Upper Limb Pathologies Flashcards
Where could pain in the right shoulder be referred from?
Gall bladder
Angina pectoris
Diaphragmatic irritation from biliary colic, subphrenic abscess
Suspect impingement syndrome, what examination special test would you do?
Jobes test where rotate outstreched hands from thumb side up to pinky side up, then push down above the elbow. Should reproduce the pain
What is the common muscle in the rotator cuff to be impinged?
Supraspinatous
What is the treatment for impingement syndrome?
NSAIDs, anaglesia, physio, subacromial steroid injection, if symptoms dont improve then surgery
40 year old painter presents with pain and weakness of his right arm. It has a non-specific ache and he cant sleep on his right side. He was standing on a bus holding a railing that suddenly stopped when he felt a pain, and its been bad ever since. On exam active movement is limited by passive ROM good when not inhibited by pain. What investigation would you send for? Likely diagnosis?
Rotator cuff tear
Ultrasound to see the rotator cuff muscles (supraspinatous, infraspinatous, teres minor, subscapularis)
What is the treatment for rotator cuff tear?
Surgical
Repair muscle with subacromial decompression
Reversed ball/ socket surgery
Physiotherapy
Diabetic 50 year old presents with progressive pain and stiffness of her shoulder over 3 months, the pain is now subsiding but the stiffness is getting worse. On examination there is loss of external rotation. What investigations would you run. Likely diagnosis?
X-ray to exclude other diagnosis Adhesive capsulitis (frozen shoulder
What is the treatment for frozen shoulder?
It is a self ilmiting condition so physiotherapy and analgesia
Man presents with acute onset of severe pain in the shoulder. On xray there was calcium deposition proximal to greater tuberosity. Likely diagnosis? Treatment?
Acute calcific tendonitis
Self limiting so subacromial steroid injection
Man 70 years presents with pain in his shoulder, it is worse with full abduction. On examination he is scarf sign positive. Likely diagnosis?
Acromioclavicular OA
Man presents with pain in his anterior shoulder radiating to the elbow particularly during flexion. He is unable to pronate his forearm. He is pop-eye positive. Diagnosis?
Biceps ruputre
Patient presents with pain in the lateral epicondyle. It is pinpoint pain, it is the common extensor origin. What would you expect to find on examination?
Pain on wrist extension and middle finger.
Pain on resisted extension of the finger
Lateral epicondylitis
What is the treatment for epicondylitis?
Self limiting so rest (but may take up to 4 years)
Physiotherapy
NSAIDs
Steroid injections but if medial then careful dont hit ulnar nerve
What would you expect to find on examination with someone with medial epicondylitis?
Paraesthesia of little finger and ring finger due to compression of the ulnar nerve
Women presents with numbness of her ring and pinky finger, and a weakness of her wrist to flex. On examination she is Tinels test positive. Diagnosis?
Cubital tunnel syndrome
Tinels test is percussion over ulnar nerve to ellicit pins/needle sensation
Pregnant women presents with pins and needles in her thumb, index and middle fingers. Its worse at night, and is finding it difficult to grip things. On examination there is thenar eminence wasting and phalens test positive. Diagnosis and treatment?
Carpal tunnel syndrome
Wrist splints at night to prevent over flexion, steroid injections
What is the pathology of dupuytrens contracture?
Specialzed palmar fascia undergoes hyperplasic forming nodules and cords that cause contractures. It is a change of fibroblasts to myofibroblasts that then produce type 3 collagen instead of 1
What are the most common sites for dupuytrens contracrture?
Ring and little finger
What are the treatments for dupytrens contracture? Depends on what?
Site of joint infected. If PIP joint then must do surgery urgently to fix it
If MCP joint then can wait for however long want to do surgery as outcome will be the same.
Can also do percutaneous needles fasciotomy, collagenase injections
What is the pathology of trigger finger?
Tendonitis of flexor tendon distal to fascial pully causing nodules to form that get stuck underneath an annular pulley
What are some of the symptoms of trigger finger? And treatment
Unable to regain full extension
Clicking sensation during flexion
Painful
Steroid injection to tendon sheath
What is a heberdens node
Where there is swelling of the DIP joint
H further in alphabet than b so why end of finger
What is bouchards node
Swelling of the PIP joint
B beginning of alphabet so closer to the body
Women with known arthritis of the knees presents with a swelling behind her knee. It fluctuates in size, it isnt painful but cosmetically annoying. Diagnosis?
Bakers cyst
