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63 Cards in this Set

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Epicondylitis:

- etiology
- general symptoms
Tendon degeneration (tendonosis) just distal to the epicondyle

Pain with contraction and ultimately pain at rest
T/F - Epicondylitis is associated with inflammation.
False
Epicondylitis PE:

- location of pain
- exacerbated by what actions x2
- numbness
- reflex
- sensations
Just distal to epicondyles
- lateral or medial

If lateral, extension of WRIST
If medial, flexion of WRIST

No numbness

Normal reflex

Normal sensations
Treatment of epicondylitis
1. Avoidance
2. Splint of WRIST (not elbow)
3. Surgery
4. NSAIDs
5. Steroids
Radial Tunnel Syndrome:

- etiology
Compression of Posterior Interosseus Nerve (PIN) as it enters the supinator/Arcade of Frohse.
What disease is Radial Tunnel Syndrome often misdiagnosed as?
Lateral Epicondylitis
Radial Tunnel Syndrome:

- symptoms x3
Pain 4 - 5 cm distal to lateral epicondyle
(worse with extension or resisted extension of wrist)

Piano key sign

Weakness to finger and thumb extensors
What is Piano key sign?
Resisted extension of the middle finger will reproduce pain.
On exam, Radial tunnel syndrome would manifest tenderness to palpation where?
Sulcus between ED and ECRB
What is the treatment for Radial Tunnel Syndrome?
1. Splint FOREARM

2. Maybe surgery
What type of steroids would apply in Radial tunnel syndrome?
NONE!

Don't you fucking give steroids for Radial Tunnel Syndrome
Cubital Tunnel Syndrome:

- AKA
- etiology
Ulnar nerve compression at the elbow

Compression of ulnar nerve at the elbow as it transverses under the Osborne's ligament
Cubital Tunnel Syndrome:

- Symptoms x4
- Symptoms at Late Phase
Medial Elbow pain

Numbness to ulnar (medial) two fingers

Frequently awaken at night with numbness

Persisten elbow flexion reproduce the symptoms.

LATE: Persistent numbness, weakness, and eventual atrophy
A physical exam for Cubital Tunnel Syndrome would manifest what? x3
1. Positive Tinel's over ulnar n.

2. Positive elbow flexion test

3. Absence of tenderness over medial epicondyle
(this is not epicondylitis)
Treatment for Cubital Tunnel Syndrome. x4
Avoidance

Night Splint

NSAIDs

Surgical decompression AND transposition of nerve anteriorly
What is the most common location for degenerative arthritis in the whole body?
Thumb
Thumb arthritis affects what two joints specifically?
CMC

TMC
Thumb arthritis:

- Symptoms x3
Pain to base of thumb

Pain to distal radial wrist

Pain to thenar
Thumb arthritis would manifest what on the physical exam
Positive Grind test

Positive Pinch test
What are the NON surgical options for Thumb arthritis? x3
Avoidance

Splint

NSAIDs

Steroids (inject into TMC)
What are the surgical alternatives for thumb arthritis? x3
Fusion (for younger, active pts)

LRTI

Prosthetic replacement
What is the diagnostic tool for thumb arthritis?
X-ray
Scaphoid bone:

- Composition
- Vasculature
80% cartilage

Tenuous Retrograde Vascular
Most common wrist fracture?
Scaphoid fx
HPI on a scaphoid fracture would reveal what?
Hx of forceful wrist extension

Pain to radial wrist

Tenderness to Snuff box and Distal pole.
Treatment for Scaphoid fracture.
Thumb spica splint

Return 2 weeks later for recheck and a reX-ray
Mallet finger:

- etiology
Loss of integrity of distal extensor tendon
Mallet finger:

- HPI would reveal what? x4
Hx of "jamming" or laceration of finger

Pain with resisted extension

Tenderness to DIP dorsum

Flexion deformity at DIP
Treatment for Mallet finger?
Splint DIP in extension
Boutonniere Deformity:

- etiology
Rupture of central slip at PIP
Boutonniere Deformity:

- HPI would reveal what? x3
Hx of "jamming" or laceration injury

GRADUAL formation of deformity

Elman's Test positive
What is Elman's test?
Hold finger over table, flexed at PIP over edge.

While securing middle phalanx, ask patient to extend finger.

Normally, the distal phalanx remains floppy.

A positive would show a hyperextension of the distal phalanx.
Tx of Boutonniere Deformity?
Splint in extension.

Make sure affected joint has normal PASSIVE ROM
In treating Boutonniere Deformity, what must you be sure of?
That the affected joint for normal PASSIVE ROM
Carpal Tunnel Syndrome:

- etiology
Compression of median nerve as it passes through the inexpansible carpal tunnel

AND

associated Tenosynovium
Define tenosynovium
Inflammation of tendon and its enveloping sheath
HPI of carpal tunnel syndrome would indicate what? x6
Associated with DM and hyperthyroidism

Pain to radial 3.5 digits

Exacerbated by activity

Numbness to radial 3.5 digits

Increased pain + numbness 2 - 3 hours after going to bed

Shoulder pain (70%)
What would a physical exam indicate for Carpal Tunnel syndrome? x4
Thenar (fasciculations, weakness, and atrophy)

Tinel's test (positive)

Digital Compression Test (positive)

Phalen's Test (positive)
What is Phalen's test?
Max wrist flexion (reverse pray) for 60 seconds will indicate pain, numbness, and tingling at median innervated digits for someone with carpal tunnel syndrome?
What is the treatment for carpal tunnel syndrome? x5
Avoidance
Splint
Surgery

NSAIDs
Steroids
DeQuervain Tenosynovitis:

- etiology
Inflammation of the tenosynovium at the 1st dorsal compartment (Abductor Pollicis Longus / Extensor Pollicis Longus)
DeQuervain Tenosynovitis:

- Hx/symptoms
- Radiation
- Exacerbation
Pain a the radial styloid

radiating proximally and distally

by activity, but later occurs all the time
DeQuervain Tenosynovitis:

- Exam reveals what? x3
Pain with thumb extension

Tenderness to 1st dorsal compartment

Finkelstein test Positive
What is the Finkelstein test?
Make fist with thumb on the inside. Tilt thumb towards ulnar.

Pain means positive.
Treatments for DeQuervain Tenosynovitis.
Avoidance
Splint
(Thumb spica with wrist immobilized)

Surgery

NSAIDs
Steroids
Ganglia:

- etiology
- Hx
Ganglion cysts (with thick fluid)

Spontaneous lump
(+/- pain)
(can pretty much appear anywhere)
Treatment of ganglia
Benign Neglect (PRIMARY)

Aspiration/Injection
(Recurrence high)

Excision
(Recurrence high, unless stalk also removed in which case the recurrence would be lower)
Trigger finger:

- AKA
Stenosing Tenosynovitis
Trigger finger:

- etiology
Repetitive, forceful grasping causes INFLAMMATION to:

- Flexor tendons
- Tendon sheaths
- Associated Tenosynovium
Trigger finger:

- history x2
Progressive pain along line of tendon in the palm

Progressive locking
Trigger Finger:

- Exam x4
1. Tender flexor tendon @ A1 pulley

2. Triggering with pressure over A1 pulley

3. Pain with resisted flexion of FDS tendon

4. Palpable nodule in flexor tendon
Trigger Finger:

- Treatment
Avoidance (sorbothane bicycle glove)

Splint

Surgery (release A1 pulley)

NSAIDs

Steroids
Match the following with the disease:

- Piano sign
Radial Tunnel Syndrome
Match the following with the disease:

- Tinel's sign
- Elbow Flexion test
Cubital Tunnel Syndrome
Match the following with the disease:

- Grind Test
- Pinch Test
Thumb arthritis
Match the following with the disease:

- Elman's Test
Boutonniere's Deformity
Match the following with the disease:

- Thenar (fasciculation, weakness, and atrophy)
- Tinel's sign
- Digital Compression Test
- Phalen's Test
Carpal Tunnel Syndrome
Match the following with the disease:

- Finkelstein Test
DeQuervain Tenosynovitis
Match the following with the disease:

- Wrist splint
Epicondylitis
Match the following with the disease:

- Forearm splint
Radial Tunnel Syndrome
Match the following with the disease:

- Night splint
Cubital Tunnel Syndrome
Match the following with the disease:

- Splint finger in extension x2
Mallet finger

Boutonniere's deformity
(make sure full, passive ROM)
Match the following with the disease:

- Thumb spica + immobilize wrist
DeQuervain Tenosynovitis