Upper Limb problems

Question 1

What is Carpal tunnel syndrome?

Answer 1

parasthesiae in the median nerve innervated digits - thumb and radial 2 and a half

Question 2

What can cause carpal tunnel syndrome?

Answer 2

rheumatoid arthritis
diabetes - anything causing fluid retention
pregnancy
weakness of the adductor pollicus brevis

Question 3

How is carpal tunnel syndrome diagnosed?

Answer 3

Tinnels test - percus the median nerve

Phalens test - hold wrist hyper flexed to reduce space in the carpal tunnel

Question 4

How is carpal tunnel syndrome managed?

Answer 4

wrist splints at night
carpal tunnel decompression
steroid injections

Question 5

What is cubital tunnel syndrome?

Answer 5

compression of the ulnar nerve behind the medial epicondyle

Question 6

What is cubital tunnel syndrome due to?

Answer 6

tight band of fascia forming the roof of the tunnel or due to tightness at the intermuscular septum as the nerve passes through or between the two heads at the origin of the flexor carpi ulnaris

Question 7

What is the presentation of cubital tunnel?

Answer 7

parasthesiae at the ulnar 1 and a half fingers
Tinnels test positive
Froments test positive

Question 8

What is the treatment for cubital tunnel syndrome?

Answer 8

surgical release

ulnar nerve decompression

Question 9

What is the general presentation of frozen shoulder?

Answer 9

gradual onset of pain

gradual decrease of stiffness (over 2-9 months)

Question 10

What are the signs of frozen shoulder?

Answer 10

loss of external rotation
thickening of the coracohumeral ligament
decrease in joint volume

Question 11

Who does frozen shoulder affect?

Answer 11

50-60 year olds

diabetics very prone to it

Question 12

What is the treatment for frozen shoulder?

Answer 12

physiotherapy and analgesia
intraarticular gleno-humeral injections
if no help, manipulation under anaesthetics can help or arthroscopic release

Question 13

What causes a rotator cuff tear?

Answer 13

degenerative changes in the tendon

trauma

Question 14

What age group is affected by rotator cuff tears?

Answer 14

> 60 year olds - usually asymptomatic

Question 15

What are the different types of rotator cuff tears?

Answer 15

partial and full thickness - involve the supraspinatous

large - involves the infraspinateous and the subscapularis

Question 16

What is the presentation of a rotator cuff tear?

Answer 16

weakness of initiation of abduction - supraspinatous
weakness of internal rotation - subscapularis
weakness of external rotation - infraspinatous
may see some muscle wasting

Question 17

How is a rotator cuff tear treated?

Answer 17

physio, rest, sling, NSAIDs, analgesia etc..

if no help -> subacromial depression and rotator cuff repair

Question 18

How is a rotator cuff tear investigated?

Answer 18

MRI

Ultrasound

Question 19

What is acute calcific tendonitis?

Answer 19

calcium deposits in the supraspinatous tendon cause severe shoulder pain

Question 20

How is acute calcific tendonitis diagnosed?

Answer 20

Xray - seen proximal to the greater tubersity

Question 21

How is acute calcific tendonitis treated?

Answer 21

subacromial steroid injections and local anaesthetic injections
pain goes away as calcium reabsorbs

Question 22

What is shoulder instabitlity?

Answer 22

painful abnormal translational movement, subluxation and/or recurrent dislocation
younger they are - more likely to reoccur

Question 23

What age group does shoulder instability affect? males or females?

Answer 23

20-30year olds
females
sporty

Question 24

What is more common: anterior or posterior shoulder dislocation?

Answer 24

anterior due to trauma

Question 25

What can occur alongside anterior shoulder dislocations?

Answer 25

Blankart lesions - repaired by open stabilisation glenoid fractures humeral head fractures

Question 26

How can a traumatic anterior shoulder dislocation be treated?

Answer 26

reduction | rest and physiotherapy - 6 week sling

Question 27

How is a shoulder instablity investigated?

Answer 27

MRI arthrogram | Xray - more than 2 planes

Question 28

When would a posterior shoulder dislocation occur?

Answer 28

epileptic fits | electrocution

Question 29

What is the treatment for an acute shoulder dislocation/

Answer 29

IV analgesia and sedation

Question 30

What is impingement syndrome?

Answer 30

tendons of the rotator cuff (usually supraspinatous) are compressed in the subacromial space during movement which produces pain

Question 31

What is the characteristic sign of impingement syndrome?

Answer 31

painful arc - between 60 and 120 degrees

Question 32

What are the causes of impingement syndrome?

Answer 32

tendonitis subacromial bursitis acromioclavicular OA with osteophytes hooked acromion rotator cuff tear

Question 33

What is the general presentation of someone with impingement syndrome?

Answer 33

30-40 years old pain radiating to deltoid and upper arm tenderness in lateral edge of the acromion Hawkins kennedy test positive

Question 34

How is impingement syndrome investigated?

Answer 34

Xray

Question 35

What is the treatment for impingement syndrome?

Answer 35

``` steroid injections physiotherapy rest NSAIDs and analgesia arthroscopic or open subacromial decompression if nothing else works ```

Question 36

What action does the radiocapitellar joint perform?

Answer 36

pronation and supination

Question 37

What action does the humero-ulnar joint perform?

Answer 37

flexion and extension