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NMS 3 > final > Flashcards

final Flashcards

1
Q

What is defined as “partial or complete injury of the elbow ligamentous complex”?

A

elbow sprain

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2
Q

What ligaments are included in the elbow complex?

A

LCL, MCL, annular lig, joint capsule

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3
Q

What are the most important stabilizers of the elbow?

A

MCL and LCL

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4
Q

What else contributes to elbow stability?

A

bony locking mechanism

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5
Q

Why does the elbow have “continual compensatory function”?

A

it is adjacent to GH joint which is inherently unstable

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6
Q

Which ligament is especially important during mid-ROM of the elbow?

A

MCL

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7
Q

When the elbow is at 90 degrees, what accounts for >50% of valgus stability and 80% of distraction stability?

A

MCL

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8
Q

When are both anterior and posterior fibers of the elbow joint capsule taut?

A

fully extended and fully flexed

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9
Q

What is considered secondary support for the MCL at the elbow?

A

common flexor tendon

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10
Q

Which side of the elbow is more prone to injury?

A

lateral side

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11
Q

What is the most common MOI of elbow sprain?

A

FOOSH

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12
Q

Which direction of stress is more likely to create a fracture, valgus or varus?

A

varus stress

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13
Q

What is an important DDX for elbow sprain?

A

lateral epicondylitis

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14
Q

What ortho tests should be done to rule in elbow sprain?

A

valgus and varus stress tests

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15
Q

What is the “P” for elbow sprain Tx?

A

sling/brace/tape in resting position

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16
Q

What is the “OL” for elbow sprain Tx?

A

technique, work position, AROM (pain free early), isometrics

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17
Q

What direction should you do soft tissue massage for an elbow sprain?

A

Start distally, move proximally

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18
Q

Which elbow dislocation is direction is rare but very serious?

A

Posterior dislocation. D/t Fx risk, massive contracture, subsequent risk of neurovascular compromise

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19
Q

What is also known as tennis elbow?

A

lateral epicondylitis

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20
Q

What is lateral epicondlyitis pain usualy d/t?

A

degenerative tendinopathy, periostitis, possible adhesions

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21
Q

What muscle/tendon is usually most involved in lateral epicondylitis?

A

ECRB (sometimes ECU, ED and supinator)

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22
Q

T/F: Golfers do not get lateral epicondylitis

A

FALSE

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23
Q

In golfers, which elbow gets medial epicondylitis?

A

trailing arm

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24
Q

In golfers, which elbow gets lateral epicondylitis?

A

leading arm

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25
Q

What is the most common elbow condition?

A

lateral epicondylitis

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26
Q

In what age group is lateral epicondylitis most often seen?

A

40-60 yo

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27
Q

What is the etiology of lateral epicondylitis?

A

repetitive overuse, usually starts with inflammation of tendon

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28
Q

how much does the risk of lateral epicondylitis increase in males over 40?

A

2x

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29
Q

how much does the risk of lateral epicondylitis increase in females over 40?

A

4x

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30
Q

Does lateral epicondylitis occur more frequently in tennis players, or as a work related injury?

A

work related

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31
Q

What is one of the most common symptoms of lateral condylitis?

A

weakness and pain with gripping

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32
Q

What ortho tests are used to Dx lateral epicondylitis?

A

Cozens test, Mills test, long finger test, book test

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33
Q

What is a good outcome measure for lateral epicondylitis?

A

grip strength via dynamometer

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34
Q

What kind of supports can be used in early treatment of lateral epicondylitis?

A

elbow/wrist sleeves (avoid tension braces early)

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35
Q

How should the wrist be positioned for splinting of lateral epicondylitis in the late stage of Tx?

A

hold wrist in extension to take stress of extensors (only in severe cases)

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36
Q

What can negatively effect the long term prognosis of lateral epicondylitis?

A

computer use

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37
Q

What increases the possibility of a poor short term outcome to conservative tx?

A

neuro s/sx

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38
Q

medial epicondylitis causes medial elbow pain involving tendinopathy of what?

A

common flexor tendon

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39
Q

what does medial epicondylitis in children lead to?

A

traction apophysitis of medial epicondyle (salter harris Fx)

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40
Q

what is the epidemiology of medial epicondylitis?

A

> 40 yo, caucasian

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41
Q

what kind of muscle imbalances occur in medial epicondylitis?

A

decreased biceps and pronator flexibility, decreased pronator and wrist flexor strength

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42
Q

T/F: medial epicondylitis usually occurs from trauma

A

false - overuse

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43
Q

which epicondylitis are baseball pitchers more likely to have?

A

medial

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44
Q

how does the pain location of child vs adult with medial epicondylitis differ?

A

child = generalized adults = localized

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45
Q

what two tests are usually positive with medial epicondylitis?

A

reverse cozens, reverse mills (both have pain at medial epicondyle)

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46
Q

In a pt with lateral elbow pain, what are the common trauma related DDXs?

A

contusion, bursitis, sprain/strain, radial head subluxation

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47
Q

in a pt with lateral elbow pain, what are the common activity related ddxs?

A

lateral epicondylitis, LCL sprain

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48
Q

what is the most common site of DVT in the upper torso?

A

periscapular

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49
Q

in a pt with medial elbow pain, what are the most common trauma related ddxs?

A

mcl rupture, fracture/avulsion

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50
Q

in a pt with medial elbow pain, what are the most common activity related conditions?

A

medial epicondylitis, mcl sprain

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51
Q

what condition usually presents with bishops hand?

A

ulnar n. entrapment

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52
Q

what are the possible ulnar n. entrapment presentations?

A

n/t/w of 4th and 5th fingers, atrophy of hypothenar, bishops hand

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53
Q

in a pt with posterior elbow pain, what are the most common trauma related conditions?

A

contusion, grade 1-2 strain (triceps), bursitis, radial head subluxation, Fx

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54
Q

in a pt with posterior elbow pain, what are the most common activity related ddxs?

A

lateral and medial epicondylitis, mcl/lcl sprain, triceps tendinopathy (can => bursitis), stress fx

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55
Q

how common is anterior elbow pain?

A

very uncommon - pain usually lateralizes

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56
Q

what is olecranon bursitis aka?

A

miner’s elbow, student/draftsman elbow, dart throwers elbow

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57
Q

what is the most common superficial bursitis in the body?

A

olecranon bursitis

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58
Q

what is the cause of about 20% of acute cases of olecranon bursitis?

A

staphylococcus or other gram + infections

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59
Q

what are some common causes of olecranon bursitis?

A

gout, pseudogout, tight triceps, tendinitis

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60
Q

what would increase the chance of septic bursitis?

A

trauma with breaks in skin

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61
Q

when palpating the bursa and it feels “gritty” what should you think of?

A

gout

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62
Q

what are the common symptoms of bursitis?

A

swelling, stiffness, localized to posterior elbow. Pain and tenderness NOT common

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63
Q

if when palpating bursa there is pain or tenderness, what should you suspect?

A

periosteum involved (poss Fx), advanced infection

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64
Q

What do 1/3 of olecranon bursitis cases require?

A

aspiration and culture

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65
Q

when should ice be used for olecranon bursitis?

A

ice is ok in absence of a lot of swelling

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66
Q

how quickly does olecranon bursitis heal?

A

slow

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67
Q

what are the follow up procedures for olecranon bursitis?

A

aspiration (fast RTP), corticosteroid injection, rarely surgery

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68
Q

what is elbow osteochondritis dissecans (ocd) aka?

A

Panner’s dz

69
Q

what is elbow OCD?

A

AVN of capitellum joint surface

70
Q

what is the most common site of OCD in the upper limb?

A

elbow

71
Q

What is more common, ocd of knee or elbow?

A

knee

72
Q

What is the epidemiology of elbow ocd?

A

males (10:1), adolescent athletes

73
Q

what causes elbow ocd?

A

repetitive valgus stress compressing radial head against capitellum

74
Q

what are 2 common risk factors for elbow ocd?

A

instability, medial epicondylitis (d/t excess valgus force)

75
Q

what is the onset of symptoms for elbow ocd?

A

gradual lateral elbow pain

76
Q

what are the common s/sx of elbow ocd?

A

decreased AROM (esp extension), tender enlarged radial head, lateral elbow pain w/ valgus stress test

77
Q

what do you use to grade severity of elbow ocd?

A

xrays

78
Q

what are the xray findings of elbow ocd?

A

stage 1 = subtle, ragged capitellum stage 2= more noticeable, enlarged radial head stage 3= obvious fragmentation(poor prognosis w/ conservative care)

79
Q

what is the most important thing to avoid in elbow ocd tx?

A

manipulation

80
Q

what is more common, mild wrist sprain or Fx/subluxation/dislocation?

A

sprain

81
Q

which row of carpals is most vulnerable to sprain?

A

proximal

82
Q

what wrist positioning is most likely to result in fx?

A

extension with radial deviation

83
Q

what wrist position is most likely to cause sprain, dislocation, or TFC tear?

A

extension with ulnar deviation

84
Q

what is the most common MOI for wrist sprain?

A

hyperextension/FOOSH

85
Q

during a foosh injury, what direction is the proximal row of carpals forced?

A

anterior

86
Q

which ligamets are sprained in a hyperextension wrist injury?

A

palmar radiocarpal and scapholunate

87
Q

with a hyperflexion wrist injury, what direction are the proximal carpals forced?

A

posterior

88
Q

which ligaments are sprained in a hyperflexion wrist injury?

A

dorsal radiocarpal and lunotriquetral

89
Q

what are the characteristics of bruising and swelling in a wrist sprain?

A

swelling is less visible than other sprains, bruising is NOT typical

90
Q

what are the most important joint plays in traumatic wrist injury?

A

scapholunate and lunotriquetral

91
Q

what test is positive with a wrist sprain?

A

scapholunate and lunotriquetral ballotment/shear test

92
Q

what is the most common form of wrist instability?

A

dorsal intercalated segmental instability (DISI)

93
Q

what is DISI caused by?

A

hyperextension

94
Q

what does DISI result in?

A

disassociation of scaphoid and lunate (+ scapholunate ballotment)

95
Q

what is a Terry Thomas sign?

A

obvious gap b/t scaphoid and lunate on xray

96
Q

What does a Terry Thomas sign indicate?

A

DISI

97
Q

what are the 2 types of wrist instability?

A

DISI and VISI

98
Q

what causes a VISI injury?

A

hyperflexion

99
Q

what does VISI result in?

A

disassociation of lunate and triquetrum (+ lunotriquetral ballotment)

100
Q

what is the most frequently dislocated carpal?

A

lunate

101
Q

what happens to the scaphoid and lunate when wrist is hyperextended?

A

they move apart

102
Q

what is the most commonly torn ligament in the wrist?

A

scapholunate

103
Q

what is the most commonly fractured carpal?

A

scaphoid

104
Q

what are the three most common cysts?

A

ganglion, bakers, sebaceous

105
Q

what is defined as “a non pathological fluid filled sac”?

A

bursa

106
Q

what is defined as a “pathological fluid filled sac”?

A

cyst

107
Q

what are the two types of ganglion cyst?

A

arthrosynovial (swelling/bulge over joint), tenosynovial (swelling/bulge overlying tendon)

108
Q

which type of ganglion cyst is more common?

A

tenosynovial

109
Q

what is the epidemiology for ganglion cysts?

A

females (3:1), teens-late 40s

110
Q

where are ganglion cysts most common?

A

wrist tendons and wrist joint (usually radiocarpal articulation)

111
Q

what would the ddx be for a cyst located on the ventral side for an older patient?

A

neurofibromatosis

112
Q

what are the theories for etiology of ganglion cysts?

A

collagenous degeneration, congenital weakness, or trauma

113
Q

what side of the wrist are ganglion cysts normally located on?

A

dorsal

114
Q

what is a carpal boss?

A

osseous overgrowth occasionally mistaken for a ganglion cyst

115
Q

what happens if a ganglion cyst is untreated?

A

becomes hard

116
Q

which type of ganglion cyst is more likely to have a recurrence?

A

arthrosynovial

117
Q

which type of ganglion cyst is more likely to need surgery?

A

arthrosynovial

118
Q

which type of ganglion cyst is usually larger, softer, and more painful?

A

tenosynovial

119
Q

what is the definition of gamekeepers thumb?

A

sprain of ulnar/medial collateral lig of 1st metacarpophalangeal joint

120
Q

what is gamekeepers thumb aka?

A

skiers thumb

121
Q

what is the etiology of gamekeepers thumb?

A

forceful hyperextension and/or hyperabduction of the thumb

122
Q

what ortho tests are used to dx gamekeepers thumb?

A

abduction stress test (0/30 flexion), extension msl test, thumb pinch

123
Q

what are the findings and likely treatment for grade 3 gamekeepers thumb?

A

instability w/o firm end point, >20-30 degrees of instability at full flexion, refer to orthopedist

124
Q

what are the findings and likely treatment for grade 2 gamekeepers thumb?

A

<20 degrees valgus instability at full flexion, firm endpoint, cast for 2-4 wks

125
Q

what is a stener lesion?

A

torn UCL and volar plate avulsion, causing significant instability, palpable nodule over UCL helps ID lesion

126
Q

would you adjust gamekeepers thumb?

A

probably not

127
Q

what type of exercises help with late tx of gamekeepers thumb?

A

rubber band/squeeze ball/silly putty

128
Q

does skiers thumb involve a sprain or strain?

A

sprain

129
Q

does Dequervains dzinvolve a sprain or strain?

A

strain

130
Q

what is dequervains disease?

A

tenosynovitis of APL and EPB along lateral wrist and base of thumb

131
Q

what is dequervains disease aka?

A

tenovaginits, stenosing tenosynovitis (severe chronic form)

132
Q

a previous dx of ____ is a common risk factor for dequervains dz

A

wrist tendonopathy, especially on radial side

133
Q

what is dequervains dz usually d/t?

A

repetitive overuse of thumb

134
Q

is skiers thumb usually d/t trauma or repetitive overuse?

A

trauma

135
Q

what is the onset of symptoms for dequervains dz?

A

gradual

136
Q

what does “squeaky thumb” refer to?

A

dequervains dz

137
Q

what is the most common site of DJD in the hand?

A

1st carpometacarpal joint

138
Q

what are the signs of dequervains dz?

A

swelling w/o bruising, pain w/ resisted thumb extension and when stretching tendons

139
Q

what test is used for dequervains dz?

A

finklesteins test

140
Q

what does “squeaky wrist” refer to?

A

intersection syndrome

141
Q

what is intersection syndrome?

A

repetitive injury to ECRB and ECRL at insertions

142
Q

what is the presentation of intersection syndrome?

A

lateral wrist pain

143
Q

what is a good indicator of 1st carpometacarpal joint OA?

A

joint enlargement, grinding crepitus (NOT SQUEAKING)

144
Q

what test should be performed for 1st carpometacarpal jt OA?

A

thumb grinding test

145
Q

what is boutonniere’s deformity?

A

forced flexion causing extensor tendon rupture at PIP

146
Q

how would you splint boutonniere’s deformity?

A

extension splinting for 6-8 wks

147
Q

what is mallet finger?

A

forced flexion causing extensor tendon avulsion at DIP

148
Q

which digit is most commonly affected by mallet finger?

A

3rd digit

149
Q

what is the common ddx for mallet finger?

A

RA (swan-neck deformity)

150
Q

what type of splint should be used for mallet finger?

A

short finger splint (10 degrees of extension) for 6-8 wks

151
Q

describe heberdens nodes

A

OA - DIP - non tender

152
Q

describe bouchards nodes

A

OA/RA - PIP - non tender

153
Q

describe haygarths nodes

A

RA - MCP - tender

154
Q

what is madelung deformity?

A

genetic disorder involving radial growth plate disturbance

155
Q

what is the most common epidemiology for madelung deformity?

A

adolescent, female dwarves

156
Q

what is madelung deformity predispose the pt to?

A

kienbocks dz (AVN of lunate) and TFC tears

157
Q

what is seal fin deformity associated with?

A

RA

158
Q

what is dupuytrens contracture aka?

A

hypertrophic nodular fiberplasia

159
Q

what is the epidemiology for dupuytrens contracture?

A

males (3:1), diabetics (RR = 4.0)

160
Q

Which digits are commonly affected by dupuytrens contracture?

A

4 and 5

161
Q

What is Volkman’s ischemic contracture?

A

forearm flexion contracture commonly caused by supracondylar fx (crush injury), tight fit cast/bandage, or acute compartment syndrome

162
Q

who is volkman’s ischemic contracture most common in?

A

children

163
Q

What are the 6 Ps for volkmans ischemic contracture?

A

pain, paresthesia, paresis, paralysis, pallor, pulseless

164
Q

what is ape hand?

A

median neuropathy causing derotation of thumb and atrophy of thenar

165
Q

is ape hand reversible?

A

no

166
Q

what is claw hand/fingers?

A

finger and thumb flexion caused by injury to median and ulnar nn., multi level radiculopathy, and/or plexopathy

167
Q

what is jersey finger/sweater sign?

A

forced finger extension causing rupture of FDP

168
Q

how does jersey finger/sweater sign present?

A

inability to flex finger completely while making a fist

NMS 3 (2 decks)

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