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Pance Re-Up > MSK Precision and Pearls #1 > Flashcards

MSK Precision and Pearls #1 Flashcards

1
Q

What is a Boxer’s Fracture what what is the mechanism of action for this fracture?

A

Fracture at the neck of the 5th metacarpal

-Punching with a clenched fist

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2
Q

Treatment for a Boxer’s Fracture (remember to check for something)

A

-Ulnar gutter splint with joints at 60 degrees

-Check for bite wounds. If present, treat with Augmentin.

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3
Q

A shoulder dislocation is a dislocation of what joint? What type is MC? What is the MOA of this type of dislocation?

A

Glenohumeral joint

Anterior

FOOSH

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4
Q

Specifically, what causes an anterior shoulder dislocation?

A

Blow to an abducted, externally rotated arm that’s extended.

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5
Q

What radiographs should be obtained with a shoulder dislocation?

What should also be ruled out and how do you test for it?

A

Axillary and scapular Y views

Axillary nerve injury (deltoid pinprick sensation test)

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6
Q

What are two unique findings on radiographs that can be seen with an anterior shoulder dislocation?

A

Hill Sach Lesion: groove fracture of humerus

Bankart Lesion: glenoid rim fracture

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7
Q

A posterior shoulder dislocation is MC associated with what things?

A

Seizures and electric shock

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8
Q

Treatment for shoulder dislocations

A

Reduction and immobilization

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9
Q

Lateral epicondylitis (also known as ________) is inflammation of which tendon? What motions cause this condition? What motions exacerbate the pain?

A

Tennis elbow

Extensor carpi radialis brevis

Repetitive pronation of forearm and wrist extension

Lateral elbow pain with wrist extension and gripping

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10
Q

Name the carpal bones in order from the thumb to pinky (what is the acronym used?)

A

Some Lovers Try Positions That They Can’t Handle

-Bottom row: Scaphoid, Lunate, Triquetrum, Pisiform
-Top Row: Trapezium, Trapezoid, Capitate, Hamate

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11
Q

A rotator cuff tear is an injury to one of the SITS muscles. Name these muscles. Which is the MC injured? What are some risk factors for this condition?

A

-Supraspinatus, Infraspinatus, Teres Minor, Subscapularis

Supraspinatus

Age >40, Overhead use, chronic/repetitive use, trauma

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12
Q

What are some symptoms of a rotator cuff tear? A supraspinatus tear has pain against what motion?

A

-Anterolateral (deltoid) shoulder pain
-Decreased ROM, especially overhead, ER and abduction
-Inability to sleep on that side
-Night pain
-Crepitus

-Pain with resisted abduction

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13
Q

What are four tests that can be done for a rotator cuff tear? Explain them.

A

-Empty can: 90% specificity for supraspinatus tear. (arm out, thumb down (IR), push down)
-Hawkins: arm in front, IR (move down)
-Neer: IR and raise arm (gymnast arm in air)
-Drop Arm Test: pain with lifting arm above shoulder level or slowly lowering it

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14
Q

Explain the proper protocol for an amputated digit

A

Wrap in gauze and soak in sterilized isotonic saline to prevent it from drying.

Then placed in a plastic bag that is immersed in ice water for cooling.

NEVER place directly in ice water because the fluid may jeopardize the microcirculation.

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15
Q

name the four muscles of the rotator cuff and the actions they perform

A

-Supraspinatus: abduction
-Infraspinatus: ER
-Teres Minor: ER and adduction
-Subscapularis: IR and adduction

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16
Q

Treatment for a sprain of the shoulder

A

Conservative: arthroscopic subacromial decompression if resistant

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17
Q

A proximal humerus fracture, commonly from a _______, is the common site of what? What is the treatment? What should you check for?

A

FOOSH

Metastatic breast cancer

Sling/Swathe + ortho follow up in 24-48 hours

Check deltoid sensation to rule out axillary nerve injuries or brachial plexus injuries

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18
Q

With a humeral shaft fracture, though, you must rule out what, which can lead to ______

A

Radial nerve injury

Wrist drop

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19
Q

What is the treatment for a humeral shaft fracture that is open or has nerve injuries?

A

Operative: ORIF

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20
Q

Treatment for an open wound on the hand

A

Thoroughly irrigate
Check for bite wounds
ABX: Augmentin
Tetanus Shot

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21
Q

Adhesive capsulitis is also known as ________. Explain what this is caused by and two conditions that are commonly associated with it.

A

Frozen Shoulder Syndrome

Shoulder stiffness due to inflammation, scarring, fibrosis

DM, Hypothyroidism, hyperthyroidism, prolonged immobility

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22
Q

Symptoms of adhesive capsulitis

A

-Restriction of both active and passive ROM that occurs in absence of known shoulder disorder
-Pain, dull ache
-Pain worse at night
-Insidious onset over months
-Gradual return of ROM
-Inability to sleep on affected side
-Late in disease, patients unable to reach overhead, scratch their back, or put on a coat

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23
Q

Treatment for adhesive capsulitis

A

-Rehab ROM (Mainstay)
-Do not immobilize
-Codman Exercises: let arm dangle and do circumduction
-Manipulation under anesthesia if all else fails

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24
Q

What is a Colles Fracture and what is the mechanism in which it occurs?

A

Distal radius fracture with dorsal angulation (dinner fork deformity)

FOOSH with wrist extension

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25
Q

What type of radiograph do you get for a Colles Fracture?

A

Lateral view - shows dorsal angulation of distal radius fracture

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26
Q

Treatment for a stable vs unstable Colles Fracture.

A

Stable: Closed reduction and sugar tong splint

Unstable: (>20’ angulation) = ORIF

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27
Q

What is the MC complication of a Colles Fracture?

A

Extensor pollicis longus tendon rupture

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28
Q

In short, what is a Bennett’s Fracture?

What is a Rolando Fracture?

A

-Intraarticular fracture through the base of the 1st metacarpal MCP bone

-Comminuted Bennett’s Fracture

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29
Q

Explain what a monteggia fracture is. What is the acronym to remember these two fractures by.

A

Fracture of proximal 1/2 of ulnar shaft + radial head dislocation

GRUMUR

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30
Q

Treatment for both Monteggia and Galeazzi Fracture

A

ORIF

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31
Q

Explain what a galeazzi fracture is and the acronym to remember these fractures by.

A

Mid distal radial shaft fracture with dislocation of DRUJ

GRUMUR

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32
Q

What is a complication of a monteggia fracture? What is a complication of a galeazzi fracture (what does this mean)

A

Radial nerve injury (wrist drop)

Anterior interosseous nerve injury: unable to pinch thumb and index finger together

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33
Q

what is a smith fracture? What is the mechanism that causes it most times?

A

Distal radius fracture with ventral angulation (garden spade deformity)

FOOSH with wrist flexed

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34
Q

Management of a stable vs unstable Smith fracture

A

Stable: closed reduction and sugar tong splint

Unstable: ORIF

35
Q

What is thoracic outlet syndrome (in the name)?

A

-Compression of the subclavian artery, subclavian vein, or brachial plexus (MC) as they exit shoulder girdle to the first rib

36
Q

What are the symptoms of thoracic outlet syndrome?

A

-Vascular compression: swelling of arm, decreased pulses

-Nerve compression: ulnar neuropathy, pain and paresthesia to forearm and arm (medial side of forearm and 4th and 5th fingers)

37
Q

Two unique exam findings of a patient with thoracic outlet syndrome. They are tests that can be done.

A

Positive Adson Sign: loss of radial pulse with head tilted toward affected side.

Roos Test: hands up like being held at gunpoint, open/close fists for 1 minute exacerbate the symptoms

38
Q

What diagnostic is done to confirm the diagnosis of thoracic outlet syndrome? What is the treatment?

A

MRI

Joint protection, PT, ortho consult

39
Q

What is a Dupuytren Contracture?

A

Progressive fibrosis of palmar fascia leading to contractures

40
Q

Risk factors of a Dupuytren Contracture

A

Genetics
ETOH abuse
DM
Men > 40
Northern European

41
Q

Symptoms of a Dupuytren Contracture

A

-Palpable nodules over distal palmar crease along course of flexor tendon
-Thickened skin or bands in palmar fascia
-Fixed flexion deformity at MCP joint

42
Q

Management of a Dupuytren Contracture

A

Intralesional corticosteroids injections
-Fasciotomy or fasciectomy if refractory, recurrent, or impaired function

43
Q

Medial epicondylitis, also known as _______, is inflammation of which two muscles due to repetitive overuse and stressor? What motions make this pain worse and where is the pain located?

A

Pronator teres and flexor carpi radialis

Worse with pulling motions, wrist flexion against resistance with elbow extended

pain over medial epicondyle

44
Q

When should you perform an X-ray of a finger with a subungal hematoma?

A

When the hematoma is >50% of the nail to evaluate for phalanx fracture

45
Q

A radial head subluxation, also known as a Nursemaid’s Elbow, occurs when _______. The MOA for this injury is _________. it is MC in _________

A

The radial head slips out of the annular ligament

Lifting, swinging, or pulling a chill while forearm pronated and extended

MC In kids 2-5 years old

46
Q

What treatment should be done for a Nursemaid’s Elbow?

A

Closed reduction: pressure on radial head with supination of the elbow followed by flexion of the elbow.

-Observe for 15 minutes and then ok to discharge if symptoms resolve.

47
Q

Explain the radial, ulnar, and median nerve on the hand as well as a motion you can do to test these nerves.

A

-Median: thumb opposition (flexors)
-Radial: thumb extension (extensors)
-Ulnar: criss cross fingers (intrinsics)

48
Q

Explain what impingement syndrome is, what motions exacerbate it, and three tests that can be done to determine this diagnosis.

A

Entrapment of supraspinatus tendon

Overhead motions

Hawkins, Neer, Empty Can

49
Q

What is the MC fractured bones in newborns (from birth) and kids, as well as adolescents?

A

Clavicle fracture

50
Q

If no history of trauma with a clavicle fracture, what should you think in children < 2 years old?

A

Malignancy, rickets, child abuse if < 2 years old

51
Q

What are the three types of clavicle fractures, which type is MC, and what are some exam findings of a clavicle fracture?

A

Type 1: (mid shaft): middle 1/3 (MC)
Type 2: (lateral 1/3 or distal)
Type 3: proximal 1/3 or medial

Pain over area, tenting of clavicle, crepitus

52
Q

For a mid 1/3 clavicle fracture, what is the treatment?

How about for a proximal 1/3 fracture?

A

-Sling immobilize, Figure 8 splint

Ortho consult

53
Q

What is cubital tunnel syndrome and what are the symptoms associated with it?

A

Ulnar nerve compression in the cubital tunnel along the medial elbow

Pain and paresthesia along the nerve length, worse with elbow flexion. In small and ring fingers (4th and 5th fingers)

54
Q

Two tests you can do to check for cubital tunnel syndrome

A

Tinel’s Sign at elbow: tap on sulcus near medial epicondyle

Froment Sign: pinch paper between adducted thumb and index finger. Positive if can’t hold it or if they flex the IP joint of the thumb to help.

55
Q

Treatment for cubital tunnel syndrome

A

Wrist immobilization, long arm splint in elbow extension

Steroid Injections

NSAIDs

56
Q

What are the three causes of olecranon bursitis?

A

Direct trauma or overuse

Gout, inflammation

Infectious/Septic: penetrating trauma (staph A)

57
Q

Although a clinical diagnosis, what should you do if you suspect an infectious cause or gout as cause of olecranon bursitis?

A

Aspiration: WBC > 2,000 is positive

58
Q

If septic olecranon bursitis, what should be given?

A

ABX: Dicloxacillin or Clindamycin

59
Q

What is a torus (buckle) fracture and what is the treatment for it?

A

Incomplete forearm fracture with “wrinkling or bump” of metaphyseal-diaphyseal junction due to axial loading

Closed reduction with long arm cast

60
Q

Salter-Harris Classification System of Fractures applies to epiphyseal plate fractures. Explain the pneumonic to use and what each means. What is the MC type?

A

SALTR

Same (isolated growth plate fx)
Above (growth plate fx + fx of metaphysis)
Lower (growth plate fx + fx of epiphysis)
Through (fx extending across metaphysis, growth plate, and epiphysis) - needs reduction
Rammed (growth plate compression injury)

MC type is Type II (Above)

61
Q

What is a nightstick fracture and what is the treatment?

A

Middle portion of ulnar shaft fx

Cast if nondisplaced
ORIF if displaced

62
Q

What is suppurative flexor tenosynovitis and what is the MCC?

A

Infection of flexor tendon sheath of finger

Staph A from a penetrating injury

63
Q

What are the symptoms of suppurative flexor tenosynovitis? Think FLEX

A

Knavel’s Signs

Finger held in flexion
Length of tendon sheath tender
Enlarged finger
Extension of finger causes pain

64
Q

What diagnostic should you do and what is the treatment for suppurative flexor tenosynovitis?

A

Aspirate and biopsy

I&D, IV ABX

65
Q

Carpal Tunnel Syndrome is what? What are risk factors of this condition?

A

Entrapment of the median nerve and compression –> neuropathy

RF: DM, RA, Pregnancy, Hypothyroidism, Occupational

66
Q

Symptoms of carpal tunnel syndrome

A

-Paresthesias and pain in palmar aspect of first three (and radial half of fourth digits) especially at night
-Clumsiness
-Thenar muscle wasting

67
Q

If thenar muscle wasting is present in carpal tunnel syndrome, what should you do?

A

Referral to ortho!

68
Q

Tests that can be done to diagnose carpal tunnel syndrome?

A

Tinel Sign: Tap over median nerve
Phalen: flexion of both wrists for 1 minute

69
Q

Management for carpal tunnel syndrome

A

Volar splint
NSAIDs
Injections
Surgery if refractory or no improvement

70
Q

A ganglion cyst is a _____ filled synovial cyst. Describe this cyst.

A

Mucin filled

Firm, well circumscribed painless mass fixed to deep tissue. Translucent with illumination.

71
Q

DeQuervain’s Tenosynovitis is entrapment of which two tendons/muscles?

A

APL and EPB

Abductor pollicis longs and extensor policis brevis

72
Q

What are some causes of Dequervain’s, what are the symptoms, and what test can be done to prove this diagnosis?

A

Overuse, DM, Postpartum (lifting baby)

Sharp pain along radial aspect of wrist and base of thumb radiating to forearm especially with gripping.

Finkelstein Test: pain with ulnar deviation while thumb is flexed in the palm.

73
Q

Treatment for DeQuervain’s?

A

Thumb spica splint, NSAIDs, PT
Steroid injections if unsuccessful

74
Q

MC fractured wrist bone and symptoms associated with it

A

Scaphoid fracture

Snuffbox tenderness, radial wrist pain

75
Q

What radiograph views are obtained if you suspect a scaphoid fracture of the wrist?

A

AP, lateral, and scaphoid view

76
Q

Because a scaphoid fracture may not show up for 2 weeks, you should treat it as such even if negative radiographs and snuffbox tenderness for two reasons. Name them.

A

High risk of nonunion and AVN

77
Q

Treatment for scaphoid fracture

A

-Nondisplaced: thumb spica splint
-Displaced: ORIF

78
Q

What is scapholunate dissociation and what is diagnostic for this?

A

Widened space between scaphoid and lunate bones

> 3mm (Terry Thomas Sign)

79
Q

Treatment for scapholunate dissociation

A

Radial gutter splint initially
Surgical repair if needed

80
Q

What is the most serious carpal fracture?

What is Kienbock’s Disease?

A

Lunate fracture

AVN of the lunate bone

81
Q

How does a mallet (baseball) finger occur?

A

Avulsion of extensor tendon after blow to tip of finger causing forced flexion of an extended finger

82
Q

What is seen on exam for a mallet finger?

Treatment for this condition

A

Unable to actively extend DIP joint of the finger affected

Uninterrupted extension splint of DIP joint for 6-8 weeks

83
Q

A gamekeeper’s (skiers) thumb is a sprain or tear of which ligament of the thumb? What is the treatment?

A

Ulnar collateral ligament

Thumb spica splint & referral to hand surgeon

84
Q

Pronator Teres Syndrome, much like carpal tunnel syndrome, is compression of which nerve. However, it occurs ______. The symptoms of this condition are more aimed at including ______ but not _________

A

Median nerve compression

where nerve transverses pronator teres muscle

Proximal forearm pain

No pain at night

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