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Clin Med I > arthritis and shoulder injuries > Flashcards

arthritis and shoulder injuries Flashcards

1
Q

hypertrophic arthritis

A
  • bone formation at site of involved joint
  • within confines of bone
  • protrusion of parent bone
  • commonly OA
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2
Q

erosive arthritis

A
  • indicates inflammation
  • tiny, irregularly shaped lytic lesions in or around joint surface
  • usually RA, gout, psoriasis
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3
Q

infectious arthritis

A
  • joint swelling, osteopenia, destruction of long contiguous segments of articular cartilage
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4
Q

psoriatic arthritis

A
  • 30% of pts with psoriasis
  • RF seronegative
  • enthesis and marginal bone erosions
  • “pencil in cup” deformity
  • joint subluxation and interphalangeal ankylosis
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5
Q

ankylosing spondylitis

A
  • chronic and progressive
  • RF seronegative
  • young males
  • symmetric fusion of SI joint and ascending involvement of spine -> decreased ROM and kyphosis
  • “bamboo sign” on x-ray
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6
Q

infectious arthritis

A
  • destructive
  • d/t seeding of synovial membrane from infectious source
  • prompt treatment required
  • either septic or nonpyogenic
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7
Q

common causes of septic infectious arthritis

A
  • staph

- gonococcal

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8
Q

common causes of nonpyogenic infectious arthritis

A
  • mycobacterium
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9
Q

risk factors for infectious arthritis

A
  • IV drug use
  • chronic steroids
  • joint replacement
  • recent joint trauma
  • DM
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10
Q

symptoms of infectious arthritis

A
  • monoarticular pain and swelling
  • decreased PROM and AROM
  • fever
  • will look VERY ill
  • purulent synovial fluid
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11
Q

diagnostic studies for infectious arthritis

A
  • CBC with diff
  • ESR, CRP
  • cultures
  • x-ray
  • MRI
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12
Q

treatment of infectious arthritis

A
  • I&D
  • abx
  • remove infecting source i.e. prosthesis
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13
Q

osteoarthritis

A
  • aka DJD
  • most common form of hypertrophic arthritis
  • primary, secondary, or erosive
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14
Q

modifiable risk factors for OA

A
  • muscle strength
  • physical activity/ occupation
  • joint injury
  • joint alignment
  • leg length inequality
  • obesity
  • diet
  • bone metabolism
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15
Q

non-modifiable risk factors for OA

A
  • age
  • sex
  • genetics
  • ethnicity
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16
Q

treatment for OA

A
  • pain control
  • PT
  • bracing
  • assistive device
  • viscosupplemetation
  • risk factor modification i.e. weight loss
  • surgery- arthroplasty or osteotomy
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17
Q

pain control options for OA

A
  • NSAIDs
  • APAP
  • steroids
  • bracing
  • topical options i.e. diclofenac
  • narcotics don’t have much of a role- short term use only
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18
Q

why does bracing help with pain in OA?

A
  • reduces muscle co-contractions and joint compression

- improves stability and function

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19
Q

when would you get an MRI for hip arthritis

A
  • if avascular necrosis is suspected d/t pain out of proportion to arthritic changes
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20
Q

viscosupplementation

A
  • hyaluronic acid found normally in synovial fluid and cartilage to act as lubricant and shock absorber
  • only FDA approved for knee “lubrication”
  • only give to physiologically young pts with less disease
  • synvisc or euflexxa
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21
Q

where do most clavicle fx occur?

A
  • middle third of clavicle

- rarely results in NV injury

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22
Q

clinical manifestation of clavicle fx

A
  • +/- deformity
  • TTP over fx site
  • pain with AROM and PROM especially in abduction and flexion
  • doesnt impact flex/ext of wrist
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23
Q

treatment of clavicle fx

A
  • sling
  • ice and NSAIDs
  • passive ROM at day 3
  • PT once fx healed
  • if displaced fx need ORIF
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24
Q

AC joint injury

A
  • usually d/t lateral force to lateral aspect of shoulder with arm adducted
  • acromion driven inferiorly and medially
  • high occurance in hockey
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25
Q

clinical manifestations of AC joint injury

A
  • pain and decreased ROM
  • TTP over AC joint
  • deformity depends on grade
  • cross arm test- elevate affected arm to 90 degrees then adduct; pain is pos
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26
Q

treatment of AC joint injury

A
  • depends on age/life style and grade of injury
  • grade I and II conservative tx
  • grade III +/- surgery
    grade IV-VI - surgery
  • joint stabilization with fixation at origin/insertion of ligament
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27
Q

grade I AC joint injury

A
  • sprain of AC ligament
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28
Q

grade II AC joint injury

A
  • tear of AC ligament
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29
Q

grade III AC joint injury

A
  • tear of AC and coracoclavicular ligament
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30
Q

sternoclavicular joint dislocation

A
  • uncommon
  • usually fall on abducted and extended arm
  • SCM pain/spasm
  • may not dislocate until days later
  • anterior more common than posterior
  • posterior requires surgery
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31
Q

proximal humerus fx

A
  • mainly in elderly
  • mostly impacted or nondisplaced d/t fall from standing
  • anterior or posterior dislocation of humeral head can occur (less common)
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32
Q

clinical presentation of proximal humeral fx

A
  • mod/ severe shoulder pain exacerbated by movement
  • swelling and ecchymosis
  • hold affected arm adducted
  • NV injury can occur if displacement occurs
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33
Q

treatment of proximal humeral fx

A
  • mainly conservative
  • sling
  • ice, analgesics
  • sleep in semi-recumbent chair
  • gentle ROM after 2 weeks
  • ROM of wrist/ elbow asap
  • if unstable ORIF or reverse TSR
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34
Q

what is the most common type of shoulder joint dislocation?

A
  • anterior (95% of the time)
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35
Q

shoulder joint dislocations

A
  • can lead to chronic instability (usually in younger pts)
  • atraumatic dislocations usually d/t laxity and repetitive
  • if it is posterior dislocation d/t fall from height, epileptic seizures, electric shock
36
Q

imaging for shoulder dislocations

A
  • AP
  • Axillary
  • Scapular Y
37
Q

clinical presentation of shoulder dislocations

A
  • deformity with humeral head dislocated anteriorly
  • shoulder adducted and IR
  • shoulder loses roundness
  • axillary nerve assessment
38
Q

treatment for shoulder dislocation

A
  • reduce ASAP
  • sling immobilization X 2 weeks with gentle ROM
    early PT to maintain ROM and strengthen RTC
39
Q

impingement syndrome

A
  • RTC tendonitis
  • pain d/t compression of tissues btwn humeral head and coracoacromial arch
  • usually recent hx of over activity
  • onset of pain with AROM, overhead movement
  • partial RTC tear is one of the most common reasons
40
Q

clinical presentation of impingement syndrome

A
  • pain sleeping on shoulder
  • pain with IR
  • TTP over greater tuberosity
  • +/- atrophy of supraspinatuous m
41
Q

hawkins test

A
  • tests for impingement syndrome
  • have pt in 90/90 flexion
  • stabilize top of shoulder while internally rotate shoulder
  • positive= pain
42
Q

imaging for impingement syndrome

A
  • AP
  • Lateral
  • Grashey
  • Scap Y
  • usually appears normal
43
Q

treatment for impingement syndrome

A
  • activity modification and PT
  • NSAIDs
  • steroids
  • surgery- arthroscopic acromioplasty with coracoacromial ligament release, bursectomy, debridement, RTC repair
44
Q

partial RTC tear

A
  • damaged RTC but not completely severed

- often heal by scarring

45
Q

full thickness RTC tear

A
  • separates all of tendon from bone
  • dont heal well
  • increase in size with time
  • usually require sx
46
Q

muscles of RTC and functions

A
  • supraspinatous- abduction
  • infraspinatous- ER
  • teres minor- ER
  • subscapularis- IR
47
Q

etiology of RTC tears

A
  • acute- FOOSH or pulling on shoulder

- chronic- repetitive over head movement or lifting

48
Q

clinical presentation of RTC tear

A
  • full thickness tear more symptomatic
  • weakness** or pain with overhead mvmt
  • pain at rest and night
  • crepitus
  • limited AROM
  • acute tears cause intense pain
49
Q

most commonly torn muscle of RTC

A

supraspinatous

50
Q

imaging for RTC tears

A
  • AP
  • Lateral
  • grashy
  • Scap Y
  • MRI
51
Q

partial RTC tear tx

A
  • 80% are nonsurgical

- PT

52
Q

full thickness RTC tear tx

A
  • usually sx

- PT for older sedentary pts

53
Q

indications for RTC sx

A
  • sx 6-12 mo
  • pt does overhead work/sports
  • large tear > 3 cm
  • significant weakness and loss of fn
  • tear d/t recent acute injury
54
Q

rehab after RTC sx

A
  • immobilization with no AROM 4-6 weeks
  • PROM at PT with start of AROM
  • strengthening 8-12 weeks
  • functional ROM and adequate strength usually by 4-6 months
55
Q

slap lesions

A
  • injury of glenoid labrum at point of attachment of long head of biceps
  • usually d/t FOOSH or throwing sports
  • type I- usually asymptomatic
  • type II and III- requires surgery
56
Q

study of choice for slap lesions

A
  • MRI
57
Q

adhesive capsulitis

A
  • minimal/ no trauma
  • pain out of proportion to clinical findings during inflammatory phase
  • stiffness during freezing phase
  • usually perimenopausal women
  • common with endocrine disorders
58
Q

clinical presentation of adhesive capsulitis

A
  • pain and decreased PROM and AROM
  • strength is normal but may appear decreased d/t pain
  • lasts about 24 mo
59
Q

treatment of adhesive capsulitis

A
  • NSAIDs
  • frequent PT
  • intra-articular steroid inj
  • +/- PO prednisone
  • surgery- manipulation and arthroscopic release
60
Q

calcific tendonitis

A
  • d/t deposition of calcium hydroxyapatite within tendon
  • usually middle aged women
  • diabetics at higher risk
  • most often in supraspinatus
61
Q

clinical presentation of calcific tendonitis

A
  • VERY painful shoulder
  • minimal/ no trauma
  • acute onset
  • pt looks in pain and tired
62
Q

imaging for calcific tendonitis

A
  • AP
  • Grashey
  • Scapular Y
63
Q

treatment for calcific tendonitis

A
  • analgesics/ anti- inflammatory
  • local steroid injection
  • PT
  • arthroscopy with aspiration of Ca deposit
64
Q

midshaft humerus fx

A
  • bimodal age distribution
  • males in 30s d/t high velocity trauma
  • females in 70s d/t low velocity falls
  • typically d/t direct blow or bending force
65
Q

clinical presentation of midshaft humerus fx

A
  • severe pain in mid arm
  • must assess for other injuries “distracting injury”
  • may have referred pain to shoulder/ elbow
  • swelling and ecchymosis
  • shortening of UE
  • assess for radial N
66
Q

radial nerve injury

A
  • weakness of wrist, finger, thumb ext
  • weakness of elbow supination
  • sensory loss on dorsum of hand
  • test motor fn by thumbs up and resisted thumb test
67
Q

treatment of midshaft humerus fx

A
  • may be nonsurgical in older pts- functional bracing

- ORIF if displacement or young pt

68
Q

elbow fx

A
  • usually d/t FOOSH
  • radial head fx, olecranon fx, or supracondylar humerus fx
  • marked by pain and decreased ROM
  • fat pad or sail sign on xray
69
Q

radial head fx

A
  • FOOSH with abducted arm and flexion of elbow joint
70
Q

radial head fx views

A
  • AP
  • external oblique
  • lat
71
Q

treatment for radial head fx

A
  • long arm splint 3-4 days
  • sling 1-2 weeks and gentle ROM
  • analgesics
  • serial xray 2 weeks post
  • PT
72
Q

olecranon fx

A
  • bimodal age distribution
  • high energy injury in young
  • low energy injury in old
  • direct blow -> comminuted fx
  • direct blow from FOOSH -> transverse or oblique fx
73
Q

olecranon fx presentation

A
  • pain in posterior elbow with palpable defect

- unable to extend elbow

74
Q

olecranon fx tx

A
  • ORIF with tension band

- plate and scrw

75
Q

elbow dislocation

A
  • mostly closed and posterior

- usually d/t FOOSH with hyperextension or posterolateral rotary mechanism

76
Q

treatment for elbow dislocation

A
  • simple- closed reduction
  • complex fx dislocation- ORIF
  • long arm posterior splint/ sling for 1-2 weeks
  • analgesia
  • PT
77
Q

lateral epicondylitis

A
  • tennis elbow
  • extensor tendons
  • pain with resisted wrist ext
78
Q

medial epicondylitis

A
  • golfer’s elbow
  • flexor tendons
  • pain with resisted wrist flexion
79
Q

epicondylitis clinical presentation

A
  • extra- articular elbow pain
  • insidious onset
  • pain can be minimal to debilitating
80
Q

treatment for epicondylitis

A
  • rest
  • ice massages
  • brace
  • NSAIDs
  • PT
  • cortisone
81
Q

both bones forearm fx

A
  • ratio of open to closed very high
  • direct trauma- protecting head
  • indirect trauma- MVA, fall from height, sports
  • gross deformity, pain and swelling
82
Q

treatment of both bones forearm fx

A
  • sugar tong splint in ED
  • casting if non-displaced (not common)
  • ORIF
83
Q

colles fx

A
  • fx of distal radial metaphyseal region
  • dorsal angulation
  • d/t FOOSH
  • extra-articular
84
Q

conservative tx for colles fx

A
  • closed reduction
  • sugar tong splint immobilization
  • long or short arm cast 4-6 weeks
85
Q

surgical tx for colles fx

A
  • ORIF then splint/cast 4-6 weeks
86
Q

smith fx

A
  • fx of distal radius with volar angulation
  • extra-articular transverse fx
  • reverse colles
  • d/t fall on flexed wrist
  • volar (cock- up) forearm splint

Clin Med I (16 decks)

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