Ortho - Forearm/wrist/hand
1. What is lateral/medial epicondylitis?: - tenderness over the lateral or medial epicondyle
2. What is the most successful treatment for lateral/medial epicondylitis?: Physical
therapy & activity modification is MORE successful than anti-inflammatory agents
3. Where is pain usually felt for lateral epicondylitis?: - at the "extensor wad" with arm,wrist
extension (grip)
- known as 'tennis elbow"
4. Where is pain usually felt for medial epicondyltisis?: - pain with pronation or wrist flexed
- "golfer's elbow"
5. What type of imaging is used to diagnose lateral/medial epicondylitis?: X-rays
are used
- MRI/US are only used to identify muscle tears
6. What is the treatment for lateral/medial epicondylitis?: 1. Activity modification and PT
- ice, NSAIDs, bracing
2. Refer to Ortho after 6 months of conservative therapy (PT) with NO improvement for surgical debridement or tendon
,repair
7. What is 2nd line treatment after PT for lateral/medial epicondylitis?: PRP injections
8. What are the symptoms of carpal tunnel syndrome?: - pain, burning, tingling in distrib-
ution of the median nerve (along forearm)
- increased pain with manual activity (extreme volar flexion or dorsiflexion)
- usually most pain during sleep
- weakness/atrophy of thenar eminence
9. Who is carpal tunnel syndrome MC in?: - pregnant patients
- DM
- rheumatoid arthritis
10. Which ligament is usually affected in carpal tunnel syndrome?: - transverse carpal
ligament
11. What appears on PE of carpal tunnel syndrome?: - + Tinel's sign
- + Phalen's sign
- +carpal compression test
Eventually also muscle weakness or atrophy at thenar eminence along with sensory deficits
, 12. What type of imaging is used to confirm a diagnosis of carpal tunnel syn-
drome?: Electromyography (EMG) and nerve conduction studies, as they reveal sensory delay
13. What is the treatment for carpal tunnel syndrome?: 1. Modify hand activities by splinting
in neutral for 3 months
- relieve pressure on the median nerve
- methylprednisone injection may also help
2. If failed conservative management, symptoms last more than 12 months, moderate or worse symptoms, or positive
electrodiagnostic test, open or endoscopic carpal tunnel release surgery is indicated
Refer to ORTHO is smyptoms last more than 3 months despite conservative treatment and use of wrist splint or if thenar
muscle weakness or muscle atrophy develops
14. Describe the contents of the carpal tunnel.: - 4 flexor digitorum superficialis tendons
- 4 flexor digitorum profundus tendons
- 1 flexor pollicis longus tendon
- Median nerve
15. What is Dupuytren Contracture?: - benign fibrosing, atraumatic disorder of the palmar fascia
- contracture of one or more fingers that leads to limited hand function
1. What is lateral/medial epicondylitis?: - tenderness over the lateral or medial epicondyle
2. What is the most successful treatment for lateral/medial epicondylitis?: Physical
therapy & activity modification is MORE successful than anti-inflammatory agents
3. Where is pain usually felt for lateral epicondylitis?: - at the "extensor wad" with arm,wrist
extension (grip)
- known as 'tennis elbow"
4. Where is pain usually felt for medial epicondyltisis?: - pain with pronation or wrist flexed
- "golfer's elbow"
5. What type of imaging is used to diagnose lateral/medial epicondylitis?: X-rays
are used
- MRI/US are only used to identify muscle tears
6. What is the treatment for lateral/medial epicondylitis?: 1. Activity modification and PT
- ice, NSAIDs, bracing
2. Refer to Ortho after 6 months of conservative therapy (PT) with NO improvement for surgical debridement or tendon
,repair
7. What is 2nd line treatment after PT for lateral/medial epicondylitis?: PRP injections
8. What are the symptoms of carpal tunnel syndrome?: - pain, burning, tingling in distrib-
ution of the median nerve (along forearm)
- increased pain with manual activity (extreme volar flexion or dorsiflexion)
- usually most pain during sleep
- weakness/atrophy of thenar eminence
9. Who is carpal tunnel syndrome MC in?: - pregnant patients
- DM
- rheumatoid arthritis
10. Which ligament is usually affected in carpal tunnel syndrome?: - transverse carpal
ligament
11. What appears on PE of carpal tunnel syndrome?: - + Tinel's sign
- + Phalen's sign
- +carpal compression test
Eventually also muscle weakness or atrophy at thenar eminence along with sensory deficits
, 12. What type of imaging is used to confirm a diagnosis of carpal tunnel syn-
drome?: Electromyography (EMG) and nerve conduction studies, as they reveal sensory delay
13. What is the treatment for carpal tunnel syndrome?: 1. Modify hand activities by splinting
in neutral for 3 months
- relieve pressure on the median nerve
- methylprednisone injection may also help
2. If failed conservative management, symptoms last more than 12 months, moderate or worse symptoms, or positive
electrodiagnostic test, open or endoscopic carpal tunnel release surgery is indicated
Refer to ORTHO is smyptoms last more than 3 months despite conservative treatment and use of wrist splint or if thenar
muscle weakness or muscle atrophy develops
14. Describe the contents of the carpal tunnel.: - 4 flexor digitorum superficialis tendons
- 4 flexor digitorum profundus tendons
- 1 flexor pollicis longus tendon
- Median nerve
15. What is Dupuytren Contracture?: - benign fibrosing, atraumatic disorder of the palmar fascia
- contracture of one or more fingers that leads to limited hand function
