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MSK > Lecture 5: UE Injuries Part 2 > Flashcards

Lecture 5: UE Injuries Part 2 Flashcards

1
Q

What joints are found in the elbow?

A
  • Ulnohumeral & Rapdiocapitellar articulation: Flex/Extend + Pronate/Supinate
  • Proximal radioulnar articulation: Pronate/Supinate

a Rad Cap = radius articulates with capitellum

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2
Q

Main 3 ligaments of the elbow

A
  1. Ulnar collateral ligament
  2. Radial ollateral ligament
  3. Annular ligament
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3
Q

Main 3 nerves of the elbow

A
  • Ulnar
  • Median
  • Radial
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4
Q

Main 3 arteries of the elbow

A
  • Brachial
  • Radial
  • Ulnar
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5
Q

XRAY views for the elbow

A
  • AP
  • Lateral
  • Oblique (radcap view, 45deg): best for radial head visualization
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6
Q

Interpreting elbow imaging rules

A
  1. Anterior humeral line should bisect middle third of capitellum
  2. Radcap line should pass through center of capitellum (3-4)
  3. Disruption may indicate fx
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7
Q

Lateral Elbow XR

A
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8
Q

AP Elbow XR

A
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9
Q

Top 3 MC Elbow complaints

A
  1. Pain
  2. Stiffness
  3. Swelling
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10
Q

Order of Elbow Assessment

A
  1. Inspect
  2. Palpate
  3. ROM
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11
Q

What does flexion/supination of the elbow use? Extension? Pronation?

Muscles & Nerves

A
  • Flexion/supination: Biceps, C5-C6, musculocutaneous nerve
  • Extension: Triceps, C7-C8
  • Pronation: Pronator teres, median nerve, C6-C7
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12
Q

Describe a valgus stress test on the elbow.

A
  • Tests medial ligament strength. (UCL)
  • Elbow 20deg flexed with supinated forearm
  • Apply pressure LATERALLY

VaL = Lateral

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13
Q

Describe a varus stress test on the elbow.

A
  • Tests lateral collateral ligament
  • Elbow 20 deg flexed and supinated forearm
  • Apply pressure from the MEDIAL SIDE
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14
Q

FOOSH

A

Falling on an outstretched hand

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15
Q

MCC of distal humerus factures

A
  1. Direct trauma
  2. Axial loading during FOOSH
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16
Q

MC Fracture patterns seen for distal humerus

A
  • Type A: supracondylar is MC in children.
  • Type B: epicondylar is medial/lateral.
  • Type C: intercondylar is MC overall.

Growth plate = looks like type A location

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17
Q

What nerves can get injured with a distal humerus fx?

A
  • Ulnar nerve: sensory + flexion/adduct of wrist, 4/5 DIP joint flexion, finger abduction
  • Radial nerve: sensory + wrist extension
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18
Q

How does a distal humerus fx present?

A
  • Pain, swelling, tender, bruising, crepitus
  • ROM limited
  • Shortening if displaced fx
  • Make sure to check NV status above and below!

supracondylar - radial artery/med nerve
epicond - uln nerve, rad nerve

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19
Q

XRAY findings for distal humerus fx

A
  • Fat pad sail sign indicates intra-articular bleeding or occult fx, MC in kids
  • If you see a posterior fat pad: ALWAYS PATHOLOGIC

AP and lateral

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20
Q

Type A supracondylar fx XR

A
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21
Q

Type B Epicondylar fx XR

A
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22
Q

Type C intercondylar fx XR

A
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23
Q

Management of Type A/supracondylar elbow fx

A
  • If no displacement/angulation: long arm cast at 90 deg
  • If displaced/angulated/NV compromise: ORIF
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24
Q

Management of type B epicondylar elbow fx

A
  1. Isolated, minimal displacement (< 2 mm): 90 deg splint.
  2. For medial condyle: Pronate forearm
  3. For lateral condyle: Supinate forearm
  4. Mod displacement (2-4mm): Perc pinning or ORIF
  5. Severe: ORIF
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25
Q

Long Arm Posterior Splint

A

Type A supracondylar fx

If epi: you would pronate for medial, supinate for lateral

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26
Q

Top 2 MOI for olecranon fx

A
  1. Falling on a semi-flexed, supinated forearm (avulsion)
  2. Direct trauma

Triceps contracting, yanking a piece of olecranon off

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27
Q

How does an olecranon fx present?

A
  • Normal stuff over olecranon process
  • Limited ROM
  • Deformity if associated dislocation
  • MC Nerve affected: Ulnar
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28
Q

How to image an olecranon fx?

A
  • Start with AP and lateral views
  • Radcap view if unclear or complicated
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29
Q

Management of a nondisplaced olecranon fx with minimal displacement (< 2 mm displacement)

A
  • Long arm posterior with elbow at any deg of flexion.
  • Forearm neutral
  • Squeeze rubber ball 5 mins/d
  • Repeat XR in 7-10 days
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30
Q

Management of displaced olecranon fx

A
  • Closed fx: Splint and ORIF
  • Open: IV abx and consult ortho
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31
Q

CI to surgery for olecranon fx

A
  • Elderly
  • Too many comorbidities

Sling and start ROM as pain allows

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32
Q

What is the MC fx of the elbow?

A

Radial Head/Neck Fx

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33
Q

What is the MOI for a radial head/neck fx?

A

FOOSH resulting in compression of radial head into capitellum

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34
Q

What are the 4 Mason classifications for radial head/neck fx?

A
  1. Type 1: < 2 mm displacement
  2. Type 2: Displaced > 2 mm
  3. Type 3: Comminuted
  4. Type 4: radial head fx + elbow dislocation
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35
Q

How does a radial head/neck fx present? (3)

A
  • Pain/tenderness along lateral aspect of elbow
  • Limited ROM, esp with pronation/supination
  • +/- swelling/ecchymosis
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36
Q

What is often seen on AP and lateral views of the elbow for a radial head/neck fx?

A
  • Fx line
  • Fat pad line

A posterior fat pad is always pathological.

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37
Q

How do we manage a Mason Type 1 Radial head/neck fx? (4)

1 = < 2 mm displacement

A
  1. Sling (can be w/ or w/o posterior splint)
  2. AROM after 24-48h (full extension + flexion, Pronation and supination with elbow flexed at 90d)
  3. Ortho f/u in 1 week
  4. Can aspirate if hemarthorsis is blocking early ROM
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38
Q

How do we manage a Mason type 2-3 Radial head/neck fx? (2)

2 = > 2 mm displacement, 3 = comminuted

A
  1. Sling + splint
  2. Ortho f/u in 2-3 days to dicuss ORIF
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39
Q

How do we manage a type IV radial head/neck fx? (1)

Fx + dislocation

A

CONSULT ORTHO IMMEDIATELY

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40
Q

What is Radial Head subluxation more colloquially known as?

A

Nursemaid’s elbow

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41
Q

What ligament does the radial head sublux through in nursemaid’s elbow?

A

Annular ligament

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42
Q

Who is radial head subluxation MC in?

A

Children under 5 years

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43
Q

What is the MOI for a radial head subluxation?

A

Pulling on a pronated forearm with elbow extended

Like you’re holding a kid’s hand as they walk

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44
Q

Once radial head subluxation occurs, how does it present? (4)

A
  • Arm held semi-flexed, adducted, pronated
  • Refusing ROM
  • Tenderness over radial head
  • No swelling or ecchymosis

It is not a fx, so swelling is rare.

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45
Q

Dx of radial head subluxation

A

Clinical

Only need imaging if you suspect a different injury.

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46
Q

Management of radial head subluxation (3)

A
  • Reduction via supination-flexion or hyperpronation
  • Make sure to premedicate with tylenol or motrin
  • You can try 3-4 times, but less likely to succeed if its been 1+ day since injury

You want to reduce it IMMEDIATELY

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47
Q

Describe the supination-flexion reduction technique.

Radial head subluxation

A
  1. Hold elbow with thumb over radial head
  2. Quickly supinate forearm completely
  3. Quickly flex forearm
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48
Q

Describe the hyperpronation technique (3)

A
  1. Hold elbow with your thumb over the radial head
  2. Hyperpronate forearm
  3. Completely extend and then flex the forearm.

EBM prefers this for the first attempt.

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49
Q

If reduction fails for a radial head subluxation, what do we do? (2)

A
  1. Order XRs
  2. Splint (posterior long-arm) and refer
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50
Q

If reduction succeeds for a radial head subluxation, what do we do? (3)

A
  1. Tylenol/motrin PRN
  2. +/- sling
  3. Parent education
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51
Q

What tendinosis is MC: Lateral wrist (extensors) or Medial wrist (flexors)?

A

Lateral epicondylitis, aka tennis elbow

Medial is golfer’s elbow

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52
Q

What is the usual MOI for epicondylitis?

A

Chronic repetitive overuse

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53
Q

When is epicondylitis MC? (age range)

A

30-50

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54
Q

What causes pain in lateral epicondylitis? (2)

A
  • Wrist extension
  • Gripping (shaking hands, computer mouse, screwdriver, back-handed tennis swing)

Extension and supination

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55
Q

Where does point tenderness occur in epicondylitis?

A

1 cm distal to the epicondyle

Medial is the same.

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56
Q

What causes pain in medial epicondylitis? (2)

A
  • Pronation and wrist flexion (golf, overhead throw, bowling)
  • Gripping weakness
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57
Q

Dx of epicondylitis

A

Clinically

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58
Q

Managment of epicondylitis (5)

A
  • Activity modification
  • NSAIDs + Ice
  • PT if failure of conservative tx
  • Counterforce brace
  • Steroids x 3 max
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59
Q

When should you refer to ortho regarding epicondylitis?

A

Symptoms persists for 6 months despite conservatie therapy

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60
Q

MOIs for olecranon bursitis (3)

A
  • Trauma: fall, direct blow
  • Inflammation: excessive leaning, RA, gout
  • Infection: Septic bursitis MC d/t staph or strep
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61
Q

Presentation of chronic olecranon bursitis (2)

A
  • Gradual swelling of bursa up to 6cm
  • +/- pain, mild tenderness, limited ROM
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62
Q

Presentation of acute olecranon bursitis

A
  • Sudden swelling of bursa
  • Pain/tenderness/limited ROM
  • Redness and warmth
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63
Q

When is aspiration indicated for olecranon bursitis? (1)

A

Large & Symptomatic

Analyze fluid with CBC, gram stain, C&S, and for crystals

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64
Q

When is AP and lateral XR indicated for olecranon bursitis? (1)

A

Hx of trauma

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65
Q

Tx of non-septic olecranon bursitis with mild swelling (2)

A
  • Activity modification
  • NSAIDs
66
Q

Tx of non-septic, large edematous olecranon bursitis (5)

A
  • Aspirate
  • Compression bandage
  • f/u in 2-7 days
  • Negative culture = reaspirate and reculture
  • Negative culture x 2 with persistent swelling = aspirate + 1 mL corticosteroid
67
Q

ABX for immunocompetent patient with mild, septic bursitis

A

Bactrim PO

Alt: keflex

68
Q

What is considered a severe septic bursitis?

A
  • Systemic toxicity
  • Rapid progression in 48hrs
  • Unable to tolerate PO
  • Close indwelling medical device
  • Immunosuppressed
69
Q

ABX for severe septic bursitis (2)

A
  • IV Vancomycin
  • Add cipro or zosyn if hx of trauma

Need pseudomonal coverage for trauma

70
Q

What is in a forearm XR series?

A
  1. AP
  2. Lateral
71
Q

What is in a wrist/hand/finger XR series? (3)

A
  1. PA
  2. Oblique
  3. Lateral
72
Q

What is a Galeazzi fx? (2)

A
  • Radial midshaft fx
  • Unstable distal radioulnar joint (DRUJ)
73
Q

What is a monteggia fx? (3)

A
  • Promixal 1/3 ulnar shaft
  • Dislocation of radial head
  • Unstable promixal radioulnar joint (PRUJ)
74
Q

MUGGER Mnemonic

A
  • MU = monteggia ulnar (A is proximal)
  • GR = Galeazzi radial (Z is distal)
75
Q

How does a forearm fx present? (3)

A
  1. Deformtity, swelling, ecchymosis
  2. Point tenderness overlying fx
  3. Decreased ROM above and below

Make sure to check NV status + compartments

76
Q

What two indications require Emergent referral for ortho for a forearm fx?

A
  1. Arterial compromise
  2. Open fx
77
Q

What 4 indications recommend an urgent referral to ortho for a forearm fx?

A
  1. Ulnar fx with < 50% apposition or > 10d angulation
  2. Any DRUJ or PRUJ instability
  3. Peripheral nerve injury
  4. Both bones got fx + displaced
78
Q

What 3 indications are just priority referrals to ortho for a forearm fx?

A
  1. Isolated radial fx
  2. Both bones fx, but mnimal/no displacement
  3. Isolated proximal 1/3 ulnar fx
79
Q

What is considered a simple, isolated fx of the ulnar shaft? (4)

A
  • Middle-distal 1/3
  • < 50% displacement
  • < 10d angulation
  • No joint involvement
80
Q

How do we manage a simple isolated, non-proximal fx of the ulnar shaft?

A
  1. Long-arm posterior splint with neutral forearm + slight wrist extension + 90d elbow
  2. After 1-3 wks, change to a functional forearm brace for 4-6 wks
  3. F/u Xrays at 1 week and q4wks until healing is done.

Usually 8 weeks to heal.

81
Q

When do we do a double sugar tong splint for a forearm fx?

A
  1. Isolated radial fx
  2. Combined radial + ulnar fx
  3. Galeazzi or Monteggia fx
82
Q

Carpal bones mnemonic

A
  • Some (scaphoid)
  • Lovers (Lunate)
  • Try (Triquetrum)
  • Position (pisiform)
  • That (Trapezium)
  • They (Trapezoid)
  • Cant (Capitate)
  • Handle (Hamate)

i before o

83
Q

Nerve distribution of the hand (3)

A
  • Ulnar: Medial (medial half of 4th digit + pinky)
  • Median: Palmar Lateral (Lateral half of 4th digit to thumb)
  • Radial: Dorsal Lateral hand (Thumb + 2nd and 3rd digit up to PIP joint)
84
Q

Palmar vs Dorsal Blood flow

A
  • Palmar has two arches and is fed by both ulnar and radial arteries
  • Dorsal has 1 arch and is fed solely by radial artery
85
Q

MC MOI for a wrist fx?

86
Q

MC type of wrist fx between Colles and Smith

A

Colles fx: distal radial fx is tilted dorsally

Dinner fork deformity (collard greens for dinner)

87
Q

Describe a smith’s fx

A

Distal radial fragment tilted volarly/palmarly

Garden spade deformity

88
Q

How does a wrist fx present clinically? (3)

A
  • Acute pain
  • Tenderness
  • Swelling
89
Q

Colles Fx XR

90
Q

Smith Fx XR

91
Q

Management of a non/miminally displaced non-articular wrist fx

A
  • Sugar tong or short arm cast for 2-3 weeks (but wait 72hrs to allow swelling)
  • AP and lateral XR weekly for 2 weeks

Wrist fx swell a lot!

92
Q

Management for displaced or open wrist fx?

93
Q

What is the MC type of carpal bone fx?

A

Scaphoid

in young men ):

94
Q

What are the 3 main complications of untreated scaphoid fx?

A
  1. High incidence of a delayed dx
  2. Non-union
  3. Avascular necrosis
95
Q

What is the MOI for a scaphoid fx?

A

FOOSH onto hyperextended hand.

96
Q

What 3 things are seen on clinical presentation of a scaphoid fx?

A
  1. Wrist pain/swelling along radial aspect
  2. Tenderness along anatomical snuff box
  3. Grip/ROM is painful/limited/weak
97
Q

What XRs do you order for a scaphoid fx? (2)

A
  • Wrist series
  • Scaphoid/navicular view (PA with wrist ulnar deviated)

CT/MRI if neg but suspicious still.

98
Q

Management of a nondisplaced fx/negative XRAY scaphoid fx (4)

A
  • Thumb spica splint/cast x 6 wk
  • Refer to ortho
  • Repeat XR in 1-2 weeks if it was initially negative
  • If XR is negative AGAIN but still tender, CT/MRI.
99
Q

Managment for a displaced scaphoid fx (2)

A
  • ORIF
  • Percutaneous pin placement
100
Q

What nerve is compressed in carpal tunnel syndrome? (CTS)

A

Median nerve

101
Q

What 4 physical tests are used to evaluate CTS?

A
  1. Tinel’s
  2. Phalen’s
  3. Carpal compression test
  4. Hand elevation test
102
Q

What physical sign suggest late CTS?

A

Thenar atrophy

103
Q

Besides activity, what can aggravate CTS?

104
Q

To diagnose CTS, what must be done?

105
Q

What are the primary management options for CTS? (3)

A
  1. Activity modification
  2. Cock-up wrist splint
  3. Corticosteroid injections
106
Q

When do you refer to ortho for CTS release? (2)

A
  1. Failure of 3 months of conservative therapy
  2. Objective neuro findings/thenar atrophy
107
Q

What is the MC hand fx?

A

Boxer’s fx = fx of 4th +/- 5th metacarpal

108
Q

In children, which part of the 5th phalange is typically injured?

A

physis of the 5th phalange

109
Q

In adults, which part of the 5th phalange is MC injured?

A

Distal phalanx

110
Q

How do Boxer’s fx tend to appear?

A

Malrotated

Note the pinky rotation

111
Q

For a metacarpal neck fx, when can you reduce it vs splint it?

A
  • > 30deg angulation => reduce it
  • < 30deg angulation = splint for 2-3 weeks
112
Q

What metacarpal neck fx requires an ulnar gutter splint? Radial gutter splint?

Ulnar gutter
A
  • Ulnar gutter = 4th or 5th metacarpal
  • Radial gutter = 2nd and 3rd metacarpal
Radial gutter
113
Q

For a non-displaced fx of 2-5th metacarpal/phalangeal shafts, what is the management? (2)

A
  • Metacarpals: Gutter splints for 3-4 weeks
  • Phalangeal: Buddy tape/aluminum splint
114
Q

For a non-displaced fx of the 1st metacarpal/phalange, what is the splint?

A

Thumb-spica + wrist in 30deg extension

115
Q

For a non-displaced/non-articular fx of the 1st metacarpal base, what is the management?

A

Thumb spica splint/cast x 4 weeks

116
Q

For any displaced/angulated metacarpal/phalangeal shaft fx or intra-articular fx, what do you do for management?

A

Call Ortho :)

117
Q

What causes gamekeeper’s thumb and what occurs?

Also called skier’s thumb

A
  • MOI: Forced radial abduction
  • Rupture of UCL of 1st MCP joint
118
Q

Clinical presentation of gamekeeper’s thumb (3)

A
  1. Pain/swelling/tenderness along medial 1st MCP joint
  2. Weak pincer function
  3. Stress test after local anesthesia
119
Q

Management for gamekeeper’s thumb (2)

A
  • Thumb spica splint
  • Refer to Ortho
120
Q

Cause and pathology of mallet finger (2)

A
  • MOI: Hyperflexion of DIP
  • Pathology: Rupture/lac/avulsion of extensor tendon at distal phalanx
121
Q

Clinical presentation of Mallet finger (4)

A
  1. DIP flexed at around 40deg + inability to actively extend
  2. PROM is intact
  3. Mild tenderness over dorsal DIP
  4. May be associated with avulsion fx
122
Q

Managment of mallet finger (2)

A
  • Splint of DIP in full extension for 4-8 wks
  • CANNOT REMOVE SPLINT
123
Q

What will occur with an improperly treated mallet finger?

A

Swan neck deformity

124
Q

Cause and pathology of boutonniere deformity (2)

A
  • MOI: foced flexion of PIP
  • Pathology: Rupture of central extensor tendon on middle insertion

The PIP version of mallet finger

125
Q

How does Boutonniere deformity present? (4)

A
  • Finger partially flexed at PIP but extended at DIP
  • Swelling/pain/point tenderness along dorsal PIP
  • Limited ROM
  • Inability to fully extend PIP
126
Q

Management of Boutonniere deformity

A

Splint PIP in extension but leave DIP free for 4-8 weeks

A more proximal version of mallet finger splinting

127
Q

When do you refer to ortho for boutonniere deformity? (3)

A
  • Failed conservative
  • Associated irreducible PIP dislocation
  • Open fx
128
Q

Describe the pathology of De Quervain’s tenosynovitis

A

Inflammation of tendon sheath covering extensors and ABductors of the thumb

129
Q

Clinical presentation of De Quervain’s Tenosynovitis (3)

A
  • Aching pain/point tenderness along radial wrist
  • Pain can radiate up arm
  • Thickened 1st dorsal compartment
130
Q

What physical test is diagnostic of De Quervain’s tenosynovitis?

A

Finkelstein test

Ulnar deviation of adducted thumb = pain

131
Q

Management of De Quervain’s tenosynovitis (3)

A
  • Thumb spica splint
  • Modify activity
  • NSAIDs
132
Q

What 2 things can ortho do for De Quervain’s?

A
  1. Corticosteroid injections into tendon sheath
  2. Surgical release of 1st dorsal compartment
133
Q

What do ganglion cysts overly?

A

Joints or tendon sheaths

134
Q

MC location and age for a ganglion cyst?

A

Female 10-40 over their dorsal aspect of wrist

Also called bible cyst so you smack it with your bible

135
Q

How can you differentiate a ganglion cyst from a solid lesion?

A

Transillumination

Clinical dx

136
Q

Management of a ganglion cyst (3)

A
  1. Observe it until it regresses
  2. Aspiration +/- corticosteroid
  3. Surgical removal
137
Q

What is the underlying pathology of trigger finger? (2)

A
  1. Idiopathic dysfunction of flexor tendon as it glides through sheath
  2. Usually due to tendon size and sheath discrepancy
138
Q

MC digits affected with trigger finger? (2)

139
Q

How does trigger finger present? (4)

A
  • Catching/snapping/locking of finger
  • Worse at night
  • Painful nodule on palm
140
Q

Management of Trigger Finger (3)

A
  • NSAIDs
  • Corticosteroid injection (1 max if hx of RA, otherwise 2nd in 3-4 wk)
  • Surgical release if above fails
141
Q

What is Dupuytren’s coontracture and who is it MC in?

A
  • Progressive fibrosis of palmar fascia
  • MC in men older than 50.
142
Q

RFs for Dupuytren’s (6)

A
  • Epilepsy
  • DM
  • Pulmonary disease
  • ETOH
  • Smoking
  • Repetitive vibrational trauma (like a jackhammer)
143
Q

MC phalange affected in Dupuytren’s

144
Q

How does Dupuytren’s contracture present?

A
  • Painless nodules near distal palmar crease
  • Cord that contracts as nodules thickens
  • Limited extension, normal flexion
145
Q

Management of Dupuytren’s (2)

A
  • Night splinting at night to help slow progression
  • Surgical release indicated if MCP is flexed more than 30deg
146
Q

3 MOIs that can cause brachial plexus syndrome

A
  1. Traction force
  2. Direct blow to top of shoulder
  3. Stretching of plexus during arm ABduction (grabbing when falling)
147
Q

What are the primary nerves that make up the brachial plexus?

148
Q

Which MOIs for brachial plexus syndrome cause C5-C7 damage typically?

A
  • Traction force
  • Direct blow
149
Q

Classic symptoms seen in brachial plexus syndrome (2)

A
  • Sharp, burning pain with radiculopathy in affected nerve root distribution
  • Weakness
150
Q

Injuries to what part of the brachial plexus may also cause Horner’s syndrome?

A

C8-T1

PAM (ptosis, andhidrosis, miosis)

151
Q

What physical finding might suggest the spinal cord is injured instead of just the brachial plexus?

A

Ipsilateral leg spasticity or weakness

152
Q

Image of C-spine nerve root physical tests

153
Q

When is MRI indicated in diagnosinsg brachial plexus syndrome? (2)

A
  • Abnormal XRs
  • Persistent symptoms
154
Q

What test might help us pinpoint specific locations of nerve dysfunction?

155
Q

Management of Brachial plexus syndrome (3)

A
  • Strengthening and stretching
  • Splinting neutral position if any joints are affected by paralyzed muscles
  • Encourage PROM

Atheletes cannot return to activity until fully resolved.

156
Q

What is in the thoracic outlet? (5)

A
  • First rib
  • Subclavian artery/vein
  • Brachial plexus
  • Clavicle
  • Lung apex
157
Q

What is thoracic outlet syndrome and who is it MC in?

A
  • Compression of brachial plexus and/or subclavian vessels in shoulder girdle/1st rib
  • MC in women 20-50
158
Q

How does thoracic outlet syndrome present?

A
  1. Compression of brachial plexus
  2. Compression of vascular structures (swelling/discoloration)
  3. Fatigue, weakness, aching pain
  4. Exacerbated by lifting arm above head
159
Q

What must you palpate for if you suspect thoracic outlet syndrome?

A

Supraclavicular fossa to assess for a mass

160
Q

What is the physical test used to check for thoracic outlet syndrome?

A

Elevated arm stress test

161
Q

Management of Thoracic outlet syndrome (3)

A
  • Home exercise programs
  • Muscle strengthening + posture exercises
  • NSAIDs, muscle relaxers, TENS

MSK (27 decks)

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