Exam II (UE) Pathologies Flashcards
Shoulder Complex Grade I
AC ligament sprain
CC ligaments and Deltotrapezial facia intact
Nondisplaced
Shoulder Complex Grade II
AC Ligament complete tear
CC ligaments sprain
Delto-trapezial fascia intact
<25% Superior displacement
Shoulder Complex Grade III
AC and CC ligaments complete tear
Delto-trapezial fascia injuried
25-200% superior displacement
Shoulder Complete Grade IV-VI
AC & CC ligaments complete tear
Delto-trapezial fascia detached
All displaced
Generally requires surgery
What is it called when clavicle separates from acromion?
acromioclavicular (AC) separation
What is it called when the humerus separates from the glenohumeral capsule?
Glenohumeral dislocation
Where can a shoulder impingement be?
Supraspinatus or biceps LH
Subacromial bursa
What can shoulder impingement be caused by?
Chronic tendonitis of supraspinatus or biceps LH,
Subacromial bursa
Weakness of rotator cuff
Abnormal movement of scapula (Anterior tipping)
Type 3 acromion
Posture
Capsule (tightness, requires joint mobz)
Pathologies of glenohumeral joint
Subluxation
Adhesive capsulitis
What is GH joint subluxation and what is it caused by?
When humerus comes out of joint but does not dislocate
Common in stroke patients; no mm tone to counteract weight of arm
Connective tissue is decreased, so there is increased motion
What is GH adhesive capsulitis?
AKA Frozen Shoulder
How does adhesive capsulitis/frozen shoulder occur?
Intact MM
Fibrosis of capsule
Connective tissue (collagen) increases causing decreased motion
What is the most lost motion in adhesive capsulitis?
ER is the primary motion lost, which will affect shoulder flexion
What are the causes (primary & secondary) of adhesive capsulitis?
Primary: insidious; unknown reasons
Secondary: arthritis, RC tear, trauma, cardiac, neurology, pulmonary disease, diabetes, thyroid disease
What is a bankart lesion and how does it happen?
anterior inferior lesion to the labrum of GH capsule
Occurs at 90 flexion, 90 abduction
What is the most common result of a shoulder dislocation?
Bankart lesion
What is a Hill-Sachs leison and how does it occur?
Dislocation of humeral head causes muscles to spasm and push head into the edge of GH cavity causing a gouge in humeral head
How are Hill-sachs leisons treated?
it is left alone if the gouge in humeral head is less than 20% of the surface, if more can be filled with bone graph
What is a SLAP Tear and how does it happen?
Minor subluxation causing a tear in the superior labrum anterior to posterior, extreme forces causing LH of bicep tendon pull on the labrum
Who commonly gets SLAP tears?
Overhead athletes eg. baseball players 90-90
What causes winging of the inferior angle of the scapula?
Weakness of serratus anterior
What plane does scapula winging occur in?
coronal plane
abduction/protraction
Damage to what peripheral nerve causes scapula winging?
Long Thoracic N.
Damage to what cranial nerve causes scapula winging?
C5-C7
What occurs when there is damage to the spinal accessory nerve?
scapula is elevated and entire medial boarder of scapula is lifted/winged
What motions are limited with damage to CNXI (spinal accessory)
Shoulder flexion to 90 degrees
Abduction to 20-30 degrees
If pectoralis minor is tight, what motion is limited?
Shoulder flexion since shoulder is anteriorly tilted…
Coracoacromial ligament hits the greater tubercle
Where can suprascapular nerve get compressed and what muscles become weak at that location?
Suprascapular notch: Supraspinatus and Infraspinatus
Spinoglenoid notch: Infraspinatus
What would swelling within the quadrangular space compress?
Axillary n. (deltoid & teres minor)
Posterior humeral circumflex a.
What would swelling within the triangular space compress?
Scapular circumflex a.
What would swelling within the triangular interval compress?
Profunda Brachial A.
Radial N. (Triceps, brachioradialis, anconeous, APL, Supinator, all wrist extensors)
What is the most common clavicular fracture?
Middle third of clavicle
Medial fragment displaced upward by pull of sternocleidomastoid, lateral fragment displaced downward by weight of shoulder
If C5 spinal nerve was damaged, what would not work?
Elbow flexion (biceps)
If C6 spinal nerve was damaged, what would not work?
Wrist extension (eg. extensor carpi radialis)
If C7 spinal nerve was damaged, what would not work?
Elbow extension(eg. triceps)
If C8 spinal nerve was damaged, what would not work?
Finger flexion (eg. flexor digitorum profundus)
If T1 spinal nerve was damaged, what would not work?
Small finger abductors (eg. abductor digiti minimi)
How does UCL (Ulna Collateral Ligament) tears occur?
Typically in baseball players due to decreased internal rotation. Damage to the anterior band
What muscle weaknesses contribute to UCL tears?
Primarily flexor digitorum superficialis, but also pronator teres and flexor carpi ulnaris
Damage to the common flexor tendon affects what muscles?
Pronator teres, flexor capri radialis, palmaris longus, flexor carpi ulnaris, and flexor digitorum superficialis
wich would affect: pronation, flexion of wrist, ulnar and radial deviation weakness, and PIP flexion
What is Nursemaid’s elbow?
Subluxation of radial head; tear distal part of annular ligament
Proximal part of ligament is trapped between radial head and capitulum (blocking motion)
How does nursemaid’s elbow occur?
Axial traction is the most common
Can happy from a fall
Infants can get it after being assisted to roll over
What is a common elbow injury from children falling?
Supracondylar fx, from hyper extension
Typical clinical manifestation from nursemaid’s elbow
Child protective of arm
Anxiety is greater than pain
Elbow flexed 15-20 degrees
No warmth or swilling
distal circulation, sensation and motor activity are normal
Tenderness at radial head
Pt resists pronation, supination, flex, and ext
What is an elbow complex dislocation
Dislocation with fracture
Pts almost never get full ROM in the future
What are the 4 bursaes in the elbow?
Olecranon (2-subcutatneous and subtendinous)
Bicipital
Radioulnar
What bursitis in the elbow would not be painful?
Subcutatneous; superficial between skin and olecranon
Damage to the musculocutaneous nerve would cause weakness in what muscles?
coracobrachialis C6-7
biceps brachii C5-6
brachialis C5-6
Damage to the musculocutaneous nerve would cause sensory loss to what?
Lateral forearm (lateral antebrachial cutaneous)
Damage to the median nerve would cause weakness in what muscles?
Anterior compartment of forearm, and palmar hand
Damage to the median nerve would cause sensory loss to what?
anterior hand and posterior digits 2-4
Damage to the ulnar nerve would cause weakness to what?
anterior compartment forearm and palmer hand
Damage to ulnar nerve would cause sensory loss to what?
Little finger, lateral half of digit IV, and hypothenar
Damage to the radial nerve would cause weakness in what muscles?
Triceps Anconeus Brachioradialis Supinator Wrist extensors
Damage to the radial nerve would cause sensory loss in what?
posterior arm, forearm, and hand
What is myositis ossificans?
Bone growing within the muscle
Typically happens with bleeding
What are heterotropic ossification commonly seen with?
supracondylar fractures
posterior dislocation of elbow
aggressive stretching of elbow flexors
Examples of injuries that can damage the radial nerve
humeral fractures at radial groove
direct trauma
Radial head fracture dislocation can damage what nerve?
Deep radial nerve
- Superficial (all sensory)
- Deep (posterior interosseous nerve)
Damage to the common extensor tendon would effect what muscles?
Extensor carpi radialis brevis, extensor digitorum, extensor carpi ulnaris, extensor digiti minimi
What is a common area the axillary nerve would be damaged?
quadrangular space
How is the musculocutaneous nerve commonly damaged?
entrapment by coracoprachialis
What are common ways to damage the ulnar nerve?
Honeymooner’s palsy, cubital tunnel, tunnel guyon
How would the ulnar nerve get damaged at the cubital tunnel?
Compression against medial epicondyle, repetitive pressure, stretching, trauma
What are common ways to damage median nerve?
pronator teres entrapment, anterior interosseous syndrome, carpal tunnel, honeymooner’s palsy
Anterior interosseous syndrome (from the median nerve) affects what muscles?
Flexor digitorum profundus I&II
Flexor pollicis longus
pronator quadratus
What is the cause of honeymooner’s palsy
Pressure on the upper arm from head lying on the arm
What type of occupation could have entrapment of their median nerve?
Carpenters, anyone with repetitive pronation (pronator teres entraps nerve)
Who would get nerve damage at the tunnel of guyon?
long distance bikers, mma
anyone with excess pressure or force on hypothenar
What are common ways to damage the radial nerve?
compression in triangular interval Radial groove (saturday night palsy) Radial head dislocations supinator syndrome posterior interosseous syndrome superficial radial n.
What nerve damage causes wrist drop
Compression to radial nerve at spiral groove
AKA Saturday night palsy
What is affected with Saturday Night Palsy?
branch to triceps are spared
long extensor of forearm paralyzed
small loss of sensation over the dorsal surface of the hand and lateral 3 fingers
What is Wartenberg’s syndrome?
Compression of superficial radial nerve?
Is there loss of motor, sensory, or both with Watenberg’s syndrome
Sensory only (back of the hand)
How does Watenberg’s Syndrome happen?
Superficial radial nerve compressed by scissoring of brachioradialis and extensor carpi radialis longus during pronation
What test could be performed to assess for anterior interosseous nerve palsy?
Ask patient to make an O with index and thumb
FDP II&III, FPL, PQ
Rule of dislocations with fractures of forearm
dislocation of the head, fx of bone near by
What is a Monteggia Fracture?
fx of proximal 1/3 of ulna
Anterior dislocation of radial head
What is a Galeazzi Fracture?
Fx of radial shaft
Ulnar head dislocation at distal radioulnar joint
What is a Smith Fracture?
fracture of radial head
