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Surgery > MSK - Upper Extremity > Flashcards

MSK - Upper Extremity Flashcards

1
Q

What is the most unstable position for the shoulder?

A

Abducted, ER, Flexed to 90 degrees

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2
Q

Describe the difference between the anatomical neck and surgical neck of the humerus?

A

Anatomical neck - more superior, above lesser tuberosity, where cartilage ends
Surgical neck - inferior to anatomical neck, between tubercles

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3
Q

What portion of elevation is due to scapulothoracic motion? Glenohumeral?

A

Scapulothoracic - 1/3

Glenohumeral - 2/3

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4
Q

What muscles are typically thought of when needing full shoulder ROM?

A

Rotator cuff + deltoid

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5
Q

If the rotator cuff was torn, what active motion could still be seen at the shoulder?

A

Elevation (due to deltoid)

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6
Q

What would a cyst over the suprascapular notch cause? Over the spinoglenoid notch?

A

Suprascaular notch - reduce innervation to supra and infra, reducing ER and abduction
Spinoglenoid notch - reduce innervation to infra only, reducing ER

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7
Q

Which muscles are stronger in the shoulder, internal or external rotators?

A

Internal rotators

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8
Q

What causes lateral scapular translation winging deformity? Why?

A

Injury to spinal accessory nerve

Causes unopposed pull of serratus anterior

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9
Q

What causes medial scapular translation (winging)?

A

Injury to long thoracic nerve

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10
Q

How will the pt presentation differ between an anterior and posterior shoulder dislocation?

A

Anterior - slightly abducted, ER

Posterior - slightly adducted, IR

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11
Q

What is a Bankart lesion?

A

Anterior labrum tear as a result of anterior dislocation

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12
Q

What would potentially be injured if a patient complained of deep, front to back shoulder pain?

A

Labrum tear

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13
Q

What does the Empty can test isolate?

A

Supraspinatus

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14
Q

What does ER of the shoulder test?

A

Infraspinatus and teres mminor

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15
Q

What does Belly Press test?

A

Subscapularis strength

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16
Q

What is the Hawkin’s test position? What does it evaluate?

A

Flex elbow, raise shoulder, IR. Dr impinge greater tubercle on acromion
Evaluates potential impingement of supraspinatus

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17
Q

What is Speed’s test? What does it evaluate?

A

Dr. resists pts shoudler elevation while hand monitors biceps tendon
Positive if pain/feel biceps tendon popping out at shoulder

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18
Q

What is Yergason’s test? What does it evaluate?

A

Dr. resists patients supination while elbow flexed

Tests biceps

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19
Q

What is a positive O’brien’s test? What does it evaluation

A

Pt extends arm, thumb down, adduction. This causes pain. Pain relieved when thumb points up
Isolated labrum tears

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20
Q

What is the apprehension test? What is positive?

A

Pt supine, shoulder abducted and ER. Positive if patient becomes very nervous and feels like shoulder is coming out of place

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21
Q

What is initial treatment for atraumatic shoulder instability?

A

Supervised rehabilitation

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22
Q

What dislocation is most likely in a person who falls on an outstretched arm or has a seizure/is electrocuted?

A

Traumatic posterior dislocation (instability)

23
Q

What is a SLAP tear? What typically causes these? What is the most specific diagnostic tool?

A

Superior labrum anterior to posterior tear
Fall/jerking motion
MRI arthrogram

24
Q

How does the treatment differ for an acute SLAP tear vs. a degenerative SLAP tear?

A

Acute - arthroscopic fixation

Degenerative - arthroscopic debridement

25
Q

What is the most likely diagnosis for a person without remarkable shoulder history, whole slowly looses ROM, maintains strength, and has severely decreased active and passive ROM? What is initial treatment? Secondary?

A

Adhesive capsulitis (frozen shoulder)
Initial: Injections, PT, steriords
Secondary: Manipulation under anesthesia

26
Q

What are the three phases of adhesive capsulitis?

A

Inflammatory - first 6 months
Plateua - tight, little/no pain
Thawing - spontaneously resolves

27
Q

What is initial treatment for shoulder arthritis?

A

Non-op

28
Q

What treatment is appropriate for a person with rotator cuff impingment pain and no predictors for a tear?

A

NSAIDs, PT, injection

29
Q

What treatment is appropriate for a person with rotator cuff impingement pain and minor weakness lasting longer than 6 weeks?

A

MRI

30
Q

What type of shoulder replacement is done on someone with chronic rotator cuff arthropathy?

A

Reverse total shoulder

31
Q

What is the treatment for Type I and II AC joint separation? IV, V, VI? III?

A

I and II - conservative
IV, V, VI - surgery
III - controversial

32
Q

What is the initial treatment for a clivical fx? Scapula fx? Proximal humerus in youger pts? Older?

A

Clavicle - ORIF
Scapula - non-op
Proximal humerus younger - ORIF
Proximal humerus older - Hemi/Reverse total shoulder

33
Q

What is function ROM for the elbow? (Flexion, extension, pronation, supination) What is normal?

A

Functional: 30-130, 50 pronation and supination
Normal: 0-150, 90 pronation and supination

34
Q

What are the three medial collateral ligaments? Which is most important for resisting valgus stress?

A

Anterior - most important for resisting valgus stress
Posterior
Transverse

35
Q

What clinically can be seen with a distal biceps rupture? What are treatment options for low demand pt vs. young/healthy patient?

A

Weak supination
Low demand pt - non-op
Young/health - Surgery

36
Q

What tendon is most often affected in lateral epicondylitis?

A

Extensor carpi radialis brevis

37
Q

What is osteochondritis dissecans? What are the 3 types? What is treatment for each? How does treatment differ for Panner’s Disease?

A 
Separation of articular cartilage of capitellum in elbow
Type 1 - intact, stable - non-op
Type 2 - collapse - op
Type 3 - loose body - op
Panner's disease - DO NOT OP
38
Q

What is nurse maid’s elbow? What age group is it most common in? How is it reduced?

A

Subluxation of radial head
1-3 years old
Flex and supinate elbow

39
Q

At what point are radial head fractures in adults treated with ORIF?

A

> 1/3 radial head, displaced/comminuted

40
Q

What degree of angulation is acceptable in pediatric radial head fractures?

A

<30 degrees

41
Q

How are non-displaced olecranon fractures treated? Displaced?

A

Non-displaced - immobilization

Displaced - ORIF

42
Q

What does the Phalen maneuver diagnose if postive? How is it set up?

A

Patient’s arms extended, wrists flexed

Tests for median nerve compression in flexor retinaculum

43
Q

After clinical findings suggestive of carpal tunnel, what test should be ordered?

A

NCV - nerve conduction velocity test

44
Q

How is carpal tunnel syndrome treated?

A

Initial - non-op, conservative, NSAIDs, injection, night braces
Secondary - surgery

45
Q

What finger most commonly gets Dupuytren’s contracture? What is it a thickening of? What is the treatment?

A

Ring finger
Palmar fascia
Collagenase injections or percutaneous aponeurotomy (surgery is difficult)

46
Q

What is the treatment for trigger finger?

A

Rest, NSAIDs, ice, injection, surgery to cut A1 pulley

47
Q

What is the Finklesteins test? What is treatment for the condition?

A

Adduct thumb in fist, Dr. resists patients radial deviation of wrist
DeQuervains’s tenosynovitis
Spica splint, injection, NSAIDs, Surgical release

48
Q

What is Jersey finger? What tendon is injured in Zone 1? Zone 2? Treatment?

A

Avulsion of tendon on distal surface of phalynx (flexor tendon injury)
Zone 1 - FDP
Zone 2 - FDS and FDP
Surgery within 1 week of injury

49
Q

What is mallet finger? How is it treated?

A

Extensor tendon injury
Continuous splinting for 6 weeks
Surgery only if compliance is an issue

50
Q

What is a Galeazzi Fracture?

A

Radial fracture with dislocation of distal radioulnar joint

51
Q

What is a Monteggia fracture

A

Ulnar fracture with dislocation of proximal radiocapitellar joint

52
Q

What is the treatment for a scaphoid fracture?

A

Surgical screw

53
Q

What degree of angulation is acceptable in a Boxer’s fracture?

A

10-15 degrees

Surgery (10 decks)

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