Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSS > 16 Clinical Correlation of Upper Extremity > Flashcards

16 Clinical Correlation of Upper Extremity Flashcards

1
Q

most commonly fall directly onto shoulder
Pain with overhead motions, deformity of superior
shoulder

A

Acromioclavicular (AC) sprains

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Pain with cross body adduction of arm (positive cross-chest
test)
Painful arc of abduction over 150°

A

Exam finding for AC sprain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Exam finding for AC sprain

A

pain with cross body adduction, painful overhead motions, deformity of superior shoulder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Grade I for AC

A

AC ligament stretch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Grade II for AC

A

AC ligament tear and coronoid-clavicular (CC)

ligament stretch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Grade III for AC

A

complete tears of both AC & CC ligaments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Grades IV+ for AC

A

complete tears + clavicular displacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Tx options for AC Grades
I and II
III
IV

A

Non-operative – grades I & II

b) Operative grade IV+
c) Either – grade III

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

most common dislocation of shoulder

A

anterior dislocatoin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

a) Forced extension, abduction and external rotation of the
arm (e.g. open arm tackle or fall onto abducted arm
b) Direct blow to posterior shoulder

A

Will cause anterior shoulder dislocation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pt comes in with arm held in opposite hand in slight abduction and external rotation. He doesn’t want to abduct his arm and doesn’t want to internally rotate

A

Shoulder dislocation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What would you expect the shoulder to look like on shoulder dislocation

A

(1) Prominent acromion
(2) Humeral head anterior to acromion and adjacent to
coracoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How can you test a patient for shoulder dislocation?

A

Positive apprehension test – feeling of instability with
stressing of the joint (note – feeling of pain is not a positive test; this test is done when patient is currently reduced/in normal anatomical alignment – not when dislocated)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What neurovascular structures should we worry about in a shoulder dislocation?

A

axillary & musculocutaneous nerves -sensation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How do we tx a non-surgical acute shoulder dislocation?

A

Non-operative - immobilization with sling and
watch for 3 to 4 weeks for young adult; for older adult
sling for comfort and gentle mobilization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When would we consider surgical measures for a shoulder dislocation?

A

consider for adolescent athlete and high

level athletes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Radiology for shoulder dislocation?

A

multi-planar x-rays

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Pt comes in with pain on overhead arm movement

A

Rotator cuff injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What 3 impingement tests can we do if we expect a rotator cuff injury?

A

(1) Neer’s test – pain when arm is elevated through
forward flexion
(2) Empty can test (Jobes) - arms (vertically) abducted
to 90°; 30° horizontally adducted; thumbs down to
floor; push downward to floor against resistance
(3) Hawkins Test - pain with resisted external rotation
with elbow flexed and across body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is a Neers test

A

pain when arm is elevated through forward flexion

–for rotator cuff injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is an Empty Can test?

A

arms (vertically) abducted
to 90°; 30° horizontally adducted; thumbs down to
floor; push downward to floor against resistance
–for rotator cuff injuy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Hawkins Test -

A

pain with resisted external rotation
with elbow flexed and across body
–for rotator cuff injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Rotator cuff weakness; patient has profound weakness when abducting their arm; may even drop it

A

possible complete tear of rotator cuff: via drop arm test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What degree of abduction is painful for rotator cuff injuries?

A

Painful arc of abduction (80° to 120°)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Tender at insertion of supraspinatus tendon on greater

tuberosity of humerus

A

rotator cuff injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Treatment for rotator cuff injuries

A

a) Non-operative for small tears and tendonopathies

b) Surgical for large tear or in a younger athletic patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Pt comes in complaining of painful, stiff shoulder

A

Adhesive capsulitis; frozen shoulder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Etiology of frozen shoulder -

A

complication of many injuries including dislocation,

rotator cuff tendinitis, reflex sympathetic dystrophy and fractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What do we expect to see on exam with a pt with a frozen shoulder?

A 
limited passive (& active) ROM – especially noted in 
external rotation
30
Q

Treatment for adhesive capsulitis

A
  • time - often resolve in 1-2 years

younger patients better prognosis of spontaneous resolution

31
Q

Pt comes in with pain on medial elbow and secondary weakness. ON exam, they state tenderness over medial epicondyle and pain with resisted wrist flexion and forearm pronation

A

Medial epicondylitis “golfer’s elbow”

32
Q

Etiology of medial epicondylitis

A

overuse of the wrist flexors - (especially - pronator teres

and flexor carpi radialis)

33
Q

– overuse from repetitive extension (especially - extensor

carpi radialis brevis)

A

Lateral epicondylitis

34
Q

pain over lateral elbow radiating into forearm; late -

weakness

A

lateral epicondylitis or tennis elbow

35
Q

Signs of lateral epicondylitis:

A

tenderness over lateral epicondyle; pain with resisted wrist
dorsiflexion & middle finger extension

36
Q

tenderness over lateral epicondyle; pain with resisted wrist
dorsiflexion & middle finger extension

A

Lateral epicondylitis

37
Q

Pt had a fall on outstretched hand and is experiencing tenderness in anatomic snuffbox

A

scaphoid frx

38
Q

What radiology tests do we order when we expect a scaphoid fracture?

A

Radiology – often need to consider MRI, CT or bone scan

39
Q

Etiology of carpal tunnel

A

irritation of the median nerve in carpal tunnel

40
Q

Tingling & pain in median nerve distribution
(1) Especially at night - frequently accompanied by
numbness

A

carpal tunnel syndrome

41
Q

Early Signs of carpal tunnel

A

a) Tinel’s sign - percussion over the carpal tunnel reproduces symptoms
b) Phalen’s sign - wrists are held in maximal flexion for 1
minute reproducing symptoms
c) Sensory loss of the radial 31/2 fingers

42
Q

Late findings of carpal tunnel

A

thenar eminence atrophy and loss of 2 point discripination

43
Q

overproduction of fluid by a joint of tendon sheath

a) Filled with thick gelatinous material

A

wrist ganglion

44
Q

pt has a firm but mobile lump in her wrist, what’s the tx

A

wrist ganglion:

a) Typically clinically observation
b) Aspiration – if painful, but often reoccurs
c) Surgery – for definitive treatment, but still may recur

45
Q

Recommend tx for fractures

A
  1. immobilization

2. avoid NSAIDs: may interfere with bony healing via PGs

46
Q

Initial tx of patient with broken scaphoid

A

immobilization

47
Q

What is a worry with a scaphoid frx

A

its a watershed region and can disrupt blood supply and become necrotic. certain areas are more sensitive to blood loss then others

48
Q

What are the contents of the snuffbox

A

Radial nerve and artery; parathesis on back of thumb
Cephalic vein
scaphoid bone

49
Q

What do we worry about with a femoral head fracture

A

medial circumflex supplies most of femoral head. we worry with a frx to femoral head that we will impede the blood supply from this area: key for head and neck of femur

50
Q

Pt presents with significant crepitus, pain with motions but has almost FROM, stregth WNL and positive apprehension sign… shes 16 yo with recurrent shoulder pain and self reduced her dislocated shoulder at home

A

pt has arthritis (crepitus and history of dislocations) if it was rotator cuff tendinitis she wouldn’t have FROM

51
Q

What would we see in the history of pt with arthritis?

A

stiffness, especially after rest and worse after prolounged use

52
Q

What would the exam findings would you expect from someone with arthritis

A

joint line tenderness, mild swelling, deformity, symptoms with both passive and active motions
see damage to articular cartiledge

53
Q

Capsulitis history

A

Limited ROM
Painful earl with decreased ROM (freeze phase)
non-painful with stable, decreased ROM (frozen phase)
Non-painful with improving ROM (thawing phase)

54
Q

Risk factors for capsulitis

A

injury, diabetes, thryoid disease

55
Q

What to look for on MRI of capsulitis

A

see brighter white signal in the inferior aspect of joint capsule signifying joint inflammation

56
Q

Tx for capsulitis

A

reassurance, educate and set expecation, maintain ROM and pain control
takes 2-3 years to get back to normal, keep using the arm

57
Q

Pt hear their shoulder pop and now has a bulge in biceps area, most likely diagnosis

A

Long head biceps tendon rupture

58
Q

Key signs in exam of long head biceps rupture

A

see a furrow by the deltiod where the tendon usually is and the bulge is more distal on the arm

59
Q

Best tx for a tx of long head biceps tendon rupture

A

do nothing
Ask: what impact does missing muscle action have, are there altenative muscles, what are the functional requirements of my patient

60
Q

disorder of muscular or tendinous bony attachment

A

enthesopathy; type of musculoskeletal injury

61
Q

technically acute inflammation of tendon

–often dt a blow or pull

A

Tendinitis

62
Q

chronic degenerative condition of tendon; seen with submaximal repetitive irritation

A

Tendinosis

63
Q

Pt presents with pain in left elbow, got hit with golf ball, has 2 cm area of pain over distal humerus and lateral proximal radius.
pain persists with wrist and middle finger extension and with supination
no pain with varus or valgus stress

A

Lateral epicondylitis

64
Q

Causes of Muscle strain

A 
muscle fiber damage from overstretching: 
eccentric loading (muscle lengthening during firing)
65
Q

Syptoms of muscle strain

A

stiffness, bruising, swelling, soreness

66
Q

What situations are NSAIDS most favorable

A

Acute patellar tendinitis

67
Q

Pt fell right onto shoulder. Has pain with overhead motions and deformity of superior shoulder.
On exam has pain and deformity of AC joint, pain with cross body adduction of arm and painful arc of abduction over 150 degrees

A

Acromioclavicular (AC) sprain

68
Q

Microscopic damage with no increased laxity, but pain with stress

A

Grade I Sprain

69
Q

Partial tear with increased laxity and pain

A

Grade II sprain

70
Q

Complete tear with significant laxity

A

Grade III sprain

71
Q

What structures do we worry about getting damaged in anterior shoulder dislocation?

A

Axillary nerve: deltoid is innervated by axillary so check for abduction past 30 degrees (supraspinatous does first 30 degrees of abduction)
also have the musculocutaneous: check skin over deltiod and the skin on arm

72
Q

What is our most effective passive stabilizer

A

vacuum phenomena

MSS (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions