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Brad 4th Ed Part 2 > Ch.38 Upper Extremity > Flashcards

Ch.38 Upper Extremity Flashcards

1
Q

What rehab should be done in the acute stage of injury?

A

RICE, cardio that doesn’t involved affected limb, gental ROM, stablization exercises

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2
Q

What can be done for pain in acute injury?

A

Cryotherapy, E-stim, NSAIDs, tylenol, opiods, oral/injected steroids

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3
Q

When can a patient advance to the recovery phase of rehab?

A

When pain is controlled and tissue healing occured

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4
Q

What is the emphasis of recovery rehab?

A

Restoration of flexibility, strength and proprioception of injured limb

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5
Q

Open kinetic chain exercises should be used for __.

A

Correcting strength imbalances

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6
Q

Closed kinetic chain execises should be used for __.

A

provide joint stabilization throught muscle co-contraction

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7
Q

When can a patient advance to the functional phase of rehab?

A

Injured limbe gained 80% of strength compared to normal limb and not flexibility imbalances

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8
Q

What is addressed in functional rehab?

A

maladaptive movement patterns, muscle subsitution and full strength obtained

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9
Q

2/3 of sternoclavicular joint dislocations are __.

A

Anterior

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10
Q

Grade I Sternoclavicular Sprain

A

Tenderness to palpation w/o joint laxity

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11
Q

Grade II Sternoclavicular Sprain

A

Tenderness to palpation w/ joint laxity w/ a good endpoint

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12
Q

Grade III Sternoclavicular Sprain

A

Tenderness to palpation w/ significant joint laxity and no endpoint

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13
Q

Tx of Grade I & II Sternoclavicular Sprain

A

nonoperative, sling immbolization for comfort in acute phase, rehab

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14
Q

When can patient return to activity with sternoclavicular sprain?

A

Grade I: 1-2 weeks, Grade II: 4-6 weeks

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15
Q

Tx of Grade III Sternoclavicular Sprain

A

Can be nonoperative but recuires surgery if unstable or for mediastinal compression

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16
Q

80% of clavicle fractures occur __.

A

at middle 1/3 of clavicle

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17
Q

Tx of clavicle fx in good alignment

A

immobilization in sling or figure of eigh bandage

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18
Q

When should surgery be considered for clavicle fx?

A

15-20mm shortening, ope fx, neuovascular compromise or tenting of skin

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19
Q

What are teh Rockwood classifications of AC joint sprains?

A

I: sprain AC ligaments
II: tear AC & sprain CC ligaments
III: tear both AC & CC ligaments IV: III plus posterior displacement of distal clavicle into trapezius V: IV plus rupture of deltotrapezial fascia VI: V plus displacement of clavicle below acromion or coracoid process

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20
Q

Tx of type I & II AC joint sprains

A

nonoperative and rehab

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21
Q

Tx of type III AC joint sprains

A

no-op unless persistent pain, comestic or heavy labors and athletes

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22
Q

Tx of type IV-VI AC joint sprains

A

Surgery

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23
Q

How does osteolysis of the distal clavicle develop?

A

repetive overloading: bech press or military press lifts

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24
Q

What is the hx of osteolysis of the distal clavicle?

A

Gradual onset AC joint pain increased with overhead or bench presses, esp when bar lowered to chest

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25
Q

What are the pathologic changes on Xray for oteolysis?

A

distal clavicular subchondral bone loss and cystic changes

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26
Q

Tx of distal clavicle osteolysis

A

avoidance of aggraviting activities, rehab, steroid injection to AC joint, distal clavicle resection

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27
Q

What is does a loud grating scapulothoracic crepitus indicate?

A

Bursitis, fibrotic/atrophic muscle, anomal muscular insertions

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28
Q

What is does a loud snapping scapulothoracic crepitus indicate?

A

Boney pathology: osteophyte, rib/scapular osteochondroma/fx

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29
Q

What are the Neer classications of rotator cuff injury?

A

I: Inflammation & edema of cuffs II: Fibrosis & tendonitis of cuffs III: partial or complete tear of cuff

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30
Q

What are the Bigliani classifications of acromion shapes?

A

I: flat, II: curved, III: hooked

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31
Q

What augments rotator cuff contact to posteriorsuperior glenoid rim?

A

anterior glenohumeral head instability and posterior glenohumeral head capsular tightness

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32
Q

Rotator cuff impingement can be caused by:

A

hooked acromion, thick coracoacromial ligament, glenohumeral joint instability, scapulothoracic dyskinesis and instability

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33
Q

What stage of throwing can cause microtrauma to rotator cuffs due to eccentric overload?

A

External rotators during decceleration phase

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34
Q

Rotator cuff muscle strengthening should begin with:

A

closed chain exercises to promote stability and proprioception

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35
Q

Open chain exercises should be used rotator cuff disorders to __.

A

Correct strength imbalance of shoulder ER relative to IR

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36
Q

Hx of long head biceps tendon ruputure

A

> 40yo, hx of rotator cuff dz, “pop” at injury, during lifting or pulling

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37
Q

Best imaging for biceps tendon rupture

A

MRI or US

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38
Q

Tx of biceps tendon rupture in >40yo or sedentary pt

A

Sling for compfort, strengthen shoudler girdle and rotator cuff muscles

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39
Q

Tx of biceps tendon rupture in young active pt

A

Surgery

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40
Q

MCC of pectoralis major strain

A

forceful shoulder adduction & IR (weight lifters & football players)

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41
Q

What muscle is important for anterior and posterior glenohumeral joint stability?

A

Subscapularis

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42
Q

What is the most frequent type of unidirectional glenohumeral joint instability?

A

Traumatic anterior instability

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43
Q

What is multidirectional glenohumeral joint instability due to?

A

Congenital capsular laxity (Marfans or EDS) or chronic repetitive microtrauma

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44
Q

What is a Bankhart lesion?

A

avulsion of anterior-inferior glenoid labrum w/ or w/o bone from glenoid rim

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45
Q

What’s a SLAP lesion?

A

Superior labral anterior to posterior lesion

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46
Q

What is a Hill-Sachs defect?

A

compression fx of posterolateral aspec of humeral head from anterior humeral dislocation

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47
Q

What is a reverse Bankhart lesion?

A

Tear of the posterior inferior glenoid labrum causing separation from the glenoid fossa rim

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48
Q

What are common sx of shoulder subluxation?

A

Burning or dead feeling in arm

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49
Q

How can an Hill-Sachs defect bee seen on X-ray?

A

AP view with shoulder IR and Stryker Notch view

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50
Q

What does the scapular Y view on xray show?

A

Assess glenohumeral joint alignment

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51
Q

What does the axillary lateral view show on xray?

A

Anterior or posterior subulxation or dislocation and fx of glenoid rim

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52
Q

What are the best views for Bankhar lesion on xray?

A

Garth view and West Point view

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53
Q

What patient has a high rate of redislocation after first time shoulder dislocation?

A

Young active patient, require surgery

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54
Q

When should shoulder immbolization be done after dislocation?

A

First 24 hrs, then 3 weeks with humer ER 30 deg. if not done in the first day benefits not significant

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55
Q

What conditions are associated with adhesive capsulitis?

A

DM, inflam arthritis, trauma, prolonged immobilization, thydroid dz, CVA, MI, autoimmune dz

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56
Q

Sx of adhesive capsulitis in Stage I

A

Painful and restricted ROM in first 1-3 mo

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57
Q

Sx of adhesive capsulitis in Stage II

A

Painful ROM, progressive loss of glenohumeral motion (3-9 mo)

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58
Q

Sx of adhesive capsulitis in Stage III

A

“Frozen stage”: Reduced pain w/ shoulder movement, severely restricted glenohumeral ROM (9-15 mo)

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59
Q

Sx of adhesive capsulitis in Stage IV

A

“Thawing stage”: Minimal pain, progressive normalization of ROM (15-24 mo)

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60
Q

Type 1 SLAP lesion

A

fraying of superior labrum w/o detached biceps tendon

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61
Q

Type 2 SLAP lesion

A

Bicep tendon detached from supraglenoid tubercle

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62
Q

Type 3 SLAP lesion

A

Bucket handle tear of superior labrum w/o detachment of biceps tendon

63
Q

Type 4 SLAP lesion

A

Tear of superior labrum extends to biceps tendon

64
Q

What exam finding can indicate SLAP lesion?

A

Postive O’Brien test

65
Q

What is the gold standard for dx of SLAP lesion?

A

Arthroscopy

66
Q

What imaging is used to dx SLAP lesion?

A

Gadolinium-enhanced MRI

67
Q

Which tendon is MC involved in lateral epicondylosis?

A

Extensor carpi radialis brevis

68
Q

What disorder can mimic lateral epicondylosis?

A

PIN syndrome

69
Q

What exercise regimen should be used for tx of lateral epicondylosis?

A

Eccentric stengthening of wrist extensors

70
Q

What are the MC involved tendons in medial epicondylosis?

A

Pronator teres and flexor carpi radialis

71
Q

What can be seen on X-ray in Lateral/Medial epicondylosis?

A

punctuate calcifications at tendon origin

72
Q

Exercises used for treatment of tendonopathy.

A

Eccentric stengthening

73
Q

History of distal biceps tendonitis

A

Pain in antecubital fossa with repetive elbow bending & follow through phase of throwing

74
Q

History of distal biceps tendon rupture

A

Male 30-50, dominant limb, heavy lifting with elbow at 90 deg flexion

75
Q

History of triceps tendonitis

A

Aching and burning at distal triceps aggravated by throwing, using a hammer, wt lifting

76
Q

How can tricep tendon rupture occur?

A

FOOSH injury, steroid use

77
Q

Hx of snapping triceps tendon

A

snapping sensation over medial epicondyle with eblow flexion & extension

78
Q

Hx of aseptic olecranon bursitis

A

direct blow or repetitive trauma to olecranon process develops small liquid pouch

79
Q

Hx of septic olectranon bursitis

A

localized or systemic injection l/t infected joint

80
Q

Tx of aseptic olecranon bursitis

A

Aspiration of bursa followed by compresive dressing and elbow pad

81
Q

Tx of septic olecranon bursitis

A

Aspiration of bursa for CS and gram stain, followed by compresive dressing and Abx

82
Q

Cause of ulnar collateral ligament strain

A

valgus stress to the elbow

83
Q

What phases of throwing put stress on the UCL?

A

late cocking and acceleration phase of overhead throwing

84
Q

PE of UCL strain

A

5 deg elbow flexion contracture, UCL tenderness and pain w/ or w/o laxity during UCL instability testing

85
Q

Tx of UCL strain

A

no throwing for 3-6 wks, ROM, medial forearm muscle strengthening, interval throwing program once pain free ROM

86
Q

Definition of valgus extension overload (VEO) disorder

A

impingement of posteromedial olecran against medial wall of olecranon fossa from valgus elbow stres w/ overhead throwing

87
Q

PE of valgus extension overload (VEO) disorder

A

Pain over posterior medial tip of olecranon and pasive hyperextension w/ valgus load of elbow

88
Q

What phase of throwing aggravates valgus extension overload (VEO) disorder

A

acceleration and follow through

89
Q

Rehab of valgus extension overload (VEO) disorder

A

Scapula/core kinetics, medial forearm muscle strengthening

90
Q

What disorders are referred to as Little Leaguer’s elbow?

A

Medial epicondolitis, traction apophytiis, stress fx, throught medial epicondylar epiphyses and avulsion fx of medial epicondyle

91
Q

What is Panner’s disease?

A

osteochondrosis of capitellum that occurs in ages 7-10

92
Q

PE of Panner’s disease

A

Dull, aching lateral elbow pain aggravated by throwing, elbow effusion, ROM not restricted

93
Q

Tx of Panner’s disease

A

Stop throwing, posterior long arm splint for pain control

94
Q

Hx of osteochondritis desicans of capitellum

A

throwing athletes 9-15yo, lateral elbow pain, 15 deg flexion contracture focal lesions to capitellum w/ loose body formation

95
Q

Tx of osteochondritis desicans of capitellum

A

stop throwing for 6 wks, posterior long arm splint for pain control, surgery for loose bodies

96
Q

MCC of elbow dislocation

A

FOOSh injury

97
Q

MC direction of elbow dislocation

A

posterior lateral

98
Q

Injuries associated w/ elbow dislocation

A

collateral ligament, flexor/pronator forearm muscle, brachial artery, median/ulnar/radial nerve disruptions

99
Q

Hx of FCU tendonitis

A

volar wrist pain w/ wrist flexion & ulnar deviation (racquet sports, golf)

100
Q

What can be associated with FCU tedonitis?

A

Pisotriquetral compression sydnrome as pisiform bone embedded in FCU tendon

101
Q

Tx of FCU tendonitis

A

wrist hand orthoses in 25 deg flexion or surgery to resect pisiform bone w/or w/o Z-plasty lengthening of FCU tendon

102
Q

Hx of FCR tendonitis

A

Lateral wrist pain w/ wrist flexion, radial deviation and grip

103
Q

Tx of FCR tendonitis

A

wrist hand orthoses in 25 deg flexion

104
Q

Tendons involved in de Quervain’s syndrome

A

Abductor pollicis longus & extensor pollics brevis over radial styloid

105
Q

Tx of de Quervain’s syndrome

A

rest, thumb spica splint, first dorsal compartment steroid injection

106
Q

What is Intersection syndrome?

A

Friction b/w abductor pollicis longus & extensor pollicis brevis tedongs 4-6 cm proximal to Lister’s tubercle

107
Q

Who is Intersection syndrome seen in?

A

Oarsmen, racquet sports, wt lifters

108
Q

PE of Intersection syndrome

A

Dorsoradial distal forearm pain aggravated by wrist extension

109
Q

Tx of Intersection syndrome

A

neutral wrist-hand orthosis, steroid injection to point at maximal tenderness, rarely surgery

110
Q

Hx of extensor carpi ulnaris tendonitis

A

dorsoulnar wristpain w/ reptitive wrist extension & ulnar deviation in nondominant hand of tennis two-handed backhand

111
Q

Hx of ECU subluxation

A

pop after forceful volar wrist flexion & ulnar deviation w/ pain

112
Q

Tx of ECU tendonitis

A

neutral wrist-hand orthosis

113
Q

What should be assessed for if pt w/ ECU tendonitis does not get better with conservative therapy?

A

Triangular fibrocartilage complex injury

114
Q

Tx of ECU tendon subluxation

A

Acute: cast of wrist in pronated and dorsiflexion for 6 wk or surgery Chronic: sugrical reconstruction

115
Q

What is the MC wrist ligament injury?

A

Scapholunate instability

116
Q

Hx of scapholunate instability

A

Fall on hand in pronation, wrist extension & ulnar deviation

117
Q

What is the dorsal intercalated segemental instability (DISI) pattern?

A

scaphoid into flexed position, lunate and triqetrum become extended

118
Q

What test may indicate scapholunate instability?

A

Watson test

119
Q

What can be seen on X-ray in DISI pattern?

A

scapholunate angle >60 deg on lateral view or gap >3 mm b/w scaphoid and lunate on AP view

120
Q

Tx of scapholunate ligament injury

A

Surgery

121
Q

What hand fx is prone to AVN or nonunion?

A

proximal or middle scaphoid fx d/t disrupted BS

122
Q

Tx of middle or proximal scaphoid fx

A

6 wk in long arm thumb-spica cast w/ elbow 90 deg flexion & wrist in neutral w/ thumb in slight ext & ABD

123
Q

Tx of distal 1/3 scaphoid fx

A

short arm thumb spica cast w/ wrist in neutral & thumb in slight ext & ABD

124
Q

MC fx of the body

A

distal radius

125
Q

What is the classification system for distal radius fx?

A

Frykman

126
Q

MC distal radius fx

A

Frkyman type I or Colles fx

127
Q

What is a Colles fx?

A

fx 2 cm proximal to distal radius w/ dorsal angulation of distal segment & radial shortening

128
Q

Tx of Colles fx

A

Closed reduction & immobilization w/ sugar tong splint w/ wrist in slight flexion & ulnar deviation for 3 days then cast for 6 wks if non-displaced on xray

129
Q

What is Kienbock’s disease?

A

Progressive collapse of lunate d/t repetitive compressive forces to wrist

130
Q

Hx of Keinbock’s disease

A

Pain & stiffness of wrist

131
Q

PE of Keinbock’s disease

A

Pain to palpation over dorsum of lunate

132
Q

Tx of Keinbock’s disease

A

immobilization to allow revascularization, may need surgery to correct ulnar minus wrist

133
Q

What is the trianular fibrocartilage complex (TFCC)?

A

Avascular central articular disc & vascular dorsal & palmar radioulnar ligaments

134
Q

Hx of TFCC injury

A

Axial load to wrist w/ rotational stress l/t locking & catching

135
Q

PE of TFCC injury

A

Pain at hollow b/w FCU & ECU tendon distal to ulnar styloid process

136
Q

Tx of TFCC injury

A

Surgery

137
Q

What can rupture of the central slip of extensor tendon at base of middle phalanx result in?

A

Boutonniere injury

138
Q

What is a Boutonneire injury?

A

Inability to actively extend PIP joint

139
Q

MOI of central slip extensor tedon rupture

A

Crush injury, forced flexion or lateral volar PIP dislocation

140
Q

What causes a mallet finger?

A

Disruption of distal extensor tendon at insertion on dorsal proximal aspect of distal phalanx

141
Q

What is the MOI of a mallet finger?

A

Hyperflexion force to an extended DIP joint

142
Q

PE of a mallet finger

A

DIP joint in flexed position, pt unable to actively extend

143
Q

Tx of a mallet finger

A

Splint DIP joint 24hr/day for 6-8 weeks

144
Q

MOI of flexor digitorum profundus rupture (jersey finger)

A

Forced extension of flexed finger

145
Q

Which finger is most likely to be effected by FDP tendon rupture?

A

Ring Finger

146
Q

What is the MC dislocated joint in the hand?

A

PIP joint

147
Q

What is the MC direction of PIP dislocation?

A

Dorsal

148
Q

Tx of dorsal PIP dislocation

A

Reduction, Xrays, 45 deg extension block splint with 10 deg reduction in angle each week

149
Q

What is a gameskeeper’s thumb?

A

1st metacarpophalangeal jointUCL sprain

150
Q

What is the MOI of a 1st MCP joint UCL sprain?

A

Radially directed force acrost 1st MCP joint

151
Q

What is a Stener lesion?

A

Interposition of adductor pollicis aponeurosis b/w proximal phalanx and UCL ligament

152
Q

Tx of 1st MCP joint UCL sprain

A

Partial: thumb spica splint; Rupture: surgery

153
Q

What is a jammed finger?

A

Collateral ligament sprains of DIP or PIP joints

Brad 4th Ed Part 2 (28 decks)

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