MSK UE Flashcards
(true/false) bacterial endocarditis often presents at the shoulder
true
RTC pathologies will have a (low/high)-riding humeral head
high-riding
Head is pulled up due to the spastic muscles which narrows the coracoacromial space
How long can a surgeon wait to repair a supraspinatus tear? What can happen if they wait too long?
a. approx. 8-10 months
b. if the tendon is retracted too much, the surgery is less likely to connect the tendon in its original position = leads to achoring the tendon onto the humeral head which changes shoulder mechanics
What is a Bankhart lesion? What is the MOI?
a. anteroinferior glenoid labral tear with fracture of the glenoid
b. Anterior shoulder dislocation
increases the risk of shoulder dislocation and capsule damage
What is a hill-sachs lesion? What is the MOI?
a. Fracture of the posterolateral humeral head
b. posterior shoulder dislocation
What is a reverse hill-sachs lesion? What is the MOI?
a. Fracture of the anteromedial aspect of the humeral head
b. posterior dislocation
How long can bruising caused by bakhart lesion and/or hill-sachs lesion last?
10-12 months
What type of acromion abnormality is the worst?
Type 3
curved acromion that looks like the end of a field hockey stick
What is the surgical intervention for the supraspinatus after being damaged by the acromion?
SAD procedure
Subacromial decompression that removes the distal end of the acromion
4 weeks of recovery (easiest to recover from)
What type(s) of acromion curve(s) minimally respond to conservative intervention?
Types 2 and 3
What is the CPR for diagnostic imaging of elbow injuries?
NO emergent imaging if the patient has NORMAL extension, flexion, and supination
(true/false) It takes a short amount of time for an olecranon fracture to heal
FALSE
What are common MOIs for olecranon fractures?
- FOOSH with elbow EXT
- falling/direct blow to the elbow
What is the Sail sign? What does it suggest?
definition: Fat pads between the bone and muscles are fanned out due to bleeding around the joint
- suggestive of an occult radial head fracture
occlusion is commonly hidden which is why the sail sign is helpful w/ dx
What are red flags indicating a possible radial head fracture?
- FOOSH
- Sail sign
- arm being held in OPP
- restricted/painful PRON/SUP AROM
- radial head TTP
What are common medial nerve entrapment sites?
- between the heads of PT
- carpal tunnel
What are common ulnar nerve entrapment sites?
- ulnar groove
- between heads of FCU
- Guyon’s canal
What are the common radial nerve entrapment sites?
- triangular interval
- supinator
Note: pierces the supinator (deep radial nerve)
What are red flags that can be indicative of compartment syndrome in the UE?
- trauma, surgery, extreme unaccustomed activity
- persistent forearm pain and tightness
- tingling, burning, or numbness
- TTP and tension of the compartment
- pain increases with stretching
- paresthesia, paresis, sensory deficit
- diminished pulse and capillary refill
What is the technical term for a “dinner fork fracture”?
colle’s Fx
(true/false) Colle’s Fx and smith Fx are the same fx
true BUT they are distinguished between the position/movement of the wrist
What is a smith fx?
Flexion fracture of the radius
What is a colle’s fracture?
Extension fracture of the radius
What are red flags that suggest scaphoid fractures?
- FOOSH
- male 15-30
- females with osteoporosis
- swelling and bruising around the wrist
- TTP over anatomical snuff box/scaphoid tubercle
- increased pain with gripping
What portion of the scaphoid has the best blood supply when a scaphoid fracture is present?
distal pole
What are red flags that indicate possible lunate fracture or dislocation?
- MOI: Falling on hand or a strain
- general wrist pain
- pain at end range of wrist EXT
- decreased grip strength (+ pain)
(true/false) The lunate loses blood supply with dislocation and/or fractures
true
one of the worst wrist pathologies causing decreased wrist function
What anatomically occurs with a lunate dislocation?
Lunate moves medially towards the scaphoid, allowing the capitate to slide down
causes decreased wrist function
What is scapholunate separation?
Extensive amount of joint space between the scaphoid and lunate
“Terry Thomas Sign”
What is a boxer’s fracture?
Fracture of the 4th and/or 5th metacarpal
What is a bennett fracture?
Fracture at the 1st CMC joint
What are red flags indicating possible space infection of the hand?
- recent wound
- sxs of inflammation and infection
- digit FLX
- uniform swelling
- TTP over involved tendon
- severe pain with digit hyperEXT
Where in the hand are space infections found?
- mid palmar space
- thenar space
What are red flags that can indicate possible long flexor tendon rupture?
- laceration
- forceful contraction
- loss of FLX AROM at the DIP or PIP
- possible palpable defect in the muscle involved
What digit commonly experiences long flexor tendon ruptures?
4th digit
What causes mallet finger?
high velocity finger flexion into a surface (“jamming your finger”)
What are red flags for possible Raynaud’s phenomenon?
- family Hx
- women on estrogen therapy
- cold exposure
- underlying vascular disease
- medication that promotes vasoconstriction
- pallor
- cyanosis
- hyperemic erythema of the fingers
Medications: beta blockers, amphetamines, decongestants, caffeine
What are red flags indicating possible CRPS?
- trauma or surgery
- severe burning/aching/boring pain out of proportion to the inciting event
- pain not responsive to typical analgesics
- secondary hyperalgesia/hypersensitivity
- swollen, warm, red
- temperature difference between extremities
What UE pathology can resemble lymphedema but is very painful and presents with flaky and dry skin?
CRPS
What are possible interventions for CRPS?
- manual desensitization
- E-stim
- mirror therapy (graded motor imagery)
What are the most common referral sites from systemic diseases?
- mid-low back
- chest
- shoulder/scapula
- pelvis
- hip/groin
