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upper limb problems Flashcards

1
Q

what is carpal tunnel syndrome

A

nerve compression within the carpal tunnel due to swelling within the tunnel

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2
Q

what forms the carpal tunnel

A

carpal bones

flexor retinaculum

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3
Q

what does the carpal tunnel contain

A

median nerve

9 flexor tendons

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4
Q

what are the causes of carpal tunnel syndrome

A

idiopathic (most common)
rheumatoid arthritis
any condition resulting in fluid retention
wrist fracture (Colles fracture)

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5
Q

how does rheumatoid arthritis lead to carpal tunnel syndrome

A

synovitis results in less space

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6
Q

what conditions would result in fluid retention

A

pregnancy
diabetes
chronic renal failure
hypothyroidism

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7
Q

what are the symptoms of carpal tunnel syndrome

A

loss of feeling/movement in median nerve innervated digits

muscle wasting of the thinner eminence = chronic cases

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8
Q

what does the median nerve innervate

A

thumb and radial 2 1/2 fingers

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9
Q

what are the investigations of carpal tunnel syndrome

A

tinels test = percuss over the median nerve
Phalen’s test = holding wrists hyper flexed causes symptoms
nerve conduction studies = slow conduction

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10
Q

what is the treatment of carpal tunnel syndrome

A

nighttime wrist splints
corticosteroid injections
carpal tunnel decompression

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11
Q

what is cubital tunnel syndrome

A

compression of the ulnar nerve at the elbow behind the medial epicondyle (funny bone area)

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12
Q

what are the causes of cubital tunnel syndrome

A

tight ban of fascia forming at the roof of the tunnel = Osborne’s fascia
tightness at inter-muscular septum

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13
Q

what are the symptoms of cubital tunnel syndrome

A

numbness/loss of movement in ulnar 1 1/2 fingers = pinky
weakness in abduction of index finger
weakness in adductor pollicis

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14
Q

what are the investigations of cubital tunnel syndrome

A

nerve conduction test

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15
Q

what bones make up the shoulder griddle

A

scapula
clavicle
proximal humerus

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16
Q

what bones make up the shoulder joint

A

humeral head

scapular glenoid

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17
Q

what 4 muscles make up the rotator cuff

A

Supraspinatus 
Infraspinatus
Teres minor
Subscapularis

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18
Q

where does the supraspinatus attach to

A

proximal = supraspinatus fossa of scapula

distal = greater tubercle of humerus

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19
Q

what is the supraspinatus innervated by

A

suprascapular nerve

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20
Q

what is the main action of the supraspinatus

A

abducts arm

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21
Q

where does the infraspinatus attach to

A

proximal = infraspinatus fossa of scapula

distal = greater tubercle of humerus

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22
Q

what is the infraspinatus innervated by

A

suprascapular nerve

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23
Q

what is the main action of the infraspinatus

A

externally rotates the arm

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24
Q

where does the teres minor attach

A

proximal = middle part of lateral border of scapula

distal = greater tuberosity of humerus

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25
what is the innervation of teres minor
axillary nerve
26
what is the main action of teres minor
externally rotates the arm
27
where does the subscapularis attach
proximal = subscapular fossa of scapula distal = lesser tuberosity of humerus
28
what is the innervation of subscapularis
upper and lower subscapular nerves
29
what is the main action of subscapularis
internally rotates the arm
30
what is the function of the deltoid
abducts the arm
31
what is the innervation of the deltoid
axillary nerve
32
where does the deltoid attach
proximal = clavicle, acromion, spine of scapula distal = deltoid tuberosity on lateral aspect of humerus
33
what is the function of the biceps brachii
flexes elbow | supinates forearm
34
what is the innervation of the biceps brachii
musculocutaneous nerve
35
what is the biceps brachii attached to
proximal short head = caracoid process long head = labrum/glenoid distal = tuberosity of radius
36
what is the most common shoulder condition in a young adult
instability (dislocation)
37
what is the most common shoulder condition in an elderly person
OA
38
what are the most common shoulder conditions in a middle aged person
frozen shoulder | rotator cuff tear
39
what is impingement syndrome
tendons of the rotator cuff are compressed in the tight subacromial space during movement
40
what is commonly affected in impingement syndrome
supraspinatus
41
what are the causes of impingement syndrome (3)
OA with inferior osteophyte bursitis hooked acromion
42
what are the symptoms of impingement syndrome
Painful arc between 60-120 degree Pain radiates to deltoid and upper arm Tenderness below the lateral edge of the acromion +ve hawkins-kennedy test
43
what is the hawkins-kennedy test
internally rotating arm. positive if causes pain
44
what are the investigations of impingement syndrome
US or MRI if mobility is poor | X-ray = calcification
45
what is the treatment of impingement syndrome
pain relief subacromial steroid injections (up to 3) subacromial decompression surgery
46
what usually causes a rotator cuff tear
``` >40 = sudden jerk movement young = significant injury ```
47
what is usually affected in a rotator cuff tear
supraspinatus large tear may extend into subscapularis or infraspinatus
48
what are the symptoms of rotator cuff tear
weakness of initiation of abduction, internal and external rotation passive movement > active movement wasting of the supraspinatus
49
what are the investigations of rotator cuff tear
US | MRI if very stiff
50
what is the treatment of rotator cuff tear
physio subacromial steroid injections surgery
51
what is frozen shoulder also known as
adhesive capsulitis
52
what is frozen shoulder
progressive pain and stiffness of the shoulder with unknown cause
53
who is affected by frozen shoulder
40-60 yr old patients
54
what are the symptoms of frozen shoulder
sudden onset pain and stiffness | loss of external rotation +/- loss of other movements
55
what are the investigations of frozen shoulder
rely on history as x-ray is normal
56
what is the aim of treatment of frozen shoulder
Non-operative with the aim to relive pain and prevent further stiffening
57
what is the treatment of frozen shoulder
physio + pain relief | resolves after 18-40months
58
what is acute calcific tendonitis
calcium deposits in the supraspinatus tendon proximal to the greater tuberosity
59
what is the symptoms of acute calcific tendonitis
acute onset of severe shoulder pain
60
what is the investigation of acute calcific tendonitis
X-ray
61
what is the treatment of acute calcific tendonitis
subacromial steroid or local anaesthetic injection | self-limiting until calcification reabsorbs
62
what is biceps tendonitis
inflammation of the tendon of the long head of the biceps
63
what is the symptoms of biceps tendonitis
anterior shoulder pain pain on resisted biceps contraction popeye deformity
64
what is a popeye deformity
spontaneous rupture of the biceps tendon which will prove relief of pain in biceps tendonitis
65
what is the treatment of biceps tendonitis
surgical division of the tendon +/- attachment to the proximal humerus
66
what are the two types of instability
traumatic | atraumatic
67
what is the cause of instability
traumatic = trauma posterior traumatic = fits atraumatic = generalised ligament laxity
68
give examples of conditions that could result in atraumatic instability
idiopathic generalised laxity Marfans elhers-danos
69
give examples of conditions that could result in posterior traumatic instability
epileptic fits alcoholic fits electrocution
70
what are the symptoms of instability
subluxation/dislocation postitive apprehension test winging dyskinesia
71
what are the investigations of instability
X-ray | MRI arthrogram = if had multiple dislocations
72
what is the treatment of instability
reduction & rest | surgery = recurrent dislocation
73
what are the compartments of the arm
posterior compartment | anterior compartment
74
what muscles are located in the anterior compartment of the arm
biceps brachii brachialis coracobrachialis
75
what is the innervation of the anterior compartment of the arm
musculocutaneous nerve
76
what is the action of the anterior compartment of the arm
flexion of the arm and forearm
77
what is the attachment of the biceps brachii
proximal long head = supraglenoid tubercle of scapula short head = tip of coracoid process distal = radial tuberosity
78
what is the action of the biceps brachii
flexion of the arm and forearm | supinates forearm
79
what is the attachment of the coracobrachialis
``` proximal = tip of coracoid process distal = middle 1/3 of medial surface pf humerus ```
80
what is the attachment of the brachialis
``` proximal = distal 1/2 of anterior humerus distal = coronoid process and tuberosity of ulna ```
81
what muscle is located in the posterior compartment of the arm
triceps brachii
82
what is the nerve supply of the posterior compartment of the arm
radial nerve
83
what is the action of the posterior compartment of the arm
extension of arm and forearm
84
what are the 3 heads of the triceps brachii
long head lateral head medial head
85
where does the long head of the triceps brachii attach
``` proximal = infraglenoid tubercle of scapula distal = proximal end of olecranon of ulna ```
86
where does the lateral head of the triceps brachii attach
``` proximal = posterior surface of humerus, SUPERIOR to the radial groove distal = proximal end of olecranon of ulna ```
87
where does the medial head of the triceps brachii attach
``` proximal = posterior surface of humerus, INFERIOR to the radial groove distal = proximal end of olecranon of ulna ```
88
what is the treatment of cubital tunnel syndrome
may need surgical release of any tight structures
89
describe the passage of the ulnar nerve in the elbow
passes posterior to the medial epicondyle and enters an arch formed by the two heads of the flexor carpi ulnaris under the acute ligament
90
what is tennis elbow also known as
lateral epicondylitis
91
describe the pathology of tennis elbow
the common extensor can become painful which can give rise to tennis elbow
92
where does the common extensor arise from
the lateral epicondyle
93
what causes tennis elbow
repetitive strain injury degenerative enthesopathy micro tears
94
what is the treatment of tennis elbow
rest | self-limiting
95
where does the common flexor arise from
the medial epicondyle
96
describe the pathology of golfer's elbow
the common flexor can be come painful which can give rise to medial epicondylitis
97
what is golfer's elbow also known as
medial epicondylitis
98
what causes golfer's elbow
repetitive strain injury | degenerative enthesopathy
99
what is the treatment of golfer's elbow
rest | self-limiting
100
what must NEVER be given as a treatment in golfer's elbow
steroid injections
101
why must steroid injections never be given in golfer's elbow
risk of injury to the ulnar nerve
102
what is a mucous cyst
outputting of synovial fluid from a DIP joint affected by OA
103
what is the treatment of a mucous cyst
``` asymptomatic = leave alone symptomatic = excise ```
104
what is dupuytren's contracture
proliferative connective tissue disease where the palmar fascia undergoes hyperplasia forming nodules, cords, and bands
105
what cells are produced in dupuytren's contracture
myofibroblast cells | collagen type 3
106
what are the symptoms of dupuytren's contracture
painless, gradual progression | palpable nodules/puckering
107
what fingers are affected in dupuytren's contracture
pinky and ring
108
what is the treatment of dupuytren's contracture
stretching activity modification surgery amputation
109
what is trigger finger
tendonitis of a flexor tendon to a digit resulting in nodular enlargement
110
what are the symptoms of trigger finger
pain clicking sensation on movement finger locked in flexed position
111
what is the treatment of trigger finger
resolves spontaneously steroid injection recurrent = surgery
112
what is DeQuervain's tendonitis
spontaneous inflammation the sheath which surrounds the two tendons involved in moving the thumb
113
what are the symptoms of DeQuervain's tendonitis
pain swelling redness
114
what is the treatment of DeQuervain's tendonitis
rest + splint steroid injection decompression surgery
115
what is paronychia
infection within the nail fold
116
what is he treatment of paronychia
incise and drain +/- antibiotics
117
what is a flexor tendon sheath infection
infection within the sheath tracking up the palm +/- arm
118
what is the symptoms of lexor tendon sheath infection
extreme pain causing limited movement
119
what is the treatment of lexor tendon sheath infection
wash out tendon sheath

MSK (mine) (17 decks)

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