Disorders of the UE Flashcards
What are the muscles of the RTC
SITS
supraspinatus
infraspinatus
teres minor
subscapularis
what is the insertion and MOA for supraspinatus
Greater tuberosity (GT)
ABduction
what is the insertion and MOA for Infraspinatus
GT
ER
what is the insertion and MOA for Teres Minor
GT
ER
what is the insertion and MOA for Subscapularis
Lower Tuberosity (LT)
IR
what is the most common muscle inflamed in the RTC
supraspinatus
what type of injury causes RTC tendonitis
overuse injury
repetitive overhead activity, lifting, athletes with repetitive shoulder movement
What is the presentation for RTC tendonitis
unknown onset of shoulder pain - commonly anterior and lateral and pain with physical activity
what is present on the physical exam for RTC tendonitis
point tenderness over supraspinatus/GT, reduced ROM, esp ABduction, weakness
What special tests are used for assessing the supraspinatus
Hawkins-Kennedy, Neer and Empty Can test
all positive for pain and or weakness
What is the treatment of RTC tendonitis
activity modification and rest, NSAIDs, subacromial injection, PT for strengthening and stretching
What is the number one cause of shoulder pain
subacromial impingement
What is important with the presentation of subacromial impingement
night time pain otherwise presents with shoulder pain, pain with overhead activities
what special tests are positive with subacromial impingement
Neer and Hawkins- Kennedy test with tenderness over the greater tuberosity
What is the treatment for subacromial impingement
first line is conservative treatment and if failure, operative for subacromial decompression
what is the least likely muscle to tear in a RTCT
subscapularis
what is the presentation of RTCT
similar to tendonitis and impingement with night pain and +/- weakness and/or loss of ROM
What special tests are positive for RTCT
empty can, Drop arm, Infraspinatus and lift off test all positive with RTCT
What is the treatment for RTCT
first line is conservative
partial tears with subacromial impingement - subacromial decompression
complete and/or significant symptomatic tears - RTCR, tendon transfers and Reverse TSA
What special tests are used for biceps tendonitis
speeds test and yergasons test
what is the MOI for bicep tendon rupture
sudden or prolonged bicep contraction against resistance
what injury is commonly seen with the “pop eye” deformity
biceps tendon rupture
What is the MOI for AC joint injuries
direct blow to the shoulder, fall onto shoulder, FOOSH
treatment of AC joint injury
most treated non-op (type 1-3) with conservative management, operative at type 4-6 or failed non-op
What is the MOI for SC joint dislocation
MVC or sports injury (direct blow)
what is essential to be assessed for SC joint dislocation
neurovascular status - brachial plexus and major vascular structures nearby
what are the complications wtih SC joint dislocation
pneumothorax, SVC injury, Esophageal injury, compression of subclavian artery or carotid artery, voice changes and venous congestion
what is the best test to assess for SC joint dislocation
CT Scan is the best
what is the treatment of SC joint dislocation
closed or ORIF - often thoracic surgeon/cardiology
What special tests are used for dislocation patients
apprehension test and sulcus sign
what is something to be aware of with a clavicle fracture
risk for pneumothorax from fracture fragment - diminished breath sounds on affected side
when os operative treatment necessary for clavicle fracutres
open fracture, pending open fractures (skin tenting), associated neurovascular injury, significant displacement
What does the axillary nerve innervate
deltoid
What is important to check with a humerus fracture
neurovascular assessment for median, radial and ulnar nerve function
What is lateral epicondylitis
tennis elbow - inflammation of the extensor tendon insertion
what is medial epicondylitis
golfers elbow - inflammation of the flexor tendon insertion site (medial epicondyle)
when is Nursemaids elbow most common
kids 6 months to 6 years - peak incidence ages 2-3
what is the MOI for Nursemaids elbow
longitudinal traction to extended elbow
What type direction is most common for elbow dislocations
posterior dislocation is 80-90%
what are the three points of articulation in the elbow
ulnotrochlear
radiocapitellar
proximal radioulnar
what is the common MOI for elbow dislocation
FOOSH is the most common
When do you need to assess neurovascular status for elbow dislocations
pre-reduction and post-reduction
when is operative treatment necessary for elbow dislocations
if neurovascular deficit, associated fracture or unstable
What are the common MOI for radial and ulnar shaft fractures
MVC including motorcycle
sports injuries
night stick injury
falls from height
what do you need to assess for with radial and ulnar shaft fractures
neurovascular status and compartment syndrome
what tool can you use to assess ganglion cysts
transilluminates with light
what part of the hand does the median nerve affect
thumb through to the medial aspect of the ring finger
special tests for CTS
Tinels and Phalens test
what ligament is cut during CTR
transverse carpal ligament
What is a colles frature
dorsal displacement
what is a smiths frature
volar displacement
what is another name for navicular fracture
scaphoid fracture
DeQuervains is inflammation of what tendon sheath
1st MCP joint
What test is used for the diagnosis of DeQuervains
Finkelsteins
