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MSK > Upper limb pathology > Flashcards

Upper limb pathology Flashcards

1
Q

What two neuropathologies of the upper limb do we need to know?

A

Carpal Tunnel Syndrome

Cubital Tunnel Syndrome

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2
Q

What is Carpal Tunnel Syndrome?

A

Compression of median nerve as it passes through the carpal tunnel. 8x more common in women than men.

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3
Q

What causes carpal tunnel syndrome?

A

Idiopathic
RA (Synovitis leads to decreases space)
Fluid retention
Fracture

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4
Q

What are the symptoms of carpal tunnel syndrome?

A

Paresthesia of thumb and 1st 2 1/2 fingers which is worse at night.
Loss of sensation
Weakness

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5
Q

How do you treat carpal tunnel syndrome?

A

Splint at night to prevent flexion
Steroid injections
Divide transverse carpal ligament

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6
Q

What is cubital tunnel syndrome?

A

Compression of ulnar nerve at elbow behind medial epicondyle.

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7
Q

What are the symptoms of cubital tunnel syndrome?

A

Paresthesia of last 1 1/2 fingers.

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8
Q

What causes cubital tunnel syndrome?

A

Tightness in fascia at origin of flexor carpi ulnaris to nerve sheath.

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9
Q

What are the five shoulder conditions we need to know?

A 
Instability
Rotator Cuff Tear
Adhesive Capsulitis
Impingement syndrome
Acute Calcified Tendonitis
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10
Q

What is the most common cause of shoulder pain in young patients?

A

Instability

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11
Q

What is the most common cause of shoulder pain in middle aged patients?

A

Rotator cuff tear and adhesive capsulitis

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12
Q

What is the most common cause of shoulder pain in older patients?

A

OA of glenohumeral joint

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13
Q

Pain from which location can radiate to the shoulder?

A

Neck

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14
Q

What is a shoulder instability?

A

Lack of bony stability and muscular instability lead to recurrent subluxation or dislocation.

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15
Q

What are the two forms of shoulder instability?

A

Traumatic- Anterior dislocation

Atraumatic- Posterior, anterior or inferior dislocation

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16
Q

What is a traumatic instability of the shoulder?

A

Trauma causes anterior dislocation that can reduce and heal but some do not stabilize and are liable to dislocate again

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17
Q

How do you treat a traumatic instability of the shoulder?

A

Bankart’s repair- reattach labrum and capsule to anterior glenoid

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18
Q

What is an atraumatic instability of the shoulder?

A

Generalized ligament laxity (Marfan’s or Ehlers-Danlos) lead to recurrent dislocation.

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19
Q

What is a rotator cuff tear?

A

A full or partial tear in the tendons of the rotator cuff muscles (supraspinatus usually) leading to weakness and pain.

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20
Q

What causes a rotator cuff tear?

A

Degeneration of tendon followed by minor trauma.

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21
Q

How do you diagnose a rotator cuff tear?

A

US or MRI

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22
Q

How do you treat a rotator cuff tear?

A

Physio and subacromial steroid injection

ROtator cuff repair surgery but likely to reoccur

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23
Q

What age group is most likely to suffer from shoulder instability?

A

Young

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24
Q

What age group is most likely to suffer from rotator cuff tears?

A

Middle aged

Very rare in the young but can happen with major trauma.

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25
Q

What is adhesive capsulitis?

A

Progressive pain and stiffening in the shoulder in 40-60YO which resolves.

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26
Q

What is the main symptom of adhesive capsulitis?

A

Loss of external rotation.

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27
Q

How does adhesive capsulitis progress?

A

Pain 2-9m -> Stiffness 4-12m -> Recovery

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28
Q

What causes adhesive capsulitis?

A

Unclear but potentially: diabetes, injury, hypercholesterolemia, Dupuytren’s

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29
Q

How do you treat adhesive capsulitis?

A

Physio and analgesia
Steroid injections
Manipulation under anaesthetic
Rarely surgical capsule release

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30
Q

What is the common name for adhesive capsulitis?

A

Frozen shoulder

31
Q

What age group is most affected by adhesive capsulitis?

A

Middle aged (40-60). Can mimic OA but that’s usually seen on older age group.

32
Q

What is impingement syndrome?

A

Where tendons of the rotator cuff (supraspinatus normally) are compressed in the subacromial space during movement.

33
Q

What is the common name for impingement syndrome?

A

Painful arc

34
Q

Between which degrees does impingement syndrome tend to be painful?

A

60-120 degree abduction

35
Q

What causes impingement syndrome?

A

Tendonitis subacromial bursitis, AC OA w/ osteophytes, rotator cuff tear

36
Q

How do you diagnose impingement syndrome?

A

Positive Hawkins-Kennedy test- 90 degree flexion at elbow and shoulder then internally rotate.

37
Q

Where does pain from impingement syndrome radiate?

A

Deltoid and upper arm

38
Q

How do you treat impingement syndrome?

A

NSAIDs, analgesia, physio and steroids.

Subacromial decompression to create space for tendon to pass through.

39
Q

What is acute calcific tendonitis?

A

Ca deposits in the supraspinatus tendon cause acute severe shoulder pain.

40
Q

How do you diagnose acute calcific tendonitis?

A

Ca deposits proximal to greater tuberosity of humerus on XR.

41
Q

How do you treat acute calcific tendonitis?

A

Steroids and anaesthetics for pain. Self limiting so will resolve as Ca is reabsorbed.

42
Q

What are the three elbow conditions we need to know?

A

Lateral epicondylitis
Medial epicondylitis
Arthritis

43
Q

What are the two joints involved in the elbow?

A

Humeroulnar joint- Flexion and extension

Radiocapitellar joint- Pro/supination

44
Q

What is the common name for lateral epicondylitis?

A

Tennis elbow

45
Q

What in lateral epicondylitis?

A

RSI of resisted wrist extension or degenerative enthesopathy (inflammation of tendon/ligament on bone)

46
Q

What features characterise lateral epicondylitis?

A

Microtears in common extensor origin

Painful lateral epicondyle and pain on resisted elbow extension

47
Q

How do you treat lateral epicondylitis?

A

Self limiting: Rest, NSAIDs, physio, steroid injection, brace.
Very rarely surgery

48
Q

What is medial epicondylitis?

A

RSI of wrist flexor origin

49
Q

What is the common name for medial epicondylitis?

A

Golfers elbow

50
Q

How do you treat medial epicondylitis?

A

Self limiting: Physio, rest and NSAIDs

51
Q

What kinds of arthritis do you get in the elbow?

A

Primary OA is rare
OA secondary to trauma possible
RA is common

52
Q

How do you treat arthritis in the elbow?

A

Conservative treatment same as rest of OA or RA
Radiocapitellar can have surgical excision of radial head
Humeroulnar joint can get total elbow replacement but limited to lifting 2.5kg

53
Q

What are the five pathologies of the hand we need to know?

A 
Dupuytren's Contractures
Trigger finger
OA
RA
Ganglion Cyst
54
Q

What is a ganglion cyst?

A

Mucinous filled cyst adjacent to a tendon or synovial joint- outpouching of synovial membrane

55
Q

Where do you commonly get ganglion cysts?

A

DIP and wrist.

Baker’s cyst in knee

56
Q

How do ganglion cysts present?

A

Local pain and irritation but mainly cosmetic.

Firm, smooth, rubbery, transilluminate cyst

57
Q

How do you treat ganglion cysts?

A

Can be aspirated but usually recur

Can be surgically removed but can leave painful scar.

58
Q

What joint does RA most commonly affect?

A

PIP- Bouchard’s nodes

59
Q

What is the progression of RA in the PIP?

A

Synovitis and tendonitis
Erosion of joint
Joint instability and tendon rupture

60
Q

What malformations are common with RA?

A

Swan neck- PIP hyperextended and DIP flexed

Boutonniere- Flexed PIP and extended DIP

61
Q

How do you treat RA in the hands?

A

Same as other joints then:

Tenosynovectomy to prevent tendon rupture and lengthening of soft tissue

62
Q

Where does OA commonly occur in the hands?

A

DIP- Heberden’s nodes
PIP- Bouchard’s nodes
Rarely affects MCPs but can be secondary to other insult- 1st MCP most common.

63
Q

How do you treat OA in the hands?

A

Mild- remove osteophytes and mucous cysts
Severe- arthrodesis
General- steroid injections and joint replacement

64
Q

What is trigger finger?

A

Tendonitis of flexor tendon to digit. Formes nodule which gets stuck.

65
Q

How does trigger finger present?

A

Clicking sensation which is painful and can lead to locking.

66
Q

WHich fingers are most commonly affected by trigger finger?

A

Middle and ring

67
Q

How do you treat trigger finger?

A

Steroid injections round sheath and surgery to open sheath in recurrent cases.

68
Q

What is Dupuytren’s contractures?

A

Hyperplasia of palmar fascia which forms nodules and bundles leading to contractures of MCP and PIP

69
Q

Which fingers are most commonly affected by Dupuytren’s?

A

Ring and little

70
Q

Which abnormal type of collagen in present in Dupuytren’s?

A

Type 3 instead of type 1

71
Q

What are some potential causes of Dupuytren’s?

A

Alcohol cirrhosis, diabetes, male, phenytoin therapy, Peyronie’s disease and Ledderhose disease

72
Q

How do you treat Dupuytren’s?

A

Mild- Leave unless interfering with life in which case operate. Operation: remove all diseased tissue or divide cords.
Severe- Amputate

73
Q

WHat is the cut off for surgery in mild Dupuytren’s?

A

MCP over 30 degree flexion or and PIP flexion

MSK (17 decks)

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