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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
Q

etiology of carpal tunnel

A

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

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26
Q

epidemiology of carpal tunnel

A

3-6% prevalence of adult population

500,000 surgical procedures per year

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27
Q

2 primary clinical tests for carpal tunnel

A 
tinel test (TAP)
phalen test (FLAP)
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28
Q

tinel test procedure

A

tap over wrist at point where the median nerve passes through
creates electric, sharp pain and tingling
sens 50%, spec 77%

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29
Q

phalen test procedure

A

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%

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30
Q

confirmatory testing for carpal tunnel

A

EMG or nerve conduction

only needed when surgery becomes a consideration

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31
Q

conservative carpal tunnel treatment

A 
night bracing
ice
rest (modify work station)
NSAIDs
steroid injections
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32
Q

surgical release of carpal tunnel

A

sono guided closed techniques

open surgical techniques

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33
Q

colloquial terms for ulnar neuropathy at the wrist

A

cyclist wrist

handlebar palsy

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34
Q

what is ulnar neuropathy at the wrist

A

compression of the ulnar nerve at the wrist

classically seen in cyclists due to pressure from handlebars

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35
Q

treatment for ulnar neuropathy at the wrist

A

padding (gloves or handlebars)
NSAIDs
ice
rarely need more

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36
Q

scaphoid fracture epidemiology

A

most commonly fractured bone in the wrist

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37
Q

complication of scaphoid fracture

A

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

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38
Q

treatment for scaphoid fracture

A

surgery recommended

39
Q

diagnosis of scaphoid fracture

A

snuff box tenderness

scaphoid tubercle tenderness

40
Q

cause of nursemaids elbow

A

usually pulling on small childs arm

radial head dislocation

41
Q

clinical indication of nursemaids elbow

A

history is key

child with arm held limp and partially flexed

42
Q

nursemaids elbow on exam

A

apprehensive
unremarkable inspection
tenderness over lateral aspect with palpation

43
Q

how to reduce nursemaids elbow

A
  1. apply pressure at radial head
  2. grasp wrist and apply slight traction
  3. supinate wrist while flexing elbow to 90 degrees
44
Q

how do medial and lateral epicondylitis develop

A

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

45
Q

predisposing factors for epicondylitis

A

age 45-50
smoking
obesity

46
Q

tendinosis

A

degeneration of the tendon’s collagen in response to chronic overuse

47
Q

tendinitis

A

inflammation of the tendon that results from microtears

48
Q

presentation of epicondylitis

A

pain with tenderness at the insertion of tendons on the epicondyle

49
Q

location of lateral epicondyle pain

A

pain w resisted extension at the wrist

pain w resisted supination of the hand

50
Q

location of medial epicondyle pain

A

pain w resisted flexion of the wrist

pain w resisted pronation of the hand

51
Q

conservative epicondylitis treatment

A 
activity modification
counterforce brace
NSAIDs
physical therapy (twisting and rolling motion w towel)
may take several weeks
52
Q

4 muscles of the rotator cuff

A

Supraspinatus
Infraspinatus
teres minor
Subscapularis

53
Q

components of shoulder inspection

A

compare for symmetry

both shoulders should be exposed

54
Q

standard palpation of shoulder

A

acromion
A-C joint
coracoid
major bones

55
Q

components of shoulder exam

A

inspection
palpation
range of motion

56
Q

function of supraspinatus

A

abducts arm initially (before action of deltoid)

57
Q

supraspinatus innervation

A

suprascapular nerve

58
Q

epidemiology of supraspinatus injury

A

most common rotator cuff injury

trauma or degeneration and impingement tendinopathy or tear

59
Q

test for supraspinatus injury

A

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
Q

function of infraspinatus

A

externally rotates arm

61
Q

epidemiology of infraspinatus injury

A

pitching injury

62
Q

infraspinatus innervation

A

suprascapular nerve

63
Q

function of teres minor

A

adducts and externally rotates arm

64
Q

teres minor innervation

A

axillary nerve

65
Q

function of subscapularis

A

internally rotates and adducts arm

66
Q

subscapularis innervation

A

upper and lower subscapular nerve

67
Q

empty can test

A

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
Q

infraspinatus/teres minor test of function

A

external rotation

isometric ER, patient presses against the examiners hand

69
Q

subscapularis test of function

A

internal rotation
push off test
pain and weakness is a positive test

70
Q

how does AC separation occur

A

player falling and hitting shoulder while the arm is adducted with a downward force
10% of shoulder injuries

71
Q

type I AC separation

A

ligament sprain, joint intact

72
Q

type II AC separation

A

AC ligament torn, CC ligament intact

73
Q

type III AC separation

A

both AC and CC torn, joint dislocation

74
Q

types IV-VI AC separation

A

displacement of distal clavicle + other components of previous types

75
Q

repair of type I & II AC separation

A

conservation management with immobilization

76
Q

repair of type III AC separation

A

unclear

50% usually need surgery

77
Q

repair of type IV-VI AC separation

A

surgical reduction and repair

78
Q

etiology of subacromial bursitis

A

trauma, overuse, inflammation

infection

79
Q

how to determine if subacromial bursitis is due to infection

A

aspirate of the bursa

imaging usually not needed

80
Q

management of subacromial bursitis

A

infection- hospitalization

others: conservative w/ NSAIDs, reduced use, and intrabursal corticosteroids

81
Q

what is adhesive capsulitis

A

“frozen shoulder”
pain and limited ROM of the shoulder
largely unknown cause with spontaneous resolution

82
Q

presentation of adhesive capsulitis

A

gradually increasing pain and stiffness without cause
initial phase 3-9 months
NO FOCAL TENDERNESS, but may have muscle spasms
normal xray

83
Q

stages of adhesive capsulitis

A

painful
adhesive
recovery

84
Q

treatment for adhesive capsulitis

A

supportive and conservative with resolution in 80-90%

85
Q

what is calcific tendinopathy

A

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
Q

exam for calcific tendinopathy

A 
active abduction (passive has minimal tenderness)
impingement tests frequently positive (can pinpoint location of pain)
imaging is confirmatory
87
Q

treatment for calcific tendinopathy

A 
supportive, conservative
usually self limiting
injections of steroids may be helpful
ESWT has been helpful
surgery if refractory
88
Q

what is the Hawkins kennedy test

A

looks for impingement

stabilize pt shoulder with one hand, flex elbow at 90 deg, passively internally rotate the shoulder using the other hand

89
Q

passive painful arc test

A

passively raising the arm in flexion while holding the shoulder from shrugging

90
Q

how to diagnose a rotator cuff tear

A

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
Q

conservative treatment for rotator cuff injury

A

rest
PT- ROM, exercises
NSAIDs
injection of subacromial steroids

92
Q

when do you need an immediate ortho referral for rotator cuff injury

A

trauma with full thickness tear

93
Q

methods for rotator cuff exercises

A

light weight
once daily
work up to 20-30 reps
warm up before, ice after

MM Test 1 (20 decks)

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