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MM Test 1 > B6.085 Common Pathological Conditions of the Upper Extemity > Flashcards

B6.085 Common Pathological Conditions of the Upper Extemity Flashcards

1
Q

what is dupuytrens contracture

A

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

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2
Q

associations with dupuytrens contracture

A 
northern European of Scandinavian ancestry
pronounced genetic predisposition
smoking
drinking
DM
thyroid disease
age > 50
M > F (80% male)
repetitive palmar trauma/vibration
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3
Q

clinical features of dupuytrens contracture

A

gradual onset
begins as one or more small tender lumps in the palm
pain resolves with time, and then the nodules may thicken and contract, forming tough bands of tissue
can result in loss of full extension
4th and 5th fingers commonly affected

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4
Q

treatment of mild dupuytrens contracture

A

padding
steroid injections
splinting, massage, and exercise don’t work

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5
Q

treatment of progressive dupuytrens contracture

A
  1. surgical removal of fibrotic adhesions, often combined with steroid injections
  2. injection of clostridia histolyticum collagenase (if mild and contractures less than 50 degrees)
  3. needling, 65% risk of recurrence
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6
Q

mechanism of mallet finger injury

A

attempting to catch a ball and impact causes sudden flexion of DIP joint of an extended finger
most common closed tendon injury of the finger

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7
Q

what is a mallet finger deformity

A

traumatic disruption of the terminal slip of the extensor tendon at the DIP

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8
Q

treatment for uncomplicated mallet finger

A

splinting for 6-8 weeks

immobilization with slight hyperextension from 5-15 degrees

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9
Q

treatment for complicated mallet finger

A

referral and surgical repair

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10
Q

long term complications of mallet finger

A

some degree of extensor lag is not unusual

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11
Q

what is a “jammed finger”

A

prolonged swelling of the PIP joint after an axial loading force
diagnosis of exclusion

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12
Q

what is the issue with “jammed fingers”

A 
can be confused w more serious injuries
signs of more serious injuries:
-deformity
-significant swelling
-significant bruising
seek attention if not improving in 1-2 days
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13
Q

treatment of jammed finger

A

conservative management

early ROM is important

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14
Q

describe the pathological process of a trigger finger

A

flexor tendon catches in the first annular (A1) pulley of the MCP and causes a snapping, catching, or locking when flexing or extending the finger

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15
Q

features of trigger finger pain

A

usually worse in the AM

pain in palm at entrance to flexor tendon sheath

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16
Q

risk factors for trigger finger

A

diabetes
age
female gender

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17
Q

another name for trigger finger

A

stenosing flexor tenosynovitis

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18
Q

conservative treatment of trigger finger

A

splinting
NSAIDs
modify repetitive activity

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19
Q

escalated management of trigger finger

A

steroid injections

surgery (release of A1 pulley or teasing out of nodule)

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20
Q

pathological process of gamekeepers/skiers thumb

A

forced abduction can result in rupture of the ulnar collateral ligament

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21
Q

exam for gamekeepers thumb

A

tenderness over ulnar aspect of MCP joint of thumb
swelling
laxity of 30-40 degrees more than the uninjured thumb are suggestive of complete ulnar collateral ligament tear
no “endpoint” to the radial deviation of the phalanx

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22
Q

treatment of gamekeepers thumb

A

thumb spika cast/splint

surgical referral if significant avulsion fracture

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23
Q

clinical features of carpal tunnel

A

nocturnal paresthesia (tingling)
paresthesia worsened by gripping
weakness of grip

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24
Q

risks of carpal tunnel

A 
female
pregnancy
DM
obesity
RA
hypothyroid
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25
etiology of carpal tunnel
not completely understood median nerve passed through "carpal tunnel" with tendons inflammation/edema of tendons can lead to compression of median nerve and subsequent neuropathy
26
epidemiology of carpal tunnel
3-6% prevalence of adult population | 500,000 surgical procedures per year
27
2 primary clinical tests for carpal tunnel
``` tinel test (TAP) phalen test (FLAP) ```
28
tinel test procedure
tap over wrist at point where the median nerve passes through creates electric, sharp pain and tingling sens 50%, spec 77%
29
phalen test procedure
flex the wrists with the elbows raised and the backs of the hands pressed together for 1 minute positive test is pain or tingling in the median nerve distribution sens 68%, spec 73%
30
confirmatory testing for carpal tunnel
EMG or nerve conduction | only needed when surgery becomes a consideration
31
conservative carpal tunnel treatment
``` night bracing ice rest (modify work station) NSAIDs steroid injections ```
32
surgical release of carpal tunnel
sono guided closed techniques | open surgical techniques
33
colloquial terms for ulnar neuropathy at the wrist
cyclist wrist | handlebar palsy
34
what is ulnar neuropathy at the wrist
compression of the ulnar nerve at the wrist | classically seen in cyclists due to pressure from handlebars
35
treatment for ulnar neuropathy at the wrist
padding (gloves or handlebars) NSAIDs ice rarely need more
36
scaphoid fracture epidemiology
most commonly fractured bone in the wrist
37
complication of scaphoid fracture
avascular necrosis of proximal scaphoid blood supply comes from radial artery (feeding bone on dorsal surface near tubercle and scaphoid waist), thus the proximal portion has no direct blood supply
38
treatment for scaphoid fracture
surgery recommended
39
diagnosis of scaphoid fracture
snuff box tenderness | scaphoid tubercle tenderness
40
cause of nursemaids elbow
usually pulling on small childs arm | radial head dislocation
41
clinical indication of nursemaids elbow
history is key | child with arm held limp and partially flexed
42
nursemaids elbow on exam
apprehensive unremarkable inspection tenderness over lateral aspect with palpation
43
how to reduce nursemaids elbow
1. apply pressure at radial head 2. grasp wrist and apply slight traction 3. supinate wrist while flexing elbow to 90 degrees
44
how do medial and lateral epicondylitis develop
repetitive motion with either extension (lateral) of flexion (medial)
45
predisposing factors for epicondylitis
age 45-50 smoking obesity
46
tendinosis
degeneration of the tendon's collagen in response to chronic overuse
47
tendinitis
inflammation of the tendon that results from microtears
48
presentation of epicondylitis
pain with tenderness at the insertion of tendons on the epicondyle
49
location of lateral epicondyle pain
pain w resisted extension at the wrist | pain w resisted supination of the hand
50
location of medial epicondyle pain
pain w resisted flexion of the wrist | pain w resisted pronation of the hand
51
conservative epicondylitis treatment
``` activity modification counterforce brace NSAIDs physical therapy (twisting and rolling motion w towel) may take several weeks ```
52
4 muscles of the rotator cuff
Supraspinatus Infraspinatus teres minor Subscapularis
53
components of shoulder inspection
compare for symmetry | both shoulders should be exposed
54
standard palpation of shoulder
acromion A-C joint coracoid major bones
55
components of shoulder exam
inspection palpation range of motion
56
function of supraspinatus
abducts arm initially (before action of deltoid)
57
supraspinatus innervation
suprascapular nerve
58
epidemiology of supraspinatus injury
most common rotator cuff injury | trauma or degeneration and impingement tendinopathy or tear
59
test for supraspinatus injury
empty/full can active painful arc (move arm through abduction, positive is pain past abduction of 90 deg) drop arm test (lowering arm from full abduction is not smooth and coordinated)
60
function of infraspinatus
externally rotates arm
61
epidemiology of infraspinatus injury
pitching injury
62
infraspinatus innervation
suprascapular nerve
63
function of teres minor
adducts and externally rotates arm
64
teres minor innervation
axillary nerve
65
function of subscapularis
internally rotates and adducts arm
66
subscapularis innervation
upper and lower subscapular nerve
67
empty can test
arm held out at 90 deg of abduction and 30 deg forward flexion internally rotating completely with thumb pointed down pain without weakness = tendinopathy pain with weakness = tear
68
infraspinatus/teres minor test of function
external rotation | isometric ER, patient presses against the examiners hand
69
subscapularis test of function
internal rotation push off test pain and weakness is a positive test
70
how does AC separation occur
player falling and hitting shoulder while the arm is adducted with a downward force 10% of shoulder injuries
71
type I AC separation
ligament sprain, joint intact
72
type II AC separation
AC ligament torn, CC ligament intact
73
type III AC separation
both AC and CC torn, joint dislocation
74
types IV-VI AC separation
displacement of distal clavicle + other components of previous types
75
repair of type I & II AC separation
conservation management with immobilization
76
repair of type III AC separation
unclear | 50% usually need surgery
77
repair of type IV-VI AC separation
surgical reduction and repair
78
etiology of subacromial bursitis
trauma, overuse, inflammation | infection
79
how to determine if subacromial bursitis is due to infection
aspirate of the bursa | imaging usually not needed
80
management of subacromial bursitis
infection- hospitalization | others: conservative w/ NSAIDs, reduced use, and intrabursal corticosteroids
81
what is adhesive capsulitis
"frozen shoulder" pain and limited ROM of the shoulder largely unknown cause with spontaneous resolution
82
presentation of adhesive capsulitis
gradually increasing pain and stiffness without cause initial phase 3-9 months NO FOCAL TENDERNESS, but may have muscle spasms normal xray
83
stages of adhesive capsulitis
painful adhesive recovery
84
treatment for adhesive capsulitis
supportive and conservative with resolution in 80-90%
85
what is calcific tendinopathy
acute or chronic painful condition due to presence of calcific deposits inside or around the tendons of the rotator cuff deposition of calcium hydroxyapatite crystals within supraspinatus and infraspinatus tendons
86
exam for calcific tendinopathy
``` active abduction (passive has minimal tenderness) impingement tests frequently positive (can pinpoint location of pain) imaging is confirmatory ```
87
treatment for calcific tendinopathy
``` supportive, conservative usually self limiting injections of steroids may be helpful ESWT has been helpful surgery if refractory ```
88
what is the Hawkins kennedy test
looks for impingement | stabilize pt shoulder with one hand, flex elbow at 90 deg, passively internally rotate the shoulder using the other hand
89
passive painful arc test
passively raising the arm in flexion while holding the shoulder from shrugging
90
how to diagnose a rotator cuff tear
if no tests are positive, unlikely if one or more is positive, consider it more likely may need MRI to confirm (usually get MRI after conservative treatment is failed)
91
conservative treatment for rotator cuff injury
rest PT- ROM, exercises NSAIDs injection of subacromial steroids
92
when do you need an immediate ortho referral for rotator cuff injury
trauma with full thickness tear
93
methods for rotator cuff exercises
light weight once daily work up to 20-30 reps warm up before, ice after

MM Test 1 (20 decks)

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