Upper Limb Pathology Flashcards by Laura Barry

In trigger finger, which pulley most commonly has a nodular enlargement distal to it?

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In trigger finger which fingers are most commonly affected?

Middle and ring finger

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In OA, what are the two types of nodes that can be seen and where do they form?

Heberden’s nodes - DIP joints

Bouchard’s nodes - PIP joints

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In RA, what hand joints tend to be spared?

DIP joints

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Briefly, what are the 3 stages of natural history of RA?

synovitis and tenosynovitis
erosion of the joints
joint instability and tendon rupture

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What are the 5 hand deformities of RA?

Volar MCPJ subluxation
Ulnar deviation
Swan neck deformity (hyperextension at PIPJ with flesion DIPJ)
Boutonniere deformity (flexion at PIPJ with hyperextension at DIPJ)
Z-shaped thumb

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What is a ganglion cyst?

mucinous filled cysts found adjacent to a tendon or synovial joint

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With rotator cuff tear, what are the symptoms?

weakness
muscle wasting
night pain

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In carpal tunnel syndrome, which nerve is compressed?

Median nerve

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What is the most common cause of carpal tunnel syndrome?

Tendinitis (often caused by RA)

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What else can cause carpal tunnel syndrome?

Diabetes causing polyneuropathy 
trauma 
neoplasm
idiopathic 
developmental 
degenrative

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What are the symptoms of carpal tunnel syndrome?

Numbness (3 fingers supplied by median nerve)
altered sensation = dyasthesia
pain
night awakening

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What investigations are used in carpal tunnel syndrome?

Nerve conduction studies
PV
X-ray

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Give conservative treatments for carpal tunnel syndrome.

Corticosteroid injection
Splint
workplace task modification

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What are the indications for decompression in carpal tunnel sydrome?

Failed conservative treatment
constant numbness
weakness

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What are the 2 kinds of carpal tunnel release operative treatments?

Endoscopic or mini

standard open carpal tunnel release or arthroscopic

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What can cause cubital tunnel syndrome?

Acute or delayed trauma
OA
RA
Anconeus epitrochlearis

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What nerve is compressed and stretched in cubital tunnel syndrome? What are the symptoms of cubital tunnel syndrome?

Ulnar nerve
pain 
paraesthesia - 1.5 fingers supplied by ulnar nerve
numbness 
weak pinch

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What are the treatment options for cubital tunnel syndrome?

Splint
Neurolysis
Anterior transposition

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What does the patient present with in cubital tunnel syndrome?

Pain
Paraesthesia
Numbness
Weak pinch

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Colles Fracture

Dorsal angulation of radius with associated ulner styloid fracture
Elderly with osteoporosis - FOOSH

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Radia buckel fracture

children with soft bones (un-fused growth plates and un-ossified carpal bones) - FOOSH

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Scaphoid fracture

Pain in anatomical snuff box

Young males - FOOSH

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How many x-ray views are required in a suspected scaphoid fracture?

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What complication may occcur from a scaphoid fracture?

Proximal scaphoid blood supply may be disrupted leading to ANV or non-union This may lead to early wrist OA

What nerve is commonly injured in surgical neck of humerus fractures?

Axillary nerve (regimental badge area loss of sensation)

What x-ray view is required in suspected posterior shoulder dislocation?

Oblique view

In a posterior shoulder dislocation, what is the typical sign seen on x-rays?

lightbulb sign

In a supracondylar fracture, what sign can be seen on x-rays?

Visible posterior fat pads - always pathological.

Is seeing the anterior fat pad in the elbow always pathological?

No it is a normal sign

What artery could be damaged in a supracondylar fracture?

Brachial artery

What does a Bennet's fracture involve?

The articular surfaces of the 1st MC base

Tendinopathy

Disease of a tendon

Tendinitis

Tendon injuries that involve larger scale acute injuries accompanied by inflammation

Tendonosis

Chronic tendon injury with damage to a tendon at cellular level

Tenosynovitis

Inflammation of the tendon sheath

Enthesopathy

Inflammation of the tendon origin or insertion into bone

What is the clinical presentation of a rotator cuff tear?

``` achy pain shoulder tenderness difficulty sleeping on affected side, reaching overhead and on lifting painful arc positive impingment tests ```

What imaging modality is used to clarify rotator cuff tear?

US | MRI if required

Management options of rotator cuff tear

Conservative - rest, physio, steroid and LA injection | Surgery - arthroscopic or open subarchronial decompression and rotator cuff repair

What clinical signs suggest biceps rupture?

Popeye sign ad extensive bruising

What head of the biceps is predominantly affected in biceps tendinopathy?

Long head

How does biceps tendinopathy occur?

Overuse, insatbillty, impingement or trauma

Where is the pain in biceps tendinopathy? What is it aggravated by?

Pain in anterior shoulder radiatig to elbow | Shouder flexion, forearm pronation and elbow flexion

What are the management options for biceps tendinopathy?

Conservative - rest and physio | Surgery

What is Golfers elbow?

Medial epicondylitis Inflammation of the origin of flexor forearm muscles over the medial epicondyle Medial elbow pain Self limiting

Which nerve could be compressed in medial epicondylitis?

Ulner nerve - could lead to muscle weakness

Give treatment options for golfers and tennis elbow.

``` rest physio activity modification orthotics injection or surgical release ```

What is lateral epicondylitis?

Tennis Elbow | Inflammation of the origin of extensor forearm muscles over the lateral epicondyle - pain and tender

The pain in latera epicondylitis/tennis elbow is worse when..?

Worse when stretching the muscles

What is DeQuervain's tenosynovitis?

Inflammation of the tendon sheath of APL and EPB

What is the most common direction of a shoulder dislocation? How does this occur?

Anterior | Fall with shoulder in external rotation or fall onto the back of the shoulder

What other directions can a shoulder dislocate in and what causes them?

Posterior - fall with shoulder in internal rotation (posterior force on the adducted and internally rotated arm) Inferior

An impaction fracture on the anterior glenoid by the posterior humeral head, can occur in an anterior dislocaton. What is the name of this lesion?

Hill-Sachs lesion

What is the main x-ray finding in a posterior shoulder dislocation?

Light-bulb sign

What is the treatment for a shoulder dislocation?

Closed reduction under sedation/ anaesthetic Then placed in a sling for 2-3 weeks Then physiotherapy

How do elbow dislocations occur?

FOOSH

What is the most common direction of an elbow dislocation?

Posterior

What is the management of an elbow dislocation?

Closed reduction under sedation/ anaesthetic | Then placed in a sling for 2-3 weeks

How do interphalangeal joint dislocations occur and in whihc direction to they tend to be?

Hyperextension injury or direct axial blow | Almost always posterior

Management of an interphalangeal joint dislocation?

Closed reduction under digital or metacarpal block | then 2 weeks in neighbour strapping

Name the fracture that occurs when the radius fractures with dislocation of the ulna at DRUJ?

Galeazzi fracture dislocation

Name the fracture that occurs when ulna fractures with dislocation of radial head at elbow?

Monteggia fracture dislocation

If both the ulna and radius fracture what treatment is required?

ORIF

What is the treatment for a Galeazzi or Monteggia fracture?

ORIF

What is a Smith's fracture?

Extra-articular fracture of the distal radius with a fall onto the back of the hand

Do polymyositis and dermatomysitis present as proximal or distal muscle weakness? Is it symmetrical or asymmetrical?

Proximal muscle weakness | Symmetrical

Which muscle are tired in inclusion body myositis? Is it symmetrical or asymmetrical?

Disteal muscle weakness | Asymmetrical

Polymyalgia rheumatica presents as an ache where?

Shoulder and hip girdle

What other clinical manifestations of polymyalgia rheumatica are there?

Morning stiffness in shoulder and hip girdle (may have decreased ROM) Fever, weight loss, fatigue and anorexia may occur

What clinical findings are seen in fibromyalgia?

Excessive tenderness on palpation of soft tissues at least 11/18 tender points Inflam markers normal

What is the first line treatment for fibromyalgia?

Graded exercise programme and atypical analgesia - Gabapentin and pregabalin No curative treatment

Upper Limb Pathology Flashcards

(72 cards)