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Clin Med 3- Exam 2 > MSK 4 > Flashcards

MSK 4 Flashcards

1
Q

Where do the pectoralis major and deltoid muscles attach to the humerus?

A

Pectoralis major inserts on the proximal shaft and deltoid muscle attaches to the midshaft

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2
Q

What 2 branches of the axillary artery does the proximal humerus receive blood supply from?

A

Anterior and posterior humeral circumflex arteries

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3
Q

What is the blood supply of the humeral shaft?

A

Axillary and brachial arteries

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4
Q

What nerve should you be concerned about with a displaced mid-distal humeral shaft fracture?

A

Radial nerve→ check function (wrist extension)

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5
Q

What are the 4 rotator cuff muscles and what is the function of each?

A

1) Supraspinatus: initiates and acts throughout abduction cycle
2) Infraspinatus: external rotation with arm in neutral
3) Teres minor: external rotation in 90 degrees of abduction
4) Subscapularis: main internal rotator of the shoulder

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6
Q

What are the 2 suggested x-ray views of the AC joint?

A

AP with and w/o weights

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7
Q

What are the 2 suggested x-ray views of the chest?

A

PA, lateral (full inspiration)

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8
Q

What are the 2 suggested x-ray views of the clavicle?

A

AP, axial (20 degrees cephalad)

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9
Q

What are the 2 suggested x-ray views of the humerus?

A

AP, lateral

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10
Q

What are the 2 suggested x-ray views of the SC joint?

A

AP, obliques (bilat)

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11
Q

What are the 3 suggested x-ray views of the shoulder?

A

AP, Grashey, Y-scapular view

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12
Q

What is the most common location of a clavicle fracture?

A

Middle 3rd (80%)

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13
Q

What motions will be painful with clavicle fractures?

A

Active/passive ROM w/abduction/flexion of the shoulder

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14
Q

How are most clavicle fractures treated?

A

Sling to start→ initiating glenohumeral ROM w/in 1 week

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15
Q

What are 5 components of clavicle fx tx with ORIF?

A

(1) ORIF w/plate and screws (2) sling to prevent excessive motion
(3) ROM to start as soon as tolerated
(4) analgesics
(5) physical therapy

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16
Q

What is the etiology of AC joint injuries?

A

Usually occurs from direct force to lateral aspect of shoulder w/arm adducted→ drives acromion forcibly inferiorly and medially w/respect to the clavicle

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17
Q

Describe grades I, II, and III AC joint injuries.

A

Grade I: sprain of AC ligament
Grade II: tear of AC ligament→ CC ligaments still intact, but will see some migration w/weights in hand
Grade III: tear of AC and coracoclavicular ligaments

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18
Q

What test do you perform to test the AC joint and what is a positive finding?

A

Cross arm test: pt elevates the affected arm to 90 degrees, then actively adducts it; (+) finding= pain in AC joint

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19
Q

How are grades I and II AC joint injuries tx?

A

Grades I and II are treated conservatively

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20
Q

How are grades III AC joint injuries tx?

A

Grade III injuries are variably treated

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21
Q

How are grades IV, V, and VI AC joint injuries tx?

A

Grade IV, V, and VI are treated surgically

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22
Q

A sternoclavicular joint dislocation is only emergent requiring surgical repair if dislocated in which direction?

A

Posterior: requires repair if there is damage to neurovascular structures

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23
Q

What pt population is a proximal humerus fx most common in?

A

Elderly, w/> 70% occurring in pts over 60 yrs

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24
Q

What is the most common mechanism of injury of proximal humerus fractures?

A

fall from standing

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25
Q

What are 4 findings to look for on clinical presentation of a proximal humerus fx?

A

(1) moderate/severe shoulder pain that inc w/shoulder movement
(2) swelling and ecchymosis may be apparent soon after injury
(3) pt holds affected arm adducted against side
(4) suspect in elderly pts who have fallen and present with: focal tenderness at the proximal humerus and motor function limited d/t pain

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26
Q

What are the 2 most important things to check for with proximal humerus fx of the shaft?

A

Radial nerve and vascular integrity

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27
Q

When do you begin gentle ROM of the shoulder after proximal humerus fx?

A

2 weeks after injury

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28
Q

When do you begin ROM of the elbow/wrist after proximal humerus fx?

A

As soon as pain tolerates (move all the way up, and all the way back down)

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29
Q

What are the 4 major segments of the proximal humerus?

A

(1) anatomic neck
(2) surgical neck
(3) greater tuberosity
(4) lesser tuberosity

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30
Q

According to neer classification, displacement exists when a segment is angulated _____ or ____ from anatomic position.

A

According to neer classification, displacement exists when a segment is angulated >45 degrees or >1 cm from anatomic position.

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31
Q

What 2 conditions might be suspected if a person has frequent shoulder dislocations?

A

(1) Ehlers-danlos

(2) Marfan syndrome

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32
Q

How long after reduction of a dislocated shoulder will a pt continue to have limited ROM and pain?

A

4-6 weeks

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33
Q

What are AP and axillary scapula Y views used to determine in shoulder dislocations?

A

The relationship of the humerus and glenoid, and to r/o fx

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34
Q

What is the orthogonal view used to identify in a shoulder dislocation?

A

Identifies if there is a posterior shoulder dislocation

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35
Q

What are the 3 steps of tx of acute shoulder dislocations?

A

(1) reduce ASAP
(2) sling immobilization for 2 weeks + pendulum exercises
(3) early PT to maintain ROM and strengthen rotator cuff muscles

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36
Q

What is impingement syndrome also known as?

A

Rotator cuff tendonitis

37
Q

What does the short head of the biceps attach to?

A

Coracoid process

38
Q

Where does pain originate from in impingement syndrome?

A

Pain originates from compression of tissues b/w the humeral head and coracoacromial arch

39
Q

In impingement syndrome, there is decreased ____ ROM, but preserved ____ ROM.

A

In impingement syndrome, there is decreased active ROM, but preserved passive ROM.

40
Q

What is one of the most common reasons for impingement syndrome?

A

Partial rotator cuff tears

41
Q

What test do you use to determine impingement syndrome, how is it performed, and what are positive findings on it?

A

Test: Hawkin’s impingement test

Used to evaluate impingement of RC and subacromial bursa

Maneuver:
Pt seated or standing w/shoulder forward flexed to 90 degrees and elbow flexed to 90
Stabilize top of the shoulder while internally rotating the arm at the forearm

Positive findings: pain in the anterior shoulder or reproduction of the pt’s symptoms w/the test

42
Q

Which 4 x-ray views are ordered with impingement syndrome?

A

AP, lateral, Grashey, scapular Y (often normal)

43
Q

What are the 4 conservative tx for impingement syndrome?

A
  • Activity modification
  • PT with modalities for ROM and strengthening
  • NSAIDs
  • Corticosteroid injections
44
Q

What are the 3 types of surgical tx for impingement syndrome?

A
  • Arthroscopic acromioplasty w/coracoacromial ligament release
  • Bursectomy
  • Debridement or repair of rotator cuff tears
45
Q

What is the most commonly torn rotator cuff muscle?

A

Supraspinatus

46
Q

Which 4 x-ray views are ordered with rotator cuff tears?

A

AP, lateral, Grashey, scapular Y (often normal)

47
Q

What are SLAP lesions and what 2 injuries are they most commonly seen with?

A

Injuries of the glenoid labrum at point of attachment of long head of biceps; FOOSH and throwing sports athletes

48
Q

What are the 5 essentials of dx of adhesive capsulitis?

A

1) Very painful shoulder triggered by minimal or no trauma
2) Pain out of proportion to clinical findings during inflammatory phase
3) Stiffness during the “freezing” phase and resolution during the “thawing” phase
4) Commonly seen in pts 40-65 y.o.
5) Women>men especially in perimenopausal women or pts w/endocrine disorders (DM, thyroid disease)

49
Q

T/F: in adhesive capsulitis, there is usually decreased ROM in both passive and active movements.

A

True

50
Q

What are the 5 tx options of adhesive capsulitis?

A

1) NSAIDs
2) PT to maintain motion
3) Intra-articular corticosteroid injections (into joint to help dec. inflammation)
4) +/- oral prednisone
5) Surgery: manipulation under anesthesia or arthroscopic release→ immediately followed by more PT

51
Q

What is calcific tendonitis a result of?

A

Results from deposition of calcium hydroxyapatite w/in the substance of a tendon

52
Q

What is the most common location of calcific tendonitis?

A

Supraspinatus- 80%

53
Q

What is the main finding on clinical presentation of calcific tendonitis?

A

Very painful shoulder triggered by minimal or no trauma

54
Q

What are the 4 tx options of calcific tendonitis?

A

1) Analgesic/anti-inflammatory meds
2) Subacromial local anesthetic/steroid injection
3) PT with ultrasound therapy
4) Arthroscopy w/aspiration of mineralized material

55
Q

T/F: humerus fractures have a bimodal distribution.

A

True: most common in males in third decade and females in seventh decade

56
Q

What are the 2 mechanisms of injury of humerus fractures?

A

(1) trauma such as a direct blow or bending force (2) midshaft fx a result from strong muscle contractions (high velocity throwing, arm wrestling)

57
Q

What does shortening of the upper arm suggest?

A

Suggests the presence of significant humeral shaft displacement

58
Q

What is the preferred tx for transverse shaft fx and most other midshaft fx?

A

Functional bracing (usually applied after swelling has dec w/in 1-2 weeks)

59
Q

What 8 humerus fx require ORIF tx?

A
  • Adequate alignment not maintained
  • Open fx
  • Presence of vascular injury
  • Segmental fx
  • Floating elbow
  • Presence of significant other injuries
  • Non-union
  • Pathological
60
Q

What is seen on an elbow fx x-ray?

A

A positive posterior fat pad or “sail sign”

61
Q

T/F: tennis elbow is usually acute onset.

A

False: tennis elbow is usually NOT acute onset

62
Q

What are the 3 suggested x-ray views for the elbow?

A

AP, external oblique, lateral

63
Q

What are the 3 suggested x-ray views for the fingers?

A

AP, oblique of hand, lateral of affected finger

64
Q

What are the 3 suggested x-ray views for the hand?

A

AP, oblique, lateral

65
Q

What are the 3 suggested x-ray views for the thumb?

A

AP, oblique, lateral

66
Q

What are the 3 suggested x-ray views for the wrist?

A

AP, oblique, lateral

67
Q

What view are elbow effusions best seen on?

A

Lateral projection (where fluid in the joint capsule elevates the pericapsular fat)

68
Q

What are the 6 steps to tx radial head fxs?

A

1) Long arm posterior splint for 3-4 days (just long enough for swelling to settle down)
2) Sling for 1-2 weeks
3) Analgesics
4) Gentle ROM exercises w/in 1-2 days
5) Serial radiographs (2 weeks)
6) PT

69
Q

What is a supracondylar elbow a fx of?

A

Extra-articular fx of the distal humerus at the elbow

70
Q

What age group are supracondylar elbow fx most common in?

A

Children b/w 5-9

71
Q

What are >90% of supracondylar elbow fx caused from?

A

Falls onto hyper-extended elbows

72
Q

T/F: olecranon fx have a bimodal distribution.

A

True: high energy injuries in young, low energy falls in elderly

73
Q

What type of olecranon fx do direct blows result in?

A

Comminuted fx

74
Q

What type of olecranon fx do indirect blows result in?

A

Transverse or oblique fx

75
Q

What are 3 findings on clinical presentation of olecranon fx?

A

(1) pain localized to posterior elbow
(2) palpable defect
(3) inability to extend elbow-triceps muscle

76
Q

What are 2 tx options of olecranon fx?

A

(1) ORIF w/tension band

(2) ORIF w/plate and screw fixation

77
Q

What usually causes a posterior elbow dislocation?

A

A fall onto an extended arm

78
Q

What are the 2 types of tx for elbow dislocations?

A

(1) closed reduction for simple dislocations

(2) ORIF for complex fracture dislocations- long arm posterior splint/sling for 1-2 wks, analgesics, PT

79
Q

What are the 2 types of epicondylitis?

A

Lateral: tennis elbow→ affects extensor tendons of the forearm (ECRB, EDC)

Medial: golfer’s elbow→ affects flexor tendons of the forearm (pronator teres and FCR muscles)

80
Q

What is the clinical presentation of lateral epicondylitis?

A

Pain over lateral epicondyle and extensor tendon wad; pain w/resisted wrist extension

81
Q

What is the clinical presentation of medial epicondylitis?

A

Pain over medial epicondyle and flexor tendon wad; pain w/resisted wrist flexion

82
Q

What does GRIMUS stand for?

A 
Galeazzi
Radius
Inferior
Monteggia
Ulna
Superior
83
Q

What is the tx for both bones forearm fx?

A

(1) sugar-tong splint in ED (2) casting for non-displaced (3) ORIF for displaced

84
Q

What type of splint is used in greenstick fx?

A

Sugar-tong splint

85
Q

What type of splint is used in buckle fx?

A

Volar splint

86
Q

Radial nerve is most commonly injured by what type of fractures?

A

Midshaft humerus

87
Q

What sign is used to test the function of the radial nerve?

A

Thumbs up sign (and testing resisted extension of the thumb)

88
Q

What sign is used to test the function of the median nerve?

A

OK sign

89
Q

What sign is used to test the function of the ulnar nerve?

A

peace sign

Clin Med 3- Exam 2 (15 decks)

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