Musculoskeletal Flashcards
Anterior glenohumeral shoulder D/L
Abducted and externally rotated. Shoulder will look “squared off”. Hill-Sachs lesion (groove on humeral head). Bankart lesion (glenoid inferior rim fracture). Reduce it. Rule out axillary nerve injury (prick them on the deltoid)
Anterior glenohumeral shoulder D/L
Abducted and externally rotated. Shoulder will look “squared off”. Hill-Sachs lesion (groove on humeral head). Bankart lesion (glenoid inferior rim fracture). Reduce it. Rule out axillary nerve injury (prick them on the deltoid)
Posterior glenohumeral shoulder D/L
Adducted and internally rotated. More commonly caused by seizure or trauma. Reduce that thing
What view is most helpful in determining anterior from posterior shoulder D/L?
Axillary and “Y” view.
How does an AC separation happen?
Direct blow to adducted shoulder
How do you dx it?
Clinical. May have a bump deformity. You should Xray it with WEIGHT
How do you treat an AC separation?
Sling, ice, analgesia, ortho follow up. Grade 3 may need surgery
Radial nerve controls what?
BEEST - brachioradialis, extensor wrist, extensor fingers, supinator, triceps
For humeral shaft fracture, make sure you check for what?
Radial nerve damage (wrist drop). Brachial plexus injury (deltoid sensation).
How would you treat a humeral shaft fracture?
Sugar tong splint or coaptation splint
What is the most commonly fractured bone in children?
Clavicle
Suspect child abuse in child
How would you treat a clavicle fracture?
Sling
Who commonly gets frozen shoulder?
DM and hypothyroidism
What limitations will you see with frozen shoulder?
Decreased ROM (especially external rotation)
Treatment for frozen shoulder?
Rehab
A woman age 20-50 comes in with pain/parasthesias to the ULNAR side of the hand and forearm. What test might you do? How would you formally dx it?
Adson test. Rotate her head to the affected side and see if you lose a pulse. Brachial plexus most commonly affected in women age 20-50. MRI. PT is 1st ling treatment.
A 5-10yo child comes in with swelling and tenderness to the elbow. You note a prominent olecranon with depression proximally. On X-ray you not a posterior fat pad.
Supracondylar fracture
What if you saw the same XR finding in an adult?
Radial head fracture
Who gets supracondylar fractures?
Children most commonly
What would a supracondylar fracture look like if it were displaced vs non displaced?
The anterior humoral line would be abnormal.
Treatment for non displaced supracondylar fracture and radial head fractures?
Splint at 90 degrees. If displaced, you need surgery and probably should admit with ortho consult for open reduction internal fixation.
Pt presents with pain, swelling, and inability to extend elbow after falling directly on it? What is this? What might you see? How will you treat?
Olecranon fracture. You may see the triceps rupture and pull bone proximally. You should look out for ulnar nerve disfunction. Spint at 90 degrees if non displaced. If displaced, will need surgery and ortho consult.
Posterior glenohumeral shoulder D/L
Adducted and internally rotated. More commonly caused by seizure or trauma. Reduce that thing
What view is most helpful in determining anterior from posterior shoulder D/L?
Axillary and “Y” view.
How does an AC separation happen?
Direct blow to adducted shoulder
How do you dx it?
Clinical. May have a bump deformity. You should Xray it with WEIGHT
How do you treat an AC separation?
Sling, ice, analgesia, ortho follow up. Grade 3 may need surgery
Radial nerve controls what?
BEEST - brachioradialis, extensor wrist, extensor fingers, supinator, triceps
For humeral shaft fracture, make sure you check for what?
Radial nerve damage (wrist drop). Brachial plexus injury (deltoid sensation).
How would you treat a humeral shaft fracture?
Sugar tong splint or coaptation splint
What is the most commonly fractured bone in children?
Clavicle
Suspect child abuse in child
How would you treat a clavicle fracture?
Sling
Who commonly gets frozen shoulder?
DM and hypothyroidism
What limitations will you see with frozen shoulder?
Decreased ROM (especially external rotation)
Treatment for frozen shoulder?
Rehab
A woman age 20-50 comes in with pain/parasthesias to the ULNAR side of the hand and forearm. What test might you do? How would you formally dx it?
Adson test. Rotate her head to the affected side and see if you lose a pulse. Brachial plexus most commonly affected in women age 20-50. MRI. PT is 1st ling treatment.
A 5-10yo child comes in with swelling and tenderness to the elbow. You note a prominent olecranon with depression proximally. On X-ray you not a posterior fat pad.
Supracondylar fracture
What if you saw the same XR finding in an adult?
Radial head fracture
Who gets supracondylar fractures?
Children most commonly
What would a supracondylar fracture look like if it were displaced vs non displaced?
The anterior humoral line would be abnormal.
Treatment for non displaced supracondylar fracture and radial head fractures?
Splint at 90 degrees. If displaced, you need surgery and probably should admit with ortho consult for open reduction internal fixation.
Pt presents with pain, swelling, and inability to extend elbow after falling directly on it? What is this? What might you see? How will you treat?
Olecranon fracture. You may see the triceps rupture and pull bone proximally. You should look out for ulnar nerve disfunction. Spint at 90 degrees if non displaced. If displaced, will need surgery and ortho consult.
A pt has an abrupt goose egg on their elbow that is boggy, tender, and red. Limited ROM. Pt has a history of gout and inflammation of joints. Pt also had a recent trauma. What will you do?
Likely olecranon bursitis. If suspected septic you can aspirate. WBC’s will be above 5000. Rest, NSAID’s, local steroid injection, padding, avoiding repetitive motions will be best.
What is the ulnar fracture that dislocates the radial head?
Monteggia. Radial nerve injury (wrist drop???)
What is the radial fracture that dislocates the distal radio-ulnar joint?
Galeazzi (JEEZIE!!!) Unsable…needs ortho.
What does the radial head wedge into with nursemaids elbow (radial head subluxation)
Annular ligament
What might a nursemaids elbow really be if it doesn’t improve with treatment?
Hutchingson’s or Chauffurs fracture
Where is the inflammation with tennis elbow?
Extensor carpi radialis brevis
How will the pain present with tennis elbow?
Pain with gripping, pronation of forearm, wrist extension.
Treat tennis elbow with…
RICE, NSAID’s, injections if bad
A person punches with a clenched fist. What injury? What will you do?
Boxers fracture. (base of 5th metacarpal). Ulnar GUTTER splint (get you mind out of the gutter…two fingers…hahaha) Boxers like to use two fingers…bwahahaha.
What type of olecranon D/L is most common?
Posterior D/L
Nerve and artery injuries are dangerous with olecranon D/L. What ones?
brachial artery, median/ulnar/radial nerves
What do you need to do with an olecranon D/L
Urgent reduction. Then splint at 90 degrees
What is froments sign?
Pt can’t hold piece of paper without flexing IP joint of finger.
Pt has parathesias and pain along the ulnar nerve. What is this? How would you test?
Cubital tunnel syndrome. Tinel sign (tap on funny bone spot and see if medial forearm goes numb or the pinky and half of the ring finger on that same side. Also use froments sign as explained above.
Scaphoid fracture
FOOSH. Pain at radial side of wrist and anatomical snuff box. Treat if symptoms as XR may not show for weeks. Blood flow at risk. Thumb spica.
Which distal radial fracture angles the distal bone anteriorly (palm)
Smiths
Which distal radial fracture angles the distal bone posteriorly (dorsal)
Colles
What is the complication of a Colles fracture?
Extensor pollicis longus tendon rupture.
Treat both with what if stable?
Sugar tong splint
Dinner fork deformity
Colles
Garden spade deformity
Smith
What is the difference between a perilunate and lunate D/L?
Perilunate still articulates with the radius. Lunate doesn’t articulate with the capitate OR the radius. It’s urgent and needs emergency consult.
What signs will you see with perilunate and lunate D/L?
Piece of PIE sign or Spilled teacup sign.
What is the most serious carpal bone fracture?
Lunate. Because it is the one that articulates MOST with the radius.
Treatment for lunate fracture?
Thumb spica
How do you treat complex regional pain syndrome? And what the hell is it?
Pain in upper extremity out of proportion to injury. Vitamin C seems to help. Otherwise, treat as pain problem.
Sudden blow to tip of extended finger forcing flexion. Treatment?
Mallet finger. Splint in extension for 6 weeks. If not healed, will need pinning.