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Upper limb disease Flashcards

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1
Q

How is peripheral nerve compression different to cervical nerve root compression?

A

Does not cause dermatomal or myotomal changes, instead affects peripheral nerve and motor locations.

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2
Q

What forms the carpal tunnel of the wrist?

A

The carpal bones and the flexor retinaculum

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3
Q

What nerve passes through the carpal tunnel?

A

The medial nerve

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4
Q

What causes carpal tunnel syndrome?

A

Mostly idiopathic

BUT RA and conditions which cause fluid retention also cause

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5
Q

What is the presenting complaint in carpal tunnel syndrome?

A

Parasthesia in thumb and radial 2 1/2 fingers
worse at night
sometimes weakness of thumb

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6
Q

What can be seen on examination of the hand with carpal tunnel syndrome?

A

Loss of sensation or muscle wastage of thenar eminence

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7
Q

What is Tinel’s test?

A

Percussing over median nerve over the wrist and the transverse ligament, across the thumb

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8
Q

What is a positive Tinel’s test?

A

Pins and needles felt

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9
Q

What is Phalen’s test?

A

Hands together with dorsal surfaces touching for 30-60 seconds

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10
Q

What is a positive Phalen’s test?

A

Tingling in thumb, middle and half of ring finger.

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11
Q

What non-operative methods can be used to treat carpal tunnel syndrome?

A

Wrist splints at night

Steroid injection

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12
Q

What does the surgical treatment of carpal tunnel syndrome involve?

A

Division of the transverse carpal ligament under local anaesthetic.

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13
Q

What causes cubital tunnel syndrome?

A

Compression of the ulnar nerve at the elbow behind the medial epicondyle

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14
Q

How does cubital tunnel syndrome present?

A

Parasthesia in ulnar fingers.

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15
Q

On examination, what is expected in carpal tunnel syndrome?

A

Positive Tinel’s test

Positive Froment’s test (paper between fingers)

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16
Q

What bones make up the elbow joint?

A

Humerus
Radius
Ulna

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17
Q

What muscle causes elbow extension and where does it insert?

A

Triceps muscle

Olecranon process of the ulna

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18
Q

What muscle causes elbow flexion and where does it insert?

A

Biceps brachii

Bicipital tuberosity of the radius

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19
Q

Which is more common in the elbow:

RA or OA?

A

RA

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20
Q

What is lateral epicondylitis also called?

A

Tennis elbow

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21
Q

What is lateral epicondylitis?

A

Repetitive strain injury which results in micro-tears in the common extensor origin

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22
Q

How does lateral epicondylitis present?

A

Painful and tender lateral epicondyle and pain on resisted middle finger extension

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23
Q

What is the treatment for lateral epicondylitis?

A

Rest from exacerbating activities, NSAIDs and steroid injections.
Sometimes an elbow clasp brace

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24
Q

What is golfer’s elbow?

A

Medial epicondylitis

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25
Why are steroid injections not used in golfers elbow as treatment?
Risk of injury to the ulnar nerve
26
When does OA occur of the elbow?
Most commonly after trauma
27
What surgical options are there with RA/OA of the elbow?
Surgical excision of the radial head | TER which restricts lifting severely
28
What is Dupuytren's contracture?
Hyperplasia of palmar fascia
29
What is the pathology behind Duputryen's contracture?
``` Proliferation of myofibroblast cells Type III (abnormal) collagen production ```
30
What fingers are most commonly affected by Duputryen's contracture?
Ring and little | Half of cases are bilateral
31
Who tends to get Duputryen's contracture?
Men Alcohol cirrhosis Diabetes
32
What surgical procedures are indicated for Duputryen's contracture?
Fasciectomy- removal of all diseased tissue | Fasciotomy- division of cords
33
What is trigger finger?
Tendonitis of a flexor tendon
34
How does trigger finger present?
Painful, clicking sensation of the finger which does not release on extension.
35
What is the treatment of trigger finger?
Steroid injection
36
What is the pulley called in trigger finger?
A1 pulley.
37
What are nodes at the DIPs of OA called?
Heberdens nodes
38
What are the nodes at the PIPs of OA called?
Bouchard's nodes
39
What is swan necking?
PIP goes down
40
What is Boutonniere?
DIP is stuck straight
41
What are ganglion cysts?
Mucous filled cysts adjacent to a tendon or synovial joint
42
What is a ganglion cyst called if found in popliteal fossa?
Baker's cyst
43
Where are ganglions cysts most commonly found?
DIP | wrist
44
What do ganglions cysts look like?
Firm, smooth, rubbery and transilluminates
45
What benign tumours can also be found on the palmar surface of the hand?
Giant cell tumours
46
Why do giant cell tumours look brown?
They contain haemosiderin
47
What is the humero-ulnar joint responsible for?
Flexion and extension
48
What is the radiocapitellar joint responsible for?
Supination and pronation
49
What muscle is Froment's test testing?
Adductor pollicis
50
True or False. | Pain and swelling at the sternoclavicular joint is more common that at the acromioclavicular joint
False. | Acromioclavicular joint disease is more common
51
Glenohumeral OA presents with what signs?
Crepitus | Loss of external rotation
52
True or False. | Shoulder joint replacements have a better long term outcome than THR
False at 10 years
53
What are the two joints of the elbow called?
Humeroulnar | Humeroradial
54
What restrictions exist with elbow replacements?
Limited to 5kg load lifting
55
What is Phalen's test?
Test for carpal tunnel syndrome. Flexion of wrist for 1 minute. Positive test is tingling.
56
What is the average speed of nerve transmission?
30m/s
57
What is tendinopathy?
Disease of a tendon
58
What is tendonitis?
Tendon injuries with inflammation
59
What is tendonosis?
Chronic tendon injury with damage to a tendon at cellular level
60
What is tenosynovitis?
Inflammation of the tendon sheath
61
What is enthesopathy?
Inflammation of the tendon origin or the insertion into bone
62
Where does de Quervain's tenosynovitis affect?
Extensor pollicis brevis abductor poliicis longus at thenar aspect
63
Embryologically, where do tendons originate?
Lateral plate of the mesoderm
64
What do tendons do?
Joins muscle to bone
65
In which conditions are steroid injections indicated?
Rotator cuff | Tennis elbow
66
When are splints indicated?
Achilles tendonitis
67
What are the clinical findings of a rotator cuff pathology?
Achy pain with shoulder tenderness Difficulty sleeping on affected side or reaching overhead Painful arc 60-120
68
How is a rotator cuff injury treated?
Conservative management with arthroscopic suturing as a last resort
69
Which method of imaging is gold standard for a rotator cuff injury?
USS
70
Which part of the biceps is affected in biceps tendinopathy?
Long head of biceps which inserts into labrum/glenoid
71
What causes biceps tendinopathy?
Overuse, instability, impingement or trauma
72
Where does pain radiate to in biceps tendinopathy?
Anterior shoulder to elbow
73
What is the classic sign on examination of a biceps tendon rupture?
Popeye sign with extensive bruising
74
What is medial epicondylitis also known as?
Golfer's elbow
75
What makes the pain of medial epicondylitis worse?
Wrist flexion and pronation, | Also worse on grasping e.g. opening jars
76
What is the management of medial epicondylitis?
Rest and modification of activities | Physio
77
In what condition is Mill's test useful?
Lateral epicondylitis
78
What is lateral epicondylitis known as?
Tennis elbow
79
Who is most likely to get De Quervain's tenosynovitis?
Women aged 30-50 | Pregnancy
80
What makes up the extensor mechanism of the knee?
Quadriceps muscle Quadriceps tendon Patella Patella tendon
81
What makes extensor knee problems more likely?
Trauma Steroids or abx DM
82
What can be found on examination if there is an extensor knee problem?
Palpable gap | No straight leg raise
83
What is the treatment for extensor knee problems?
Surgical repair
84
What can be found on examination in achilles tendon?
Palpable gap posteriorly Unable to tiptoe stand ecchymosis
85
What test can be done for Achilles tendon?
Simmonds test. | Squeezing calf should cause plantarflexion of the ankle
86
In which patients is Achilles tendon more common in?
RA Steroid users patients with existing tendonitis
87
What are the two options for management of Achilles tendon?
Plaster | Surgical repair

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