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Y2 MSK > Upper limb problems III > Flashcards

Upper limb problems III Flashcards

1
Q

What is carpal tunnel syndrome

A

Neuropathy caused by acute or chronic compression of the median nerve in carpal tunnel

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2
Q

Cause of carpal tunnel syndrome

A

Idiopathic
RA
Pregnancy
Diabetes
Chronic renal failure
Hypothyroidism (myxoedema)
Fractures around the wrist
Acromegaly

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3
Q

How does RA cause carpal tunnel syndrome

A

Synovitis reduces space in carpal tunnel

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4
Q

How does pregnancy, diabetes, chronic renal failure and hypothyroidism cause carpal tunnel syndrome

A

Cause retention of water -> reduces space

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5
Q

Which wrist fracture causes carpal tunnel syndrome

A

Colles fracture - complete fracture of distal radius causing dorsal displacement of radius

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6
Q

Do carpal tunnel syndrome symptoms persist after pregnancy if pregnancy was the only cause

A

No, it tends to reside after childbirth

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7
Q

Motor innervation of the hand by median nerve

A

LOAF muscles
-lateral 2 lumbricals
-opponens pollicis
-abductor pollicis brevis
-flexor pollicis brevis

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8
Q

Sensory innervation of the hand by median nerve

A

Palmar aspect of lateral 3 and 1/2 fingers (thumb, index, middle and half of ring finger)
Dorsal aspect of nail beds of those fingers too

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9
Q

Symptoms of carpal tunnel syndrome

A

Weakness in thumb and radial 2 1/2 fingers
Tingling, burning sensation of those 3 fingers worse at night
Tingling, burning sensation relieved by shaking/ hanging out the hand at night
Clumsiness in fingers
Loss of sensation

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10
Q

Signs of carpal tunnel syndrome

A

Muscle wasting at thenar eminence (base of thumb)

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11
Q

Investigations for carpal tunnel syndrome

A

Tinel’s test - causes symptoms
Phalen’s test - causes symptoms
Nerve conduction studies

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12
Q

Describe tinel’s test

A

Percuss over median nerve
Positive = tingling, burning sensation over the area innervated by median nerve

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13
Q

Describe Phalen’s test

A

Ask patient to hold his wrists hyper-flexed
Positive = tingling, burning sensation over the area innervated by median nerve

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14
Q

Management of carpal tunnel syndrome

A

Wrist splints at night to prevent flexion
Corticosteroids injections
Carpal tunnel decompression surgery

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15
Q

What is De Quervain’s tenosynovitis

A

Inflammation of the extensor pollicis longus and extensor pollicis brevis tendons

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16
Q

Risk factors of De quervain’s

A

Women
30-50
Pregnancy
RA
Occupation - musicians, office workers who need to perform thumb abduction repetitively

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17
Q

Symptoms of De Quervain’s tendinopathy

A

Pain at the base of the thumb
Pain exacerbated by abduction of the thumb, gripping and ulnar deviation of the wrist
Swollen wrist

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18
Q

Investigations for DeQuervain’s tendinopathy

A

Finklestein’s test
US - rule out CMC OA
Xray - rule out CMC OA

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19
Q

Describe Finklestein’s test

A

Patient’s thumb is flexed, making a fist
Hand is ulnar deviated
Postive = pain

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20
Q

How to differentiate between CMC OA and De Quervain’s tendinopathy

A

CMC OA Finkelstein’s test is usually negative but positive in grind test

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21
Q

Management of DeQuervain’s tendinopathy

A

Splint
Rest
Physio
Analgesics
Steroid injections
Surgical decompression

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22
Q

What is Dupuytren’s contracture

A

progressive, fibrotic thickening of the palmar fascia progressing into contractures at MCP and PIP joints

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23
Q

Pathology of Dupuytren’s contracture

A

Proliferation of my-fibroblast cells
Production of type 3 collagen rather than type 1 = thickened palmar fascia

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24
Q

Risk factors of Dupuytren’s contracture

A

Males
Diabetes
Smoking
Alcohol
Cirrhosis
Epilepsy, epileptic medications
Repetitive trauma to hand

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25
Q

Which joints are involved in Dupuytren’s contracture

A

MCP
PIP

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26
Q

Symptoms of Dupuytren’s contracture

A

Painless
Starts as palmar nodule then progresses into flexion contracture of fingers
Symmetrical and bilateral

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27
Q

Which fingers are the most commonly involved in Dupuytren’s contracture

A

Ring and little fingers

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28
Q

What is Dupuytrens diathesis

A

Severe form of Dupuytren’s
Dupuytren’s contracture of the 4th and 5th fingers + Ledderhose + Peyronie’s

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29
Q

What is Ledderhose disease

A

Plantar fibromatosis - growth of fibrous nodules on soles of feet

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30
Q

What is Peyronie’s disease

A

FIbromatosis of the penis

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31
Q

Signs of Dupuytren’s contracture

A

Palpable hard nodules
fixed flexion deformity of the 4th and 5th digit (painless)

32
Q

Investigations for Dupuytren’s contracture

A

Clinical

33
Q

Management of Dupuytren’s contracture

A

Stretch
Observe
Surgery

34
Q

Name A-E

A

A- Distal phalanx
B- Proximal phalanx
C- Sesamoid bone
D- Metacarpal
E- Middle phalanx

35
Q

Name A-D

A

A- DIP joint
B- PIP joint
C- IP joint
D- MCP joint

36
Q

Name A-H

A

A- Scaphoid
B- Lunate
C- Triquetrum
D- Pisiform
E- Trapezium
F- Trapezoid
G- Capitate
H- Hamate

37
Q

Name A-F

A

A- Palmar aponeurosis
B- Flexor tendon sheaths
C- Hypothenar fascia
D- Tendon of palmaris longus
E- Flexor retinaculum
F- Thenar fascia

38
Q

Which tendons pass through the flexor tendon sheath to the digits

A

Flexor digitorum superficialis
Flexor digitorum profundus
Flexor pollicis longus

39
Q

What is the thenar eminence

A

Muscles of the thumb at the base of thumb

40
Q

Superficial muscles in thenar eminence

A

Abdcutor pollicis brevis
Flexor pollicis brevis

41
Q

Deep muscle in thenar eminence

A

Opponens pollicis

42
Q

Name A-C

A

A- Flexor pollicis brevis
B- Abductor pollicis brevis
C- opponens pollicis

43
Q

Attachment of abductor pollicis brevis

A

Origin: flexor retinaculum and tubercles of scaphoid and trapezium
Attachment: Lateral side of base of proximal phalanx of thumb

44
Q

Function of abductor pollicis brevis

A

abducts the thumb
helps opposition of the thumb

45
Q

Attachment of flexor pollicis brevis

A

Origin: flexor retinaculum and tubercles of scaphoid and trapezium
Attachment: Lateral side of base of proximal phalanx of thumb

46
Q

Function of flexor pollicis brevis

A

flexes the first MCP joint of the thumb

47
Q

Attachment of opponens pollicis

A

Origin: flexor retinaculum and tubercles of scaphoid and trapezium
Attachment: lateral side of 1st metacarpal

48
Q

Function of opponens pollicis

A

Opposition of thumb (by medially rotate and flex the metacarpal on trapezium)

49
Q

Innervation of thenar eminence

A

Recurrent branch of median nerve

50
Q

What are the hypothenar muscles

A

Muscles that control the movement of little finger at the base of the little finger

51
Q

What are the superficial hypothenar muscles

A

Abductor digiti minimi
Flexor digiti minimi

52
Q

What are the deep hypothenar muscles

A

Opponens digiti minimi

53
Q

Name A-C

A

A- Flexor digiti minimi
B- Abductor digiti minimi
C- Opponens digiti minimi

54
Q

Attachment of flexor digiti minimi

A

Origin: Hook of hamate and flexor retinaculum
Attachment: Medial side of base of proximal phalanx of 5th digit

55
Q

Function of flexor digiti minimi

A

Flexes proximal phalanx of 5th digit

56
Q

Attachment of abductor digiti minimi

A

Origin: Pisiform
Attachment: Medial side of base of proximal phalanx of 5th digit

57
Q

Function of abductor digiti minimi

A

Abduct the 5th digit
Assist in flexion of proximal phalanx of 5th digit

58
Q

Attachment of opponens digiti minimi

A

Origin: Hook of hamate and flexor retinaculum
Attachment: Medial border of 5th metacarpal

59
Q

Innervation of hypothenar eminence

A

Deep branch of ulnar nerve

60
Q

Which hand bone is the most frequently fractured

A

Scaphoid

61
Q

Mechanism of injury of scaphoid fracture

A

Fall on outstretched hand

62
Q

Symptoms of scaphoid fracture

A

Pain and tenderness in anatomical snuffbox

63
Q

Investigations for scaphoid fracture

A

Xray - AP, lateral, 2 obliques
If not visible - repeat xray in 10 days or do MRI

64
Q

If scaphoid fracture is not visible on xray initially but highly suspicious of it, what should be done

A

Start treatment (scaphoid plaster and splint)
Repeat Xray or MRI after 10 days

65
Q

Management of scaphoid fracture

A

Wrist in beer glass position
Cast
ORIF / screw fixation if needed

66
Q

Complication of scaphoid fracture

A

Compromise blood supply causing
- avascular necrosis
- increased risk of non-union
- early OA

67
Q

how may scaphoid fracture compromise blood supply

A

The fracture can damage dorsal branch of radial artery which supplies 70-80% of blood supply to scaphoid

68
Q

What is trigger finger

A

Impingement at the level of A1 pulley inhibiting smooth gliding of the tendon

69
Q

What is a pulley

A

Bands of tissues along the tendon sheath which holds the flexor tendons close to the finger bones

70
Q

Risk factors of trigger finger

A

Female
>50 (but can occur at any age)
Diabetes
RA
Occupation that requires prolonged gripping

71
Q

Pathophysiology of trigger finger

A
  1. flexor tenosynovitis from repetitive movements
  2. causes fibrocartilaginous metaplasia which forms nodules distal to the pulley on the tendon
  3. When fingers are flexed, the nodule moves proximal to the pulley but when the patient tries to extend finger, the node cannot pass back under the pulley
  4. so the finger is locked in flexed position
72
Q

Symptoms of trigger finger

A

Pain over A1 pulley (around metacarpal head)
Finger locked in flexion

73
Q

Difference between trigger finger and dupuytren’s contracture

A

Dupuytren’s contracture is painless, fixed and cannot be passively corrected

74
Q

Clinical signs of trigger finger

A

Feel nodule pass beneath pulley

75
Q

Management of trigger finger

A

Often resolves spontaneously
Splint
Steroid injections into tendon sheath
Surgical release

Y2 MSK (19 decks)

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