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MSK > Acute Upper Extremity Conditions > Flashcards

Acute Upper Extremity Conditions Flashcards

1
Q

Clavicle fracture

A 
1. Hx: 
  A. Trauma, fall on shoulder
  B. Birth
2. Physical exam
  A. Inspection: step-off fx 
  B. Palpation
  C. Neurovascular exam
    1. Sensation
    2. Strength
    3. Pulses - bilateral
  D. Imaging
3. Tx: 
  A. Sling, ROM and weight bearing restrictions
  B. Displacement = refer to ortho
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2
Q

AC joint injury grades

A
  1. Grade I: AC sprain
  2. Grade II: complete AC injury, incomplete CC injury
  3. Grade III: complete AC and CC injury
  4. Grade IV-VI: displacement of clavicle of inc severity
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3
Q

AC joint injury

A
  1. Hx: trauma
  2. Physical
    A. Inspection: step-off deformity
    B. Palpation
    C. Special tests:
      • scarf test (AC joint test)
    2. O’Brian’s test
    3. Active compression or AC joint add until next
      D. Imaging
  3. Tx:
    A. Grade I-II = conservative
    B. Grade III-VI = orthopedic referral
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4
Q

General shoulder exam

A 
1. Physical exam
  A. Inspection
  B. Palpation
  C. ROM
  D. Muscle strength of rotator cuff muscles
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5
Q

Glenohumeral dislocation

A
  1. Hx:
    A. Trauma
    B. 95% ant direction (if post, think seizure or electric shock)
  2. Complications:
    A. Nerve injury (axillary)
    B. Brachial artery/plexus injury
    C. Recurrent dislocations/instability
    D. Glenoid labrum injuries -> chronic probs
    E. Hill-Sachs/Bankart lesions
  3. Physical Exam
    A. Inspection: depression
    B. Palpation: feel humeral head
    C. Neurovascular check
    D. Special tests:
      • apprehension test/relocation test
      • sulcus sign - gently pull arm down
        E. Imaging: X-ray before reduction
  4. Tx: sling for immobilization, referral to ortho
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6
Q

Hill-Sachs lesion

A

Fracture of humeral head

1. Posterolateral aspect humeral head compresses against ant glenoid rim

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7
Q

Bankart lesion

A

Allusion of anteroinferior glenoid labrum at inferior glenohumeral ligament

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8
Q

Rotator cuff tear

A 
1. Hx: 
  A. Pain worse at night
  B. Stiffness, catching, clicking, pain
  C. Pain/weakness w/ overhead activity and lifting away from body
2. Physical exam
  A. Inspection
  B. Palpation
  C. ROM
  D. Muscle strength testing
  E. Special tests
    1. Painful arc
    2. Drop arm test
  F. Imaging: MRI/ultrasound 
3. Tx 
  A. Conservative vs. operative 
  B. Conservative for partial-thickness or asymptomatic tears
  C. Conservative for older patients w/ full-thickness w/ lower fxnal demand
  D. Referral to ortho if no improvement w/ conservative tx (ASAP young pts, athletes, trauma needs surgery)
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9
Q

Biceps tendon rupture

A 
1. Hx:
  A. Labradoodles pathology/biceps tendinopathy
  B. Weight lifters, machinist
  C. Heard a pop
2. Physical exam
  A. Inspection: Popeye deformity
  B. Palpation
  C. Neurovascular checks
  D. Muscle strength
  E. Special tests: 
    1. Hook test
    2. Squeeze test
    3. Yergason’s test
3. Tx: not always operation
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10
Q

Humeral fracture

A 
1. Complications 
  A. Surgical neck - axillary n.
  B. Radial groove - radial n. 
  C. Distal end of humerus - median n.
  D. Medial epicondyle - ulnar n.
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11
Q

Distal radius fracture

A 
Colle’s fracture
1. Hx: 
  A. Elderly
  B. FOOSH injury
2. Complications
  A. Median n. Entrapment at wrist
3. Physical exam: 
  A. Inspection
  B. Palpation: step-off
  C. Neurovascular exam
4. Tx: 
  A. Ortho referral
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12
Q

Scaphoid fracture

A
  1. Hx: FOOSH
  2. Complications:
    A. Avascular necrosis
    B. Nonunion
  3. Physical exam:
    A. Inspection
    B. Palpation
    C. ROM: pain worsens w/ wrist extension and abduction of hand
  4. Imaging:
    A. X-ray initially, may need repeat 10-14 days later
  5. Tx
    A. Thumb spica splint
    B. Repeat x-ray
    C. Displacement = operative to
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13
Q

Metacarpal and phalanges fractures

A
  1. Hx: trauma
  2. Physical exam
    A. Inspection
    1. Hematoma
    2. Overlapping fingers
      B. Palpation
  3. Tx:
    A. X-ray before reduction/splint
    B. Antibiotics?
    C. Referral to ortho
    1. Angulation or rotation
    2. Metacarpal shortening
    3. Intra-articular involvement
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14
Q

Gamekeeper thumb

A 
1. Hx: 
  A. Aka: Skier’s thumb
  B. Damage to ulnar collateral lig (UCL) on 1st MCP joint
  C. Hyperabduction of thumb
2. Physical exam
  A. ROM
  B. Special testing: laxity noted w/ valgus testing
3. Tx:
  A. X-ray
  B. Splint w/ thumb spica
  C. Ortho referral
  D. Complete tears = surgery
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15
Q

Jersey finger

A
  1. Hx:
    A. Trauma
    B. Forced extension while actively flexing
    C. Rupture of FDP tendon at DIP
  2. Physical exam
    A. Inspection: at rest, finger extended
    B. Palpation: pain at DIP
    C. Strength: weakness on distal finger flexion
  3. Imaging
  4. Tx:
    A. X-ray
    B. Splint
    C. Referral to ortho for reattachment of tendons w/in 7 days
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16
Q

Mallet finger

A
  1. Hx:
    A. Trauma
    B. Aka: baseball finger
    C. Forces flexion at DIP while actively extending
  2. Physical exam:
    A. Inspection: at rest, finger appears flexed
    B. Palpation: pain at DIP joint
    C. Strength: weakness on distal finger extension
  3. Tx:
    A. X-ray
    B. Ortho referral
    C. Splint in extension, no flexion 6 weeks
    D. Usually doesn’t require surgery
  4. Complications:
    A. Swan neck deformity

MSK (13 decks)

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