Disorders of the Upper Extremities Flashcards
Humeral Shaft Fracture
Etiology
Symptoms
Diagnosis
Treatment
Etiology
- fracture in the mid-humerus
- trauma caused in young
- older age too
Symptoms
- pain
- swelling, tenderness and brusins
- appears shortened and deformed on exam
- decreased ROM and strength decreased
- always need to assess nerve function as the radial nerve runs directly around the mid-humerus
Radial Nerve issues
- wrist drop
- weakness of finger extension
- absent sensation at posterior forearm, fingers 1-3 & 1/2 of 4
Diagnosis
- Xray
Treatment
non op: coaptation spint or functional brace
operative: ORIF or Intermed. nail
Proximal Humerus Fracture
Etiology
Symptoms
Diagnosis
Treatment
Etiology
- FOOSH
- high energy direct trauma
- excessive rotation while in abduction
- electrocution
- pathologic fx. (OP or cancer)
- seizure
Symptoms
- shoulder pain
- swelling
- decreased ROM
- brusing
need to assess neurovascualr invovlment of axillary nerve
- sensation and numb/tingling
Diagnosis
- X-ray (Y view for shoulder and humeral head!)
- can get CT for surgical planning
Treatment
sling immobilization and rehab if
- minimally displaced
- greater tub. is less tahn 5 mm displaced
- cant do surgery
surgery for
CRPP
RIF
IM nail
joint replacement
Distal Biceps Tendon Rupture
Etiology
Symptoms
Diangosis
Treatement
Etiology
- tendon rupture of the biceps tendon at the distal tendon (attachment to the radius at tuberosity)
- smoking increase risk!, steroid use, men
- occurs with sudden eccentric force
Symptoms
- “pop” sound during extension
- pain and weakness
- + reverse popeye deformity
- Hook test
- Ruland bicep squeeze: “thompson test for the elbow”
Diagnosis
- MRI can be done to see the tendons (?)
Treatment
Non-operative
- eldery, sendentary pts.
operative for others
Medial Epicondylitis (golfer’s Elbow)
Etiology
Symptoms
Diagnosis
Treatment
Etiology
- flexors attach at the medial epicondyle: insidious onset of pain at the tendon (?)
Symptoms
- insidious onset of pain at hte commone flexor tendon
- worse with writs and forearm motion and gripping
- numbness/tingling in ulnar distribution
- tender dital and anterior to the condyle
- soft tissue swelling/warmth
- pain with resistend forearm pronation/flexion
Diagnosis
- MRI is gold standard i dont think you need it….
- US can see it well
- xray wont help
Treatment
Non-op
- rest ice PT , bracing ,NSAIDS , steroid injections
operative
- if 6 months of failed concervative
- ADLS affected or severe symptoms
Lateral Epicondylitis (Tennis Elbow)
Etiology
Symptoms
Diagnosis
Treatment
Etiology
- pain at the common extensor tendon (lateral epicondlye) with repetitive movements like tennis
Symptoms
- pain with resisted wrist extension and gripping
- decreased grib strength
- point tenderness at the lateral epicondyle
- resisted wrist extension with elbow extended
- resisted extension with long fingers
- pain at elbow with passive wrist flexion in pronation
Diangnosis
- can be clincal
- Xray: wont help
- US: see thickening of the ECRB
- MRI: wont help
Treatment
Non op
- ice, rest, NSAIDS, PT, steroid injections
oprative
6-12 months of fialed conservative
intra-articaulr pathology
Olecranon Bursitis
Etiology
Symptoms
Diagnosis
treatment
Etiology
- direct injury, trauma, repetitive pressure overuse, gout or inflammation (inflammatory arthritis)
Symptoms
welling, inflammation and redness at the olecranon (elbow)
fluid filled bursa gets inflammed
Diagnosis
- can do a joing aspiration to determine contents
Treatment
- self limited
- analgesia
- joint protection
Olecranon fracture
Etiology
Symptoms
Diagnosis
Treatment
Etiology
- direct or indirect injury
- FOOSH
Symptoms
- local pain to posterior elbow
- palpable defect
- inability to extend elbow
Diagnosis
- Xray
- Ct for pre-op
Treatment
non- op
- immobilze a nondisplaced fracture with mechanism
- 45-90 degress of flexion
- encourage early ROM
Op
ORIF or IMN
Radial Head Fracture
Etiology
Symptoms
Signs (PE Tests)
Diagnosis
Treatment
Etiology
- FOOSH
- can be extraarticular: where the joint surface is not invovled (no surgery needed usually)
- can be intraarticualr ( the joint surface is invovled, surgery usually needed)
Symptoms
- brusins, swelling and tenderness around the lateral elbow
- +/- visable deformity
- hematoma
- mechanial blocks to the eblow
Signs
- test lateral ulnar collateral ligament : posteriolateral drawer test & pivot shift test
- test medial collateral ligamnet: valgus stress test
- test distal radius/ulnar junction: palpate wrist for tenderness
DX
Xray: see a pronounced posterior fat pad (abnormal finding)
Treatment
Non-Op
- immobilze: 3-7 days with early ROM
OP
- ORIF
- frag. excision
- radial head resection or replacement
Colle’s Fracture (fracture at the distal radius: with distal portion of the fracture with dorsal tilt
Etiology
Symptoms
Etiology
- most are intraarticualr: involivng the joint surface
- higher risk in women and OP
- FOOSH mechanism
Symptoms
- wrist pain & swelling
- deformitiy (dinner fork)
- limited ROM
- TTP
Diangosis
- Xray: 3 views (AP, lateral and oblique)
- CT: surgical planning and assessing intraarticualr involvement
- MRI: for tearing of fiberous cartilage & ligmanetous injuries (scapholunate & lunotriquetel)
Treatment: depends on the angle of displacement, shortening and volar tilt
Non-Op
- closed reduction with immobilization (if the angle of displacement is ok, < 5 mm shortened, extraarticular)
Operative
- CRPP and ORIF or external fixation
Scaphoid Fracture
Etiology
Bloos supply specifics
Symptoms
Etiology
- contact sports, FOOSH
Blood Supply
- majority to the scaphoid comes from major dorsal carpal branch of radial artey
- minor supply from palmar arch of radial artey
- a poor healing environment
Symptoms
- pain at wrist
- swelling, brusing, hematoma
- deformity visable
- worse pain with circumduction and pronation
Scaphoid Fracture
Signs on Exam
Diagnosis
Treatment
Complications of Scaphoid fractures
Signs on Exam
- anatomical snuffbox tenderness
- scaphoid fracture tenderness on paplation palmar
- scaphoid compression test (push = pain)
Diagnosis
- Xray: scaphoid view
- Bone scan: if occult fracture
- MRI: occult fracture view, ligament injuries, see vasculature of bone
- CT: for fracure details for surgery
Treatment
- if you are sus for this, and xray does show: can still splitna nd have they f/u to repeat xray when swlling goes down
Non-Op
- cast immobilzation with thumb spica if its a stable and nondisplaced fracture
Op
- Pins or ORIF
Complications
- malunion: wrong position
- nonunion: dont heal togeher
- osteonecrosis and avascualr necrosis
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