Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical Med I > MSK/Rheumatology - Upper Extremity I - Exam 3 > Flashcards

MSK/Rheumatology - Upper Extremity I - Exam 3 Flashcards

1
Q

What are the four muscles of the rotator cuff?

A
  • Supraspinatus
  • Infraspinatus
  • Teres Minor
  • Subscapularis

SITS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Which rotator cuff muscles perform external rotation and abduction?

A
  • Supraspinatus
  • Infraspinatus
  • Teres Minor

SIT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which rotator cuff muscles perform internal rotation?

A

Subscapularis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which rotator cuff muscle is most commonly involved in an injury?

A

Supraspinatous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which is the clinical presentation of a rotator cuff injury?

A
  • Pain over anterior and lateral shoulder
  • Decreased ROM and inability to abduct arm above shoulder level
  • Shoulder may catch
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the difference between tendonosis and tendonitis?

A

Tendonosis: Chronic degeneration of muscle typically with age

Tendonitis: Inflammation associated with repetitive trauma/everyday use of shoulder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What can cause a chronic tear of the rotator cuff?

A
  • Degeneration
  • Impingement
  • Overload
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What can cause an acute tear of the rotator cuff?

When would you suspect an acute tear?

A
  • Trauma

- Suspicion with acute shoulder pain with negative radiographs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the clinical presentation of tendonitis/impingement of the rotator cuff?

A
  • Patient does repetitive overhead activity
  • Pain comes on gradually
  • Deep ache in lateral shoulder that radiates to deltoid
  • Point tenderness
  • ROM painful > 90 degrees, but improves with analgesics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What specialized exams assess for impingement of the rotator cuff?

What are you looking for?

A

Neer’s and Hawkin’s

Looking for pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the clinical presentation of a chronic rotator cuff tear?

A
  • Male over 40
  • Pain worse with overhead activities and at night
  • Pain is followed by gradual weakness
  • Decreased ability to move arm, especially abduction
  • Restricted ADL’s >90 degrees
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What specialized exams could you perform to assess for a chronic rotator cuff tear?

What are you looking for?

A

Drop arm and Empty Can

Looking for weakness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is found on physical exam in a rotator cuff tear?

A
  • Muscle weakness is hallmark (abduction and external rotation)
  • Weakness does not improve with analgesics
  • Cannot lift 2-5 pounds overhead’
  • May have atrophy in large tears
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are some diagnostic studies that you can perform to distinguish between rotator cuff tendinopathy and a tear?

A
  • Lidocaine injection test
  • Radiographs
  • MSK U/S
  • MRI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the acute treatment options for a rotator cuff tear?

What about for persistent rotator cuff tear symptoms?

A

Acute:

  • Ice, NSAIDs
  • Weight pendulum stretching
  • Short term immobilization
  • Restrict overhead positioning

Persistent:

  • Subacromial steroid injections (no more than 3-4 injections per year)
  • Surgery (arthoscopic repair vs joint arthoplasty)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the principle cause of rotator cuff tendonitis?

A

Shoulder impingement syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the clinical presentation of shoulder impingement?

A
  • Nearly identical to rotator cuff tendonitis
  • Subacromial tenderness
  • Normal glenohumeral joint ROM (pain at >90 degrees)
  • Preserved strength
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the hallmark physical exam finding of shoulder impingement?

A

Pain reproduced by the painful arc of flexion-internal rotation maneuvers (Neer’s and Hawkin’s)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Pain of the shoulder at 45 degrees or below indicates what degree of impingement? What about at 60-70 degrees?

A
  • Severe (45 or below)

- Moderate (60-70)

20
Q

What is the treatment for shoulder impingement?

A
  • Ice, NSAIDs, activity modification
  • NO arm sling
  • Physical Therapy referral
  • Follow up 2-3 weeks later to confirm improvement in symptoms
  • May have benefit from steroid injections if persistent
  • Surgery if symptoms are severe and anatomic variant could be improved
21
Q

What is the MOI for a labral tear?

A
  • FOOSH or sudden pull

- Repetitive overuse (throwing athletes, laborer)

22
Q

What is the clinical presentation of a labral tear?

A
  • Pain if acute
  • Clicking/catching if chronic
  • Frequently associated with other shoulder pathology
23
Q

What is typically observed on physical exam in a labral tear?

A
  • Biceps tendon pain
  • Restricted internal/external rotation of the glenohumeral joint
  • Motion dysfunction of the scapula
  • Positive Anterior Glide, Speed’s, O’Brien’s test
24
Q

What imaging can be done for a labral tear?

A
  • Radiographs (initial)
  • MRA > MRI
  • Arthoscopy for definitive diagnosis
25
Q

What is the preferred treatment for a labral tear?

A
  • Nonsurgical

- NSAIDs and PT

26
Q

How is adhesive capulitis diagnosed?

A
  • ROM tests confirm reduced ROM at glenohumeral joint in 2 or more planes (passive and active) (Positive Apley Scratch Test)
  • Severe pain
  • Loss of ROM is a mechanical restriction, not pain restriction
  • Abduction/External rotation most common
27
Q

What is the treatment for adhesive capsulitis?

A
  • Consult Physical Therapy
  • Most cases are self limited
  • Conservative treatment
28
Q

What is the MOI for an acromioclavicular injury?

A

Fall onto the tip of the shoulder with arm tucked into the side

29
Q

How does a patient typically present with an acromioclavicular injury?

A

Bump on the shoulder that is worse at bedtime

30
Q

What is typical on the physical exam of a patient with an AC sprain?

A
  • AC joint swelling and possible deformity
  • AC joint tenderness
  • Pain aggravated with downward traction
  • Pain with passive cross-body adduction (Cross-Over Test)
31
Q

In a Grade I AC injury, is there any tear/separation?

What is seen on imaging?

A

There is pain, but no separation.

Radiographs will be normal

32
Q

In a Grade II AC injury, is there any tear/separation?

What is seen on imaging?

A

There is separation of the Acromioclavicular (AC) ligament (partial separation).

Radiographs show slight widening and offset at the clavicle.

33
Q

In a Grade III AC injury, is there any tear/separation?

What is seen on imaging?

A

There is separation of the Acromioclavicular (AC) AND Coracoclavicular (CC) ligaments.

Radiographs show distal clavicle at or above the superior margin of the acromion.

34
Q

What is the treatment for an AC sprain?

A
  • Shoulder immobilizer for 3-4 weeks
  • Restriction of overhead, reaching, and weights
  • Ice, rest, NSAIDs, and steroid injections if not improving after 2-4 weeks
  • Surgical consideration for Grade III
35
Q

Where do most clavicular fractures occur?

A

In the middle 1/3 of the clavicle

36
Q

Which clavicular fracture location should you evaluate for internal organ involvement and refer to a specialist?

A

Proximal 1/3 (least common)

37
Q

What is the clinical presentation of a clavicular fracture?

A
  • Visual deformity
  • Tenderness
  • Decreased ROM
38
Q

What imaging is appropriate to obtain for a clavicular fracture?

A

Single AP radiograph of the clavicle

39
Q

What is the treatment for a clavicular fracture?

A

Conservative treatment for non-displaced, minimally displaced, or pediatric patients

  • Sling vs figure of 8 harness
  • Analgesics, muscle relaxers
  • Sleep upright

Ortho Referral:

  • Displaced mid clavicle fracture and all proximal and distal 1/3 fractures
  • Surgery
40
Q

What can cause subacromial bursitis?

A
  • Repetitive movement

- May result from systemic disease (RA, gout, sepsis)

41
Q

What is the clinical presentation of subacromial bursitis?

A
  • Pain with ROM and rest
  • Localized tenderness to palpation
  • May be associated with rotator cuff tendonitis
  • May cause impingement syndrome
42
Q

What is the treatment for subacromial bursitis?

A
  • Ice and NSAIDs
  • Restriction of overuse
  • Aspiration and Steroid injection (do not do injection if you suspect sepsis or aspirate)
43
Q

What is the clinical presentation of biceps tendonitis?

A
  • Pain to anterior shoulder with abduction and external rotation
  • Max point of tenderness along bicipital groove
  • Popping sensation
  • Weakness
  • Positive Yergason’s, Speed’s
44
Q

What can be seen on clinical presentation of an individual with a ruptured biceps tendon?

A

“Popeye Deformity”

45
Q

What is the treatment of biceps tendonitis?

A
  • NSAIDs and rest to reduce inflammation
  • Physical therapy to help with strength and prevent rupture
  • Surgery for ruptured tendon

Clinical Med I (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions