Upper Limb Pathologies Flashcards
1
Q
What is adhesive capsulitis?
A
Pain and loss of motion in the shoulder (frozen shoulder)
2
Q
Give 3 conditions which are associated with adhesive capsulitis
A
Diabetes, thyroid disorders, previous surgery to lung and breast
3
Q
Describe the 3 phases of adhesive capsulitis
A
Phase 1- painful, gradual onset (6 weeks-9 months)
Phase 2- stiff, extreme decrease in ROM (4-9 months)
Phase 3- thawing, gradual return of motion (5 to 26 months)
4
Q
How would adhesive capsulitis be managed non-surgically?
A
NSAIDs, physiotherapy, steroid injections
5
Q
How would adhesive capsulitis be managed surgically?
A
Manipulation under anaesthesia
6
Q
Give 3 potential complications of adhesive capsulitis
A
Axillary nerve injury, rotator cuff tendon disruption, recurrent stiffness, fracture or dislocation
7
Q
What type of shoulder dislocation is the most common?
A
Anterior dislocation
8
Q
How will an anterior shoulder dislocation present?
A
Arm externally rotated and shoulder flattened. May see a bulge anteriorly
9
Q
What x-ray views are required for an anterior shoulder dislocation?
A
AP and Y view
10
Q
How is an anterior shoulder dislocation treated?
A
Closed reduction alongside period of immobilisation
11
Q
Give 5 complications of an anterior shoulder dislocation
A
Shoulder instability Hill-Sachs lesion Bankart lesion Damage to brachial plexus Damage to axillary artery
12
Q
What is a Hill-Sachs lesion?
A
Posterolateral humeral head compression fracture
13
Q
What is a Bankart lesion?
A
Detachment of the anterior inferior labrum from the glenoid
14
Q
What mechanism may cause a posterior shoulder dislocation?
A
Humeral head forced posteriorly in internal rotation as the arm is abduction. Seen in electrocution and convulsive disorders.
15
Q
What will be seen on an xray of a posterior shoulder dislocation?
A
Absence of external rotation
Light Bulb sign (internally rotated humeral head is rounded)
Trough line sign
Loss of half moon overlap sign
Rim sign (widened glenohumeral joint >6mm)
16
Q
Give 3 other injuries associated with a posterior shoulder dislocation
A
Reverse Bankart lesion
Reverse Hill-Sachs lesion
Proximal humerus fractures
17
Q
How is a posterior shoulder dislocation managed?
A
Normally self-reduce, if needed can use closed reduction
18
Q
How will an inferior shoulder dislocation present?
A
Arm will be in fixed abduction
19
Q
What score is used to assess hypermobility? What is the score out of?
A
Beighton score- score out of 9
20
Q
Describe what is involved in the Beighton score
A
Touch toes from forward flexion Thumb to anterior forearm x2 Little finger to posterior forearm x2 Invert elbows x2 Bend knee backwards x2
21
Q
Give 3 common ways the brachial plexus can be injured
A
Trauma
Obstetrics
Burners and stingers (sports injury)
22
Q
What nerve roots are affected in Erb’s palsy?
A
C5,C6
23
Q
How will an Erb’s palsy present? What is the arm position known as?
A
Clinically the arm will be adducted and internally rotated at the shoulder, pronated and extended at the elbow
Waiter’s Tip position
24
Q
What muscles will be weakened in a C5 injury?
A
Deltoid, Teres Minor, Supraspinatus, Infraspinatus, Biceps brachii
25
What muscles will be weakened in a C6 injury?
Brachioradialis, Supinator
26
What nerve roots are affected in Klumpke palsy?
C8,T1
27
How will a patient with Klumpke palsy present?
Weakness of the intrinsic muscles of the hand --> claw hand
| wrist in extreme extension, hyperextension in the MCP joints, IP joints flexed
28
Where do most clavicle fractures occur?
Medial 1/3rd
29
Why are clavicle fractures always displaced?
SCM muscle pulls medial fragment posterosuperiorly
| Pectoralis and gravity pull lateral segment inferomedially
30
When is a clavicle fracture operated on?
When the fracture is displaced
31
What surgical options are available for a clavicle fracture?
Open reduction and internal fixation
| Closed reduction and intramedullary fixation
32
What is a flail chest?
3 or more rib fractures
33
What other injuries with a flail chest often present with?
Scapula fracture
Clavicle fracture
Pneumothorax
Haemothorax
34
What are the signs of a flail chest?
Paradoxical respiration
Chest wall deformity
Soft tissue crepitus
35
Why are scapula fractures only associated with high energy trauma?
Thick, sturdy bone
| Surrounded by muscle and soft tissue on both sides
36
What is a SIT rotator cuff tear?
Tear of the supraspinatus, infraspinatus and teres minor muscles
37
When do SIT rotator cuff tears occur?
After a shoulder dislocation in elderly patients
38
When do subscapularis tears occur?
```
Acute avulsion in younger patients
Iatrogenic injury (failure of surgical repair)
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39
What are 3 risk factors for rotator cuff tears?
Older age, smoking, hypercholesterolaemia, family history, overhead throwing athlete
40
What are the common symptoms of a rotator cuff tear?
Pain in deltoid, night pain, pain worse when lifting arm overhead, loss of active ROM
41
What are the 2 blood vessels which supply the humeral head?
Ascending branch of humeral circumflex artery --> arcuate artery
Posterior humeral circumflex artery
42
Give 6 potential causes of avascular necrosis of the shoulder
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ASEPTIC
Alcohol/AIDS
Steroids/SLE/Sickle cell
Erlenmeyer flask
Pancreatitis
Trauma
Idiopathic/Infection
Caisson (the bends)
```
43
What classification system is used for avascular necrosis of the shoulder?
Cruess classification
44
What are the symptoms of avascular necrosis of the shoulder?
Pain, loss of motion, crepitus, weakness of rotator cuff and deltoid muscles
45
When is a hemi-arthroplasty needed in avascular necrosis of the shoulder?
Stage III and IV
Subchondral fracture
Flattening and collapse of the humeral head
46
When is a total shoulder replacement needed in avascular necrosis of the shoulder?
Stage V
| Degenerative changes extend into the glenoid
47
What is a shoulder hemi-arthroplasty?
Humeral articular surface is replaced with a stemmed humeral component and a new humeral head
48
When is a shoulder hemi-arthroplasty contraindicated?
Infection
Neuropathic joint
Unmotivated patient
Coracoacromial ligament deficiency
49
What is a total shoulder arthroplasty?
Replacement of the humeral head and glenoid resurfacing.
50
What are the symptoms of a winged scapula?
Shoulder and scapula pain, weakness in overhead lifting, discomfort when sitting in a chair
51
What is the cause of medial winged scapula?
Damage to long-thoracic nerve (C5,6,7)
| Can be caused by anaesthesia complications, repetitive stretch injury, compression injury, scapula fracture.
52
How will a medial winged scapula present?
Superior medial scapula elevates and moves medially. There is wasting of the anterior scalene triangle
53
What is the cause of lateral winged scapula?
Damage to cranial nerve 11 affecting trapezius muscle. It is often caused iatrogenically from general surgery or neurosurgery
54
How will a lateral winged scapula present?
Superior medial scapula drops downwards and lateral. Shoulder girdle appears to droop. There will be anterior scalene atrophy.
55
How are proximal humeral fractures classified?
Neer classification
| Based on the anatomical relationship of the fragments
56
What are the symptoms of a proximal humeral fracture?
Pain, swelling, decreased range of motion
57
How may a proximal humeral fracture present?
Extensive ecchymosis on chest and arm, loss of sensation in regimental badge area, lack of brachial and radial pulses
58
Give 5 complications of a proximal humeral fracture
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Avascular necrosis
Nerve injury
Malunion
Nonunion
Rotator cuff injury
Adhesive capsulitis
Infection
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59
What is a Holstein-Lewis fracture?
Spiral fracture of the distal 1/3rd of the humeral shaft commonly associated with damage to the radial nerve.
60
How may a humeral shaft fracture present?
Limb shortened and in varus, may be some neurovascular deficit
61
What is the main treatment of humeral shaft fractures?
Coaptation splint with functional brace
62
Which nerve is most at risk in a humeral shaft fracture?
Radial nerve
63
What is a sail sign when seen on a distal humerus fracture x-ray?
Soft tissue swelling around the fracture
64
What are the symptoms of a distal humerus fracture?
Elbow pain, elbow swelling, numbness in arm, lack of pulses
65
What nerve is most at risk in a distal humerus fracture?
Ulnar nerve
66
What is CRITOL used for and what does it stand for?
```
CRITOL is used for telling a child's age from the areas of growth on an x-ray of the elbow
Capitulum at 1 year
Radius (head of) at 3 years
Internal (medial) epicondyle at 5 years
Trochlea at 7 years
Olecranon at 9 years
Lateral epicondyle at 11 years
```
67
In which direction are most elbows dislocated?
Posterolaterally
68
Give 3 complications of an elbow dislocation
Early stiffness
Neurovascular injuries
Compartment syndrome
Recurrent instability
69
How is a dislocated elbow managed nonoperatively?
Closed reduction and splinting
70
How is a dislocated elbow managed operatively?
ORIF
| Capsular release
71
What is lateral epicondylitis?
Tennis Elbow
| Overuse of the common extensor tendon which leads to tendonitis and inflammation
72
What are the symptoms of lateral epicondylitis?
Pain with resisted wrist extension, pain on gripping, decreased grip strength
73
What is the 1st line treatment of tennis elbow?
Rest, activity modification, NSAIDs, physiotherapy
74
Which nerve is at risk in tennis elbow?
Radial nerve
75
What is medial epicondylitis?
Golfer's elbow
| Overuse of the flexor-pronator origin point. Rarer than tennis elbow.
76
What are the symptoms of golfer's elbow?
Pain over medial epicondyle, pain worse on forearm motion and gripping, may have tingling in ulnar digits
77
What is the first line treatment of golfer's elbow?
Rest, activity modification, bracing, NSAIDs, corticosteroid injections
78
Which nerve is at risk in Golfer's elbow?
Ulnar nerve
79
What is a Monteggia fracture?
Proximal 1/3rd ulnar fracture with associated radial head dislocation or instability
80
What are some symptoms of Monteggia fractures?
Pain and swelling at the elbow joint
Radial deviation of the hand
Weakness in the hand
81
What is a Galeazzi Fracture?
Distal 1/3rd radial shaft fracture and associated distal radioulnar joint injury.
82
Why do the radius and ulna commonly fracture together?
In close proximity
| Interosseous membrane attaches the two bones
83
What are the symptoms of a radial and ulna shaft fracture?
Gross deformity, pain, swelling, loss of forearm and hand function, pain on passive stretching of the fingers
84
What is a Colle's fracture?
Dorsally displaced, extra-articular radial fracture
85
What is a Smith's fracture?
Volar displaced, extra-articular radial fracture
86
How is a distal radial fracture managed if there is no radial shortening?
Closed reduction and cast immobilisation
87
How is a distal radial fracture managed if there is instability, displacement, severe osteoporosis or >5mm of radial shortening?
Closed reduction and percutaneous pinning
External fixation
ORIF
88
Give 3 common ways the radial nerve can be damaged
Use of crutches
Humeral fractures
Saturday night palsy- leaning on elbow for long time
89
Give 3 clinical features of a radial nerve palsy
Weakness of forearm extension and flexion
Wrist drop
Weakness of thumb adductor and extensor muscles
Sensory loss on the dorsum of the hand
90
Where are the most common site to injure the ulnar nerve?
Elbow and hand
91
What is an ulnar claw?
Hyperextension of MCP, flexion of DIP and PIP of ring and little finger. The hand is stuck in this position.
92
What is the ulnar paradox?
A lesion to the ulnar nerve above the wrist will result in a less pronounced clawing even though the damage is worse because the flexor digitorum profundus is paralysed and so the DIP joints cannot flex.
93
What is the hand of Benediction?
Result of a median nerve palsy which causes loss of flexion at the MCP and IP joints in the lateral 3 fingers. This is because the flexor digitorum superficialis and the flexor digitorum profundus lose their innervation. If the patient tries to make a fist, their 2nd and 3rd fingers will not move.
94
What are the causes of carpal tunnel syndrome?
```
MEDIAN TRAP
Myxoedema
Ethanol
Diabetes
Idiopathic
Acromegaly
Neoplasms
Trauma
Rheumatoid arthritis
Amyloidosis
Pregnancy
```
95
What are the symptoms of carpal tunnel syndrome?
Numbness and tingling in radial fingers
Clumsiness
Pain and paresthesia at night
96
What is Phalen's test?
Wrist volar flexion held for 1 minute will reproduce the symptoms
97
What is Tinel's test?
When the median nerve is tapped the symptoms start
98
What is Dupuytren's contracture?
Fibromatosis of the palmar fascia which leads to flexion deformities.
99
What is De Quervain's tenosynovitis?
Inflammation of the sheath which surrounds the tendons of the abductor pollicis longus and extensor pollicis longus.
100
What are the symptoms of De Quervain's tenosynovitis?
Pain on radial side of the hand, spasms, tenderness, swelling over the thumb, occasional burning sensation in the hand.
101
What is the major risk if someone has a scaphoid fracture and why is it a risk?
Avascular necrosis of the scaphoid. Blood supply is distally to proximally
102
What are some symptoms of a scaphoid fracture?
Pain, restricted pronation, scaphoid tubercle tenderness, pain in anatomical snuffbox
103
What is trigger finger?
Tenosynovitis caused by inflammation of the flexor tendon sheath. The inflammation causes the tendon to become stuck in the finger pulleys so the finger does not flex smoothly
104
How is trigger finger treated?
Nonoperatively --> night splinting, activity modification, NSAIDs, steroids
Operatively --> surgical debridement, release of pulley
105
What is a Boxer's fracture?
Fracture of the 5th metacarpal usually caused by a direct blow to the hand eg. punch
106
What is mallet finger? What is the main cause?
Finger deformity caused by disruption of the terminal extensor tendon distal to the DIP joint. It is often caused after a traumatic, sudden forced flexion of the tip of the finger in the extended position.
107
What is Raynaud's?
Exaggerated vasoconstriction of the arteries in the extremities. The fingers will go white, blue and then red and then become painful.
108
What is the difference between Raynaud's disease and syndrome?
Raynaud's disease is when there is no known cause and Raynaud's syndrome is when there is a known cause such as SLE, RA or scleroderma.
