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MM1 Leesy > B6.085 - Common Pathologic Conditions of Upper Extremity > Flashcards

B6.085 - Common Pathologic Conditions of Upper Extremity Flashcards

1
Q

Dupuytrens contracture

A

relatively common disorder characterized by progressive fibrosis of palmar fascia with an unknown etiology

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2
Q

associations with dupuytrens contracture

A

northern european genetics smoking drinking DM thyroid disease >50 yo M>F repetitive palmar trauma w vibration

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3
Q

clinical dx of dupuytrens contracture

A

gradual onset begins as one or more smaller tender lumps on palm pain resolves w time, nodules thicken and contract tough bands of tissue may form may result in loss of full extension 4th and 5th fingers commonly affected

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4
Q
A

dupuytrens contracture

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5
Q

tx for dupuytrens contracture

A

mild - padding, steroid injection

progressive - surgical removal of fibrotic adhesions, steroid injection

injection of clostridia histolyticum collagenased <50 degrees

minimal surgical lysis of adhesions has also been done

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6
Q

mallet finger deformity

A

injury frequentyl acquired when attempting to catch a ball and impact causes sudden flexion of DIP of an extended finger

most common closed tendon injury of finger

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7
Q

mechanically what is mallet finger

A

traumatic disruptio of terminal slip of extensor tendon at distal interphalangeal (DIP) joint

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8
Q

treatment of mallet finger

A

splinting 6-8 weeks if uncomplicated, immobilization with slight hyperextension 5-15 degrees

comlicated injuries require referral and likely surgical repair

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9
Q
A

mallet finger

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10
Q

jammed finger

A

prolonged swelling of proximal interphalangeal joint after an axial loading force

diagnosis of exlusion

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11
Q

signs of more serious injury than jammed finger

A

deformity

significant swelling

significant bruising

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12
Q

treatment of jammed finger

A

conservative management, early ROM important

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13
Q

trigger finger

A

the flexor tendon catches in what is called the first annular (A1) pully of the MCP causing a snapping, catching or locking when flexing finger

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14
Q

features of trigger finger

A

pain in palm at entrance to flexor tendon sheath

usually worse in AM improving throughout day

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15
Q

risk factors of trigger finger

A

DM, age, female

dx is clinical

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16
Q

treatment for trigger finger

A

conservative - splinting, NSAIDs, modify repetitive activity

Injection of steroids

surgery if conservative fails, release of A1 pully

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17
Q
A

trigger finger

flexor tendon catches on what is called A1 first annular MCP

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18
Q

gamekeepers thumb

A

forced abduction of the thumb can result in rupture of ulnar collateral ligament

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19
Q

exam for gamekeepers thumb

A

tenderness overlying the ulnar aspect of the MCP joint of the thumb

swelling

laxity of 30-40 degrees more than the uninjured thumb measured in neutral and 30 degrees of flexion are strongly suggestive of a complete ulnar collateral ligament tear

no end point in radial deviation of the phalanx

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20
Q

test for gamekeepers thumb

A

stressing ulnar collateral ligament of MCP joint

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21
Q

treatment of gamekeepers thumb

A

thumb spika cast or splint

may need surgical referral if there is avulsion fracture

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22
Q

carpal tunnel syndrome

A

nocturnal parasthesia worsened by gripping activities like holidng a phone, gripping steering wheel, writing

weakness of grip

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23
Q

risk factors for carpal tunnel

A

female

pregnancy

DM

obesity

RA

hypothyroid

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24
Q

what type of neuropathy is carpal tunnel

A

median nerve neuropathy

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25
Q

describe carpal tunnel as it relates to anatomy

A

unique anatomy of the median nerve as it passes through the “carpal tunnel”, increased pressure in this confined area can lead to nerve compression and subsequent neuropathy

overuse syndromes seem to cause edema and lead to compression

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26
Q

testing for carpal tunnel

A

tinel test (TAP) , phalen test (FLAP)

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27
Q

what is the tinel test

A

test for carpal tunnel

examiner taps over the wrist at the point where the median nerve passes through

tapping creates electric or sharp pain and tingling in hand, 50% sn 77% sp

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28
Q

what is the phalen test

A

patient flexes wrists with the elbows raised and the backs of the hands pressed together for 1 minute

positive is pain or tingling in median nerve distribution

sn 68% 73%sp

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29
Q

confrimatory testing for carpal tunnel

A

electromyography or nerve conduction studies

not absolutely needed until surgery is a consideration

imaging is generally not useful in providing additional information

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30
Q

treatment for carepal tunnel

A

conservative

Night bracing

ice

rest

NSAIDs

steroid injections

surgical release

sono guided techniques, open surgical

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31
Q

ulnar neuropathy at the wrist

A

compression of ular nerve at wrist

clasically seen in cyclists due to pressure from handlebars

32
Q

treatment for ulnar nerve neuropathy

A

padding, gloves or handlebars

NSAIDs

Ice

33
Q

scaphoid fracture

A

scaphoid most commonly fractured bone in wrist

34
Q

avascular necrosis of proximal scaphoid

A

complication of even the smallest amount of displacement in scaphoid fracture

blood supply from scaphoid comes from radial artery, feeding the bone on the dorsal surface near tubercle and scaphoid waist. Because the proximal portion has no direct blood supply, nonunion caused by poor blood supply is an important complication of scaphoid fracture

35
Q

treatment and dx of avascular necrosis of proximal scaphoid

A

surgical treatment recommended

can be difficult to diagnose, snuffbox tenderness most sensitive (90%)

scaphoid tubercle tenderness 87% sn, 57% sp

high index of suspicion with tenderness and negative x ray

36
Q
A

avascular necrosis of proximal scaphoid

37
Q
A

scaphoid fracture

38
Q

nursemaids elbow

A

radial head dislocation usually due to pulling small childs arm

history is key

child with arm held limp and partially flexed

39
Q

exam for nursemaids elbow

A

apprehensive

inspection frequently unremarkable

palpation shows tenderness over lateral aspect (radial head)

ROM - wait until x rays

40
Q

nursemaids elbow reduction

A

apply pressure at radial head

grasp wrist and apply slight traction

supinate wrist while flexing elbow to 90 degrees

41
Q

medial epicondylitis and lateral epicondylitis

A

repetitive motion with either extension (lateral) or flexion (medial)

42
Q

predisposing factors to epicondylitis

A

age 45-50

smoking

obesity

43
Q

what is the difference between tendititis and tendinosis

A

tendinitis is inflammation of the tendon and results from micro tears and tendinosis is a degenration of the tendons collagen in response to chronic overuse

44
Q

presentation of epicondylitis

A

pain with tenderness at insertion of tensions on epicondyle

45
Q

presentation of lateral epicondylitis

A

pain with resisted extension at wrist, supination of hand

46
Q

presentation of medial epicondylitis

A

pain with resisted flexion of wrist and pronation of hand

47
Q

treatment for epicondylitis

A

conservative

splinting, activity modification, counterforce bracing, NSAIDs, physical therapy, surgery last resort

48
Q
A
49
Q

describe examination of the shoulder

A

inspect symmetry

palpate Acromion, AC joint, coracoid, major bones

ROM

50
Q

anatomy of rotator cuff

A

SItS

Supraspinatus

Infraspinatus

teres minor

Subscapularis

51
Q

what does the supraspinatus do

A

inn by suprascapular n

abducts arm initially before action of deltoid

most common rotator cuff injury

empty can test

52
Q

what does infraspinatus do

A

inn by suprascapular n

externally rotates arm

pitching injury

53
Q

what does teres minor do

A

inn by axillary n

adducts and externally rotates arm

54
Q

what does subscapularis do

A

inn by upper and lower subscapular nerves

internally rotates and adducts arm

push away test

55
Q

special tests for supraspinatus

A

empty can test

active painful arc test - moving arm through abduction, + if pain past 90 degrees

drop arm test - lowering arm from full abduction not smooth and coordinated

56
Q

special tests for infraspinatus/ teres minor

A

external rotation - isometric ER, patient presses against examiners hand

57
Q

special test for subscapularis

A

internal rotation - assessed using the push off test painand weakness is positive

58
Q

empty can test

A

supraspinatus test

arm held at 90 degrees of abduction and 30 degrees forward flexion. Then internally rotating completely with thumb pointing down

pain without weakness indicates tendinopathy

pain with weakness indicates tear

59
Q

AC separation

A

common injury in sports resulting in player hitting shoulder while arm is adducted wiht downard force

AC joint injuries are about 10% of shoulder injuries

60
Q

treatment fro AC separation

A

Type 1-2 managed conservtively

3 judgement call

4-6 need surgical reduction and repair

61
Q

grading AC separation

A

type 1 AC separation - ligament sprain, joint intact

2 - AC ligament torn, CC intact

3 - Both AC and CC torn, joint dislocated

4 - 6 - above plus displacement of distal clavicle

62
Q

subacromial bursitis

A

can be from trauma, overuse, inflammatory, infection

need to differentiate infection, aspirate bursa, imaging usually not needed

63
Q

management of subacromial bursitis

A

infection - hospitalization

conservatively

64
Q

adhesive capsulitis

A

frozen shoulder

condition causing pain and limited ROM of shoulder

causes largely unknown

spontaneous resolution usually

risk fx - >40, F, DM

65
Q

3 stages and presentation of adhesive capsulitis

A

painful, adhesive, recovery

gradually increasing pain and stiffness without cause, initial phase can last 3-9 months. exam may have muslce spasms and decreased ROM without focal tenderness

tx - supportive and conservative

66
Q

calcific tendinopathy

A

calcific tendinitis of the shoulder as an acute or chronic painful condition due to the presence of calcific deposits inside or around the tendons of the rotator cuff; more specifically, it s caused by depositon of calcium hydroxyapatite crystals commonly within the supraspinatus and infraspinatus tendons

67
Q

exam for calcific tendinopathy

A

pain with active abduction, passive has minimal tenderness. Impingement less frequently positive

imaging is confirmatory

68
Q

tx for calcific tendinopathy

A

supportive, conservative

steroid injection

ESWT can help break up calcifications

surgery for refractory causes

69
Q

impingment

A

hawkins kennedy test is used to test for it as well as passive painful arc test

70
Q

hawkins kennedy test

A

clinician stabilizes shoulder with one hand and the patients elbow flexed at 90 degrees then passiveley internally rotates the shoulder using the other hand. Pain is positive

71
Q

passive painful arc test

A

passively raising arm in flexion while holding the shoulder from shrugging. pain is positive

72
Q

rotator cuff tear dx and tx

A

may need imaging for dx (MRI)

trial of conservative treatment (rest, PT, NSAIDs, injection)

ortho referral for refractory cases

immediate ortho if acute traumatic injury with full thickness tears

73
Q

rotator cuff exercises

A

once daily

start with light weights (1-2 lbs)

work up to 30 reps, warm up, ice after

74
Q

supraspinatus rotator cuff tear signs

A

tender to palpation of subacromion tegion

supraspinatus test (empty can)

75
Q

tx for rotator cuff injury

A

PT, steroid injection, surgery

MM1 Leesy (6 decks)

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