MSK

Question 1

what is the physiological difference between OA vs RA vs Gouty Arthirtis?

Answer 1

OA: wear and tear (most common inflammatory disease)

RA: autoimmune response = swollen inflamed synovial membrane
**inflammation is the cause of damage

GA: auto immune response resulting in monosodium urate crystals in joints

Question 2

how to tell the difference between inflammatory vs mechanical pain?

Answer 2

INFLAMMATORY:
- worse after periods of rest
- pain improves with activity

MECHANICAL:
- pain worsens with activity
- gets better when she rests
- morning stiffness that goes away after 30 minutes

Question 3

what type of arthitis is this?

Answer 3

rheumatoid arthritis

Question 4

what are the joints in the upper limb (hand)?

Answer 4

list the joints

Question 5

what are some of the things that happens in arthritis?

Answer 5

1. decrease in joint space (loss in cartildge)
2. subchondral sclerosis
3. osteophyte formation

Question 6

what is trigger finger known as?

Answer 6

stenosing tenosynovitis

Question 7

what happens in stenosing tenosynovitis

Answer 7

1. tendon
   - tendon is rubs against sheath
   = tendon gets inflamed
   = tendon undergoes fibrosis
   = tendon grows a nodule
   = tendon cannot pass through the sheath
2. sheath that surrounds the tendon

Question 8

risk factors for trigger finger

Answer 8

1. prolonged and increased tension
2. tight gripping
3. pinch activities = case more stress at
   base of the finger
4. women
5. RA, gout, OA

Question 9

symptoms of early onset trigger finger

Answer 9

• painful to bend and straighten affected finger
• popping finger
• finger lock in bent position

Question 10

how to treat trigger finger

Answer 10

1. steroid injection (max 2 injections per finger)
2. trigger finger release surgery
3. diabetes which cause a buildup of AGE (advanced glycation end products)

Question 11

what is the finkelstein test

Answer 11

place thumb on the palm, and do ulnar deviation

Question 12

what happens when finkelstein tests

Answer 12

inflammation of extensor

Question 13

name the 3 peripheral nerves that are responsible for sensory distribution in the hands

Answer 13

left to right –> U M R

Question 14

identify the structures

Answer 14

nerve A: ulnar nerve
artery B: ulnar artery
structure C: FLEXOR RETICULUM
nerve D: median nerve
structure E: FLEXOR TENDONS

Question 15

which muscles are supplied by the median nerve in the hand?

Answer 15

LOAF

lateral 2 lumbricals
opponens pollicis
abductor pollicis brevis
flexor pollicis brevis

Question 16

tests for carpal tunnel

Answer 16

1. phalens test (wrists held in flexion)
2. tinnels test (electricity sensation through fingers during percussion over flexor retinaculum)
3. thenar and hypothenar eminences on both hands (observe for wasting of thenar muscles)
4. test for thumb abduction weakness
5. test for numbness for median nerve entrapment

ASK YOURSELF
- hypothyrodism?
- diabeties?

Question 17

is the carpal tunnel above or below the wrist?

Answer 17

above (nearer the fingers)

Question 18

what happens in carpal tunnel syndrome + what happens during carpal tunnel syndrome?

Answer 18

compression of the median nerve

surgery: cut the TRANSVERSE CARPAL LIGAMENT
= relieve pressure off the median nerve

Question 19

what happens in trigger finger
which tendon is usually affected?

Answer 19

A1 pulley

Question 20

what is the test for de quervain’s tenosynovitis?

Answer 20

finkelstein’s test

Question 21

what are the tests for carpal tunnel syndrome

Answer 21

1. tinel sign
2. phalen’s manuever