Upper Limb Pathology Flashcards Preview

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Flashcards in Upper Limb Pathology Deck (72):
1

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

A1

2

In trigger finger which fingers are most commonly affected?

Middle and ring finger

3

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

4

In RA, what hand joints tend to be spared?

DIP joints

5

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

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

6

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

7

What is a ganglion cyst?

mucinous filled cysts found adjacent to a tendon or synovial joint

8

With rotator cuff tear, what are the symptoms?

weakness
muscle wasting
night pain

9

In carpal tunnel syndrome, which nerve is compressed?

Median nerve

10

What is the most common cause of carpal tunnel syndrome?

Tendinitis (often caused by RA)

11

What else can cause carpal tunnel syndrome?

Diabetes causing polyneuropathy
trauma
neoplasm
idiopathic
developmental
degenrative

12

What are the symptoms of carpal tunnel syndrome?

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

13

What investigations are used in carpal tunnel syndrome?

Nerve conduction studies
PV
X-ray

14

Give conservative treatments for carpal tunnel syndrome.

Corticosteroid injection
Splint
workplace task modification

15

What are the indications for decompression in carpal tunnel sydrome?

Failed conservative treatment
constant numbness
weakness

16

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

Endoscopic or mini
(standard open carpal tunnel release or arthroscopic)

17

What can cause cubital tunnel syndrome?

Acute or delayed trauma
OA
RA
Anconeus epitrochlearis

18

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

19

What are the treatment options for cubital tunnel syndrome?

Splint
Neurolysis
Anterior transposition

20

What does the patient present with in cubital tunnel syndrome?

Pain
Paraesthesia
Numbness
Weak pinch

21

Colles Fracture

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

22

Radia buckel fracture

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

23

Scaphoid fracture

Pain in anatomical snuff box
Young males - FOOSH

24

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

4

25

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

26

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

Axillary nerve (regimental badge area loss of sensation)

27

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

Oblique view

28

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

lightbulb sign

29

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

Visible posterior fat pads - always pathological.

30

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

No it is a normal sign

31

What artery could be damaged in a supracondylar fracture?

Brachial artery

32

What does a Bennet's fracture involve?

The articular surfaces of the 1st MC base

33

Tendinopathy

Disease of a tendon

34

Tendinitis

Tendon injuries that involve larger scale acute injuries accompanied by inflammation

35

Tendonosis

Chronic tendon injury with damage to a tendon at cellular level

36

Tenosynovitis

Inflammation of the tendon sheath

37

Enthesopathy

Inflammation of the tendon origin or insertion into bone

38

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

39

What imaging modality is used to clarify rotator cuff tear?

US
MRI if required

40

Management options of rotator cuff tear

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

41

What clinical signs suggest biceps rupture?

Popeye sign ad extensive bruising

42

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

Long head

43

How does biceps tendinopathy occur?

Overuse, insatbillty, impingement or trauma

44

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

45

What are the management options for biceps tendinopathy?

Conservative - rest and physio
Surgery

46

What is Golfers elbow?

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

47

Which nerve could be compressed in medial epicondylitis?

Ulner nerve - could lead to muscle weakness

48

Give treatment options for golfers and tennis elbow.

rest
physio
activity modification
orthotics
injection or surgical release

49

What is lateral epicondylitis?

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

50

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

Worse when stretching the muscles

51

What is DeQuervain's tenosynovitis?

Inflammation of the tendon sheath of APL and EPB

52

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

53

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

54

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

55

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

Light-bulb sign

56

What is the treatment for a shoulder dislocation?

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

57

How do elbow dislocations occur?

FOOSH

58

What is the most common direction of an elbow dislocation?

Posterior

59

What is the management of an elbow dislocation?

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

60

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

Hyperextension injury or direct axial blow
Almost always posterior

61

Management of an interphalangeal joint dislocation?

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

62

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

Galeazzi fracture dislocation

63

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

Monteggia fracture dislocation

64

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

ORIF

65

What is the treatment for a Galeazzi or Monteggia fracture?

ORIF

66

What is a Smith's fracture?

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

67

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

Proximal muscle weakness
Symmetrical

68

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

Disteal muscle weakness
Asymmetrical

69

Polymyalgia rheumatica presents as an ache where?

Shoulder and hip girdle

70

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

71

What clinical findings are seen in fibromyalgia?

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

72

What is the first line treatment for fibromyalgia?

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