian
56
dupuytren's managment
conservative surgery, needle fasciotomy, limited fasciectomy, dermofasciectomy recurrence in young severe (fingers in palm) = amputation
57
ganglion cyst pathophysio
thought to occur when the synovial membrane of tendon sheath or joint herniates forming a puch synovial fluid flows from the tendon sheath or joint into the pouch forming a cyst
58
ganglion cyst presentation
visible + palpable lump firm + non-tender on palpation skin mobile - fixed to underlying structures transilluminates (shing a torch into cyst causes it to light up)
59
ganglion cyst diagnosis
clinical US can help confirm + exclude other causes of lumps
60
ganglion cysts management
conservative - 40-50% resolve spontaneously (can take years) needle aspiration - not really done, recurrence in >50% surgical excision - open/endoscopic

MSK (14 decks)

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