lecture 11- upper extremity injuries Flashcards

1
Q

elbow area contusions

A

laterally= radial nerve at risk
extensor muscle weakness
posterolateral numbness

medially= ulnar nerve at risk
“funny bone” injuries
numbness in medial forearm and digits IV +V
flexor muscle weakness

posteriorly:
olecranon bursitis

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2
Q

Strains and tendinopathy

A

Hx: resisting a force, fall, overuse

SSx: pain worse with movement against resistance, tenderness, swelling, crepitus
–> using equipment that is too big? Often happens with kids

Tx: rest, POLICE, ROM, physio, tape, shin splints, rehab

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3
Q

most dislocated carpal bone

A

lunate

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4
Q

most fractured carpal bone

A

scaphoid

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5
Q

2 nail injuries

A
  • Avulsion (nail ripped off, high chance of infection)
  • Subungual haematoma (contusion, crush, bleeding under nail)
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6
Q

Superficial hand injuries:

A

Hand abrasions, lacerations
- always looking for infections with these!!!!!
Laceration= a cut (ex. tip of finger cut off)

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7
Q

biceps tendinopathy

A

tendinosis in biceeps, male athletes 45-60 years old

SSx: pain anterior shoulder, pain w 900 to 120 degrees shoulder flexion

Tx: rest, ice, modified activities, ROM, strengthening

can lead to biceps rupture

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8
Q

biceps rupture

A

SSx: snap, weakness, bruising, popeye’s sign (sticking up lump in biceps)

MRI or diagnostic ultrasound

Tx: surgery, rehab

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9
Q

Medial/lateral epicondylalgia

A

golfers/tennis elbow

SSx: aching pain, worse w movement

TX: rest, splints, ice, physio (eccentric loading), NSAIDs, rehab, surgery

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10
Q

tendinopathy in forearm and wrist areas may result in

A

may result in ganglion
–> cyst in tenosynovium or swelling in joint capsule

-mobile, swollen, painful, crepitus
-may lead to carpal tunnel syndrome if on palmar side (by putting pressure on the carpal tunnel)

Tx: surgery

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11
Q

carpal tunnel syndrome

A

swelling in tunnel causes compression of median nerve

Hx: repeated wrist flexion (tendinopathy), trauma (sprain, fracture, dislocation), ganglion, tumour, pregnancy

SSx:
pain, worse at night and at rest
numbness/weakness of thumb
atrophy of thenar eminence

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12
Q

carpal tunnel brace?

A

only at nigh bc it actually increases muscle activity and causes more harm than good w active movement bc have to overcome resistance!!

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13
Q

carpal tunnel syndrome Tx

A

POLIE, tear underlying cause

splint

send to MD

NSAIDs

may need surgical decompression

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14
Q

De quervain’s tenosynovitis
Hx

A

cause: repetitive use of wrist/thumb, w wrist in ulnar deviation

—> inflammation of abductor pollicis longus and extensor pollicis brevis tendon sheaths

(much more common w phone!!! having to reach w thumb)

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15
Q

De quervain’s tenosynovitis
SSx, Tx

A

SSx: pain/swelling at base of thumb/radial side of wrist.
pain and stiffness w radial deviation of wrist and thumb flexion

Tx: POLIE, rest, brace, physio, corticosteroid injection, surgery

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16
Q

Hand strains and tendinopathy
-beware of possible

A

avulsion fracture
(bone comes off with the tendon)

17
Q

upper extremity sprains and dislocations Hx

A

torsion
resisting a force
FOOSH

18
Q

upper extremity sprains and dislocations SSx

A

pain, tenderness
swelling
deformity if dislocated
bruising
reduced ROM

19
Q

upper extremity sprains and dislocations Tx

A

check neovascular status
POLICE, splint, hospital
Xray, splint or cast
Tape, physio, NSAIDs, rehab

20
Q

UCL sprain of the elbow

A

UCL is resistant to valgus stress to elbow.
UCL sprain makes elbow less stable.

SSx: pain medial elbow, laxity w valgus stress test

Tx: POLICE, NSAIDs, GH joint and elbow mechanics, pitching motion, surgery?

21
Q

Elbow sprain/dislocation

A

commonly dislocated by parents pulling child by arm

radius and ulna go back, humerus displaces forwards

dislocation of elbow= EMERGENCY!!

22
Q

wrist sprains and dislocations

A

check neovascular status

complications: lunate, other dislocations, carpal tunnel syndrome, scaphoid fracture

23
Q

annular ligament

A

circular

holds radial head in place at the elbow

24
Q

finger ligament sprains

A

collateral ligament sprains

perform valgus or varus stress tests on IP joints

25
gamekeeper's thumb (UCL tear of the thumb)
Hx: forceful abduction w hyperextension of 1st MCP joint SSx: pain over UCL, weak and painful pinch, swelling, tenderness Tx: POLICE, splint, taping, rehab **squeezing finger and thumb together to sqeeze "game" or rabbits
26
what can you do to prevent swelling of thumb
wrap string or showlace distal to proximal to move swelling out
27
general notes: upper extremity fractures
Hx: deformity, crepitus, point tenderness on bone open fractures= high risk of infection Tx: cleanse, disinfect, splint, phyio, rehab
28
Radial head fracture
Hx: common w FOOSH SSx: swelling, limited, flexion and extension Tx: stabilize, NPO, surgery, rehab
29
colles fracture is a " "
dinner fork deformity
30
scaphoid fracture
Hx: fall, direct blow Ssx: tenderness in floor of anatomical snuffbox Xray may be negative but doesn't rule out fracture! often mistaken as sprain. most commonly fracture hand bone. Tx: cast for 8 weeks if Xray pos cast for 10 days if neg