MSK - Upper Extremity Flashcards
What is the most unstable position for the shoulder?
Abducted, ER, Flexed to 90 degrees
Describe the difference between the anatomical neck and surgical neck of the humerus?
Anatomical neck - more superior, above lesser tuberosity, where cartilage ends
Surgical neck - inferior to anatomical neck, between tubercles
What portion of elevation is due to scapulothoracic motion? Glenohumeral?
Scapulothoracic - 1/3
Glenohumeral - 2/3
What muscles are typically thought of when needing full shoulder ROM?
Rotator cuff + deltoid
If the rotator cuff was torn, what active motion could still be seen at the shoulder?
Elevation (due to deltoid)
What would a cyst over the suprascapular notch cause? Over the spinoglenoid notch?
Suprascaular notch - reduce innervation to supra and infra, reducing ER and abduction
Spinoglenoid notch - reduce innervation to infra only, reducing ER
Which muscles are stronger in the shoulder, internal or external rotators?
Internal rotators
What causes lateral scapular translation winging deformity? Why?
Injury to spinal accessory nerve
Causes unopposed pull of serratus anterior
What causes medial scapular translation (winging)?
Injury to long thoracic nerve
How will the pt presentation differ between an anterior and posterior shoulder dislocation?
Anterior - slightly abducted, ER
Posterior - slightly adducted, IR
What is a Bankart lesion?
Anterior labrum tear as a result of anterior dislocation
What would potentially be injured if a patient complained of deep, front to back shoulder pain?
Labrum tear
What does the Empty can test isolate?
Supraspinatus
What does ER of the shoulder test?
Infraspinatus and teres mminor
What does Belly Press test?
Subscapularis strength
What is the Hawkin’s test position? What does it evaluate?
Flex elbow, raise shoulder, IR. Dr impinge greater tubercle on acromion
Evaluates potential impingement of supraspinatus
What is Speed’s test? What does it evaluate?
Dr. resists pts shoudler elevation while hand monitors biceps tendon
Positive if pain/feel biceps tendon popping out at shoulder
What is Yergason’s test? What does it evaluate?
Dr. resists patients supination while elbow flexed
Tests biceps
What is a positive O’brien’s test? What does it evaluation
Pt extends arm, thumb down, adduction. This causes pain. Pain relieved when thumb points up
Isolated labrum tears
What is the apprehension test? What is positive?
Pt supine, shoulder abducted and ER. Positive if patient becomes very nervous and feels like shoulder is coming out of place
What is initial treatment for atraumatic shoulder instability?
Supervised rehabilitation
What dislocation is most likely in a person who falls on an outstretched arm or has a seizure/is electrocuted?
Traumatic posterior dislocation (instability)
What is a SLAP tear? What typically causes these? What is the most specific diagnostic tool?
Superior labrum anterior to posterior tear
Fall/jerking motion
MRI arthrogram
How does the treatment differ for an acute SLAP tear vs. a degenerative SLAP tear?
Acute - arthroscopic fixation
Degenerative - arthroscopic debridement
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?
Adhesive capsulitis (frozen shoulder)
Initial: Injections, PT, steriords
Secondary: Manipulation under anesthesia
What are the three phases of adhesive capsulitis?
Inflammatory - first 6 months
Plateua - tight, little/no pain
Thawing - spontaneously resolves
What is initial treatment for shoulder arthritis?
Non-op
What treatment is appropriate for a person with rotator cuff impingment pain and no predictors for a tear?
NSAIDs, PT, injection
What treatment is appropriate for a person with rotator cuff impingement pain and minor weakness lasting longer than 6 weeks?
MRI
What type of shoulder replacement is done on someone with chronic rotator cuff arthropathy?
Reverse total shoulder
What is the treatment for Type I and II AC joint separation? IV, V, VI? III?
I and II - conservative
IV, V, VI - surgery
III - controversial
What is the initial treatment for a clivical fx? Scapula fx? Proximal humerus in youger pts? Older?
Clavicle - ORIF
Scapula - non-op
Proximal humerus younger - ORIF
Proximal humerus older - Hemi/Reverse total shoulder
What is function ROM for the elbow? (Flexion, extension, pronation, supination) What is normal?
Functional: 30-130, 50 pronation and supination
Normal: 0-150, 90 pronation and supination
What are the three medial collateral ligaments? Which is most important for resisting valgus stress?
Anterior - most important for resisting valgus stress
Posterior
Transverse
What clinically can be seen with a distal biceps rupture? What are treatment options for low demand pt vs. young/healthy patient?
Weak supination
Low demand pt - non-op
Young/health - Surgery
What tendon is most often affected in lateral epicondylitis?
Extensor carpi radialis brevis
What is osteochondritis dissecans? What are the 3 types? What is treatment for each? How does treatment differ for Panner’s Disease?
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
What is nurse maid’s elbow? What age group is it most common in? How is it reduced?
Subluxation of radial head
1-3 years old
Flex and supinate elbow
At what point are radial head fractures in adults treated with ORIF?
> 1/3 radial head, displaced/comminuted
What degree of angulation is acceptable in pediatric radial head fractures?
<30 degrees
How are non-displaced olecranon fractures treated? Displaced?
Non-displaced - immobilization
Displaced - ORIF
What does the Phalen maneuver diagnose if postive? How is it set up?
Patient’s arms extended, wrists flexed
Tests for median nerve compression in flexor retinaculum
After clinical findings suggestive of carpal tunnel, what test should be ordered?
NCV - nerve conduction velocity test
How is carpal tunnel syndrome treated?
Initial - non-op, conservative, NSAIDs, injection, night braces
Secondary - surgery
What finger most commonly gets Dupuytren’s contracture? What is it a thickening of? What is the treatment?
Ring finger
Palmar fascia
Collagenase injections or percutaneous aponeurotomy (surgery is difficult)
What is the treatment for trigger finger?
Rest, NSAIDs, ice, injection, surgery to cut A1 pulley
What is the Finklesteins test? What is treatment for the condition?
Adduct thumb in fist, Dr. resists patients radial deviation of wrist
DeQuervains’s tenosynovitis
Spica splint, injection, NSAIDs, Surgical release
What is Jersey finger? What tendon is injured in Zone 1? Zone 2? Treatment?
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
What is mallet finger? How is it treated?
Extensor tendon injury
Continuous splinting for 6 weeks
Surgery only if compliance is an issue
What is a Galeazzi Fracture?
Radial fracture with dislocation of distal radioulnar joint
What is a Monteggia fracture
Ulnar fracture with dislocation of proximal radiocapitellar joint
What is the treatment for a scaphoid fracture?
Surgical screw
What degree of angulation is acceptable in a Boxer’s fracture?
10-15 degrees
