Diagnostics Flashcards by Addie Agboola

which test has a 90% specificity for assessing supraspinatus involvement?

Empty can test

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what are some impingement tests that can be done for rotator cuff injuries?

Hawkins test
Drop Arm test
Neer test

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Elbow/shoulder flexed @ 90 degree angle with sharp anterior shoulder pain with passive internal rotation

hawkins test

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pain with inability to lift arm above shoulder level or hold it or severe pain when slowly lowering the arm after the shoulder is abducted to 90 degrees

drop arm test

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arm fully pronated (thumbs down) with pain during forward flexion (while shoulder is held down to prevent shrugging)

neer test

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inflamed bursa and/or tendon repeatedly pulled under coracoacromial arch. Pain and crepitus at subacromial space. Positive impingement tests (hawkins)

RTC impingement syndrome

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what are symptoms of RTC impingement syndrome?

Gradual onset
referred pain
night pain
anterior/lateral pain
pain with abduction

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what are symptoms of rotator cuff tears?

recurrent pain for several months, night pain
unable to/ difficulty abducting arm

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what would you see on physical exam for a RTC tear?

normal PROM and decreased AROM
positive empty can test
palpable tenderness at greater tuberosity
may be atrophy over supraspinatus muscle belly

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when would you operate on RTC tear?
when do you not operate? What is something to keep in mind?

operative in full thickness tears, acute, younger patient
non-operative in partial thickness tears, elderly, atrophy, chronic tears
*most tears self-limiting

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Posterolateral compression fracture that occurs as a result of recurrent anterior dislocations of the shoulder

Hill-sachs lesion

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what view do you want to get a posterior dislocation in for X-ray

Scapular Y and axillary lateral views best

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what position is the arm in for anterior glenohumeral dislocation?

abduction and external rotation

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what position is the arm in for posterior glenohumeral dislocation?

adducted and internally rotated

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what are symptoms of AC joint separation?

point tenderness over AC joint,
(step off) deformity
edema
pain with lifting arm

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best way take imaging for AC joint separation?

2-6 degrees is widening at the AC joint; use 10 pound weight to better visualze

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Type of AC joint separation that has sprained AC ligaments but normal CC ligaments. radiography is normal

type 1

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Type of AC joint separation that has disruption of the AC ligaments; sprained CC ligaments. Radiography shows widened AC joint and slight elevation of the clavicle

Type II

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Type of AC joint separation that has disruption of the AC and CC ligaments. Radiography shows moderate elevation of clavicle

Type III

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Type of AC joint separation that has posterior displacement through the trapezius muscle. Axillary view shows posterior displacement

Type IV

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treatment of AC joint separation?

for types 1-3; treatment is non-operative. Sling for comfort and ROM exercises

types 4-6; operative repair almost always indicated

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traction force when shoulder is forcefully depressed and head/neck tilted to opposite side

burner/stinger

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symptoms of burner/stinger

sharp burning pain radiating to hand, weakness
entire arm is limp and hanging at side
may last minutes to weeks

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what is the appropriate diagnosis and treatment for a burner/stinger?

X-rays of cervical spine and shoulder series, MRI if symptoms persist
no return to sports until asymptomatic
refer if symptoms persist

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palpable defect with popeye deformity audible snap or pop

bicepts tendon rupture (proximal)

what does the scarf test look for?

AC impingement

What does the lift off test for?

RTC, isolates subscapularis

what does the apprehension test look for?

shoulder dislocation (sulcus sign too)

treatment for biceps tendon rupture? What is something to note?

non-operative unless athlete or active adult < 40y/o *left with deformity but good function*

idiopathic thickening and contraction of capsule resulting in increased pain and decreased ROM; Also characterized as shoulder stiffness due to inflammation (especially with diabetes and hypothyroidism)

Adhesive capsulitis (frozen shoulder)

symptoms of adhesive capsulitis (frozen shoulder)

progressive loss of ROM (freezing phase) followed by steady improvement (thawing phase) -usually has a "bad side" -painful AROM and PROM increased motion at scapula to compensate

how do you treat adhesive capsulitis?

NSAIDs, heat, PT (PROM only, no strength exercises) corticosteroid injection manipulation and possible debridement under general anesthesia

lifting, swing or pulling a child (longitudinal traction) while the forearm is pronated and extended

Subluxation of the radial head (nursemaid's elbow)

how do you treat subluxation of the radial head?

closed reduction; place pressure on the radial head with supination of the elbow followed by flexion of the elbow

inflammation of the tendon insertion of the extensor carpi radialis brevis muscle due to repetitive pronation of the forearm and excessive wrist extension

Lateral epicondylitiis

inflammation of the pronator teres-flexor carpi radialis muscles due to repetitive overuse & stress at the tendon insertion of flexor forearm muscle

Medial epicondylitis

what are symptoms of lateral epicondylitis?

lateral elbow pain especially with gripping, forearm pronation & wrist extension against resistance

what are symptoms of medial epicondylitis?

tenderness over the medial epicondyle worse with pulling activities

what nerve provides sensation to the volar aspect of the thumb, index, long and radial half of the ring finger; motor to the flexor muscle of the forearm and hand as well as those muscles responsible for flexion, abduction, opposition and extension of the thumb

Median

what nerve provides sensation to ulnar half of the ring finger and small finger; motor innervation to part of the forearm and majority of the hand

ulnar

sensation to radial 3/4th of dorsal hand and dorsal thumb, index, long and radial half of ring to PIP joint; motor to posterior UE muscles

radial

what is the SAFE position?

MP flexed, PIP and DIP extended (relaxes intrinsics, keeps collaterals stretched)

dorsal angulation of fragment extension injury PE: edema, tenderness, "dinner fork deformity"

colles fracture

how do you treat a colles fracture?

reduce by slightly exaggerating, then reversing MOI while applying traction -splint acutely, then cast when swelling goes down

volar angulation; flexion injury

smith fracture

fracture of proximal portion of thumb metacarpal involving CMC joint *how do you treat this fracture*

Bennet fracture treatment: thumb spica splint/cast if nondisplaced if angulation, displacement or intraarticular irregularity- surgery

FOOSH; tenderness in anatomic snuffbox *how do you treat this fracture*

Scaphoid gracture thumb spica cast if snuffbox tenderness; repeat x-ray/bone scan/ CT *high incidence of nonunion*

rupture of extensor tendon or avulsion of dorsal distal phalanx PE: "droop at DIP" unable to extend *how do you treat this fracture*

mallet finger Continuous splinting in extended position

rupture/avulsion of flexor from distal phalanx; forced hyperextension against active flexion *how do you treat this fracture*

jersey finger usually requires surgery

finger flexed at the DIP joint, unable to extend at the DIP joint

mallet finger

finger flexed at the PIP joint and hyperextended at DIP

Boutonniere Deformity

muscle: Deltoid, Bicepts Sensation: deltoid Reflex: biceps

muscle: Wrist extenstion Sensation: Thumb, index or forefinger reflex: brachioradialis

muscle: wrist flexion, triceps sensation: middle (or long) finger reflex: Triceps

Muscle: intrinsics sensation: ring and little (or small) reflex: None

which organism do you typically see with a human bite?

Eikenella corrodens

which organism do you typically see with a dog bite?

strep. Viridans, E.corodens

which organism do you typically see with a cat bite?

Pasteurella multicoda

disruption to the neck musculature and ligaments- particularly the ALL, PLL?

soft tissue injury-(whiplash)

A clinical diagnosis based on head tilt in association with a rotatory deviation of the cranium

Torticollis

Narrowing of the central spinal canal or foramen, usually a gradual result of adding which may lead to pressure on the spinal cord

spinal stenosis

what are some signs of spinal stenonsis

global upper extremity weakness, loss of coordination, numbness in hands, loss of vibration sense or proprioception, may have bowel or bladder changes

in what condition would you see, unilateral arm pain (radiculopathy), weakness, numbness and tingling

C-spine herniated nucleus pulposus

defined as cervical spine osteoarthritis- signs of disc narrowing, osteophytes and obliques to see foramina on X-ray

cervical spondylosis

inflammation of the muscles, joints, ligaments of the cervical spine. *partial tears are more painful than full tears*

cervical strain/spine