Musk: UE Flashcards
1
Q
what rotator cuff is the most common involved in an injury
A
supraspinatus
2
Q
which rotator cuff muscle provides internal rotation
A
subscapularis
3
Q
which rotator cuff muscles provide external rotation
A
infraspinatus, teres minor
4
Q
which rotator cuff muscle provides abduction
A
supraspinatus
5
Q
clinical presentation
- pain over anterior and lateral aspects of shoulder
- radiates to deltoid
- occurs initially with overhead activity and then progresses to sx at rest
-
ROM decreased
- inability to abduct arm above shoulder level
A
Rotator cuff injury
6
Q
tendonosis
A
chronic degeneration of the muscles typically with age
7
Q
tendonitis
A
inflammation associated with repetitive trauma associated with everyday movement of the shoulder
8
Q
what can cause chronic rotator cuff tears
A
- degeneration
- impingement
- overload
*usually seen in people with overhead occupations
9
Q
an acute rotator cuff tear is often seen with what pathology
A
labral pathology
10
Q
clinical presentation
- pain comes on gradually
- c/o deep ache in lateral shoulder that radiates to deltoid
- point tenderness
- ROM painful >90 degrees
A
tendonitis; impingement
11
Q
what special testing can you do to check for impingement
A
- Neer’s (pictured): subacromial impingement
- Hawkin’s: supraspinatous tendon impingement
12
Q
what is a major risk factor for impingement
A
repetitive overhead activity
13
Q
chronic rotator cuff tears are most often seen in what patient population
A
men older than 40 years
14
Q
clinical presentation
- pain usually worse at night and interferes with sleep
- worsening pain followed by gradual weakness, weakness does not improve with analgesics
- decrease in ability to move the arm, especially abduction
A
chronic rotator cuff tear
15
Q
what tests can you do to check for rotator cuff tear
A
- empty can: supraspinatous tear
- drop arm: complete rotator cuff tear
16
Q
what is the lidocaine injection test
A
- distinguishes between tendinopathy and tear
- 10mL of lidocaine is injected in the subacromial space
17
Q
elevation of humeral head over 1 cm is highly suggestive of what condition
A
rotator cuff tear
18
Q
what is the study of choice when a full thickness tear is suspected or patient has failed conservative treatment
A
MRI
*MR arthrography preferred (inject contrast into joint)
19
Q
what are the three main goals when treating a rotator cuff tear
A
- recover lost strength
- improve global shoulder function
- treat concurrent tenonitis
20
Q
acute therapy after rotator cuff tear
A
- ice - anterolaterally over deltoid
- NSAIDs
- weighted pendulum stretching for 5 min, BID
- restrict overhead positioning, reaching, and lifting
- shoulder immobilizer for short duration
- consider PT
21
Q
if rotator cuff tear symptoms are persistant, what is the next treatment you can try? how often can you use this?
A
- subacromial steroid injection
- no more than 3-4 injections per year
22
Q
what is the final treatment option for patients with persistant rotator cuff symptoms
A
surgery
- arthroscopic repair
- joint replacement
23
Q
what is the principle cause of rotator cuff tendonitis
A
shoulder impingement syndrome
24
Q
clinical presentation
- subacromial tenderness
- normal glenohumeral joint ROM
- pain > 90 deg
- preserved strength
A
impingement
*presentation is nearly identical to rotator cuff tendonitis
25
what hallmark physical finding points to impingement
pain reproduced by the painful arc of flexion-internal rotation maneuvers
* Neer's
* Hawkins
26
how can you use Neer's sign to find the degree of impingement
* Pain at 90 deg: mild impingement
* Pain at 60-70 deg: moderate impingement
* Pain at 45 deg or below: severe impingement
27
treatment for impingement
* Ice, NSAIDs, activity modification
* \*\*no arm sling recommended
* PT referral
* corticosteroid injection if pain persistant
28
what is adhesive capsulitis (frozen shoulder)
* stiffened glenohumeral joint
* loss of ROM
* may develop adhesions
29
clinical presentation
* chronic pain
* loss of ROM that is a **mechanical restriction**, not a pain restriction
* abduction and external rotation most commonly affected
* + apley scratch test
adhesive capsulitis
30
treatment for adhesive capsulitis
consult physical therapy
* most cases are self-limited and respond to conservative therapy
* less than 10% require surgical intervention
31
this mechanism of injury often causes what injury: fall onto the tip of the shoulder with the arm tucked into the side
acromioclavicular injury
32
clinical presentation
* AC joint swelling and possible deformity
* AC joint tenderness
* pain aggravated by downward traction
* pain with cross body adduction (cross-over-test)
acromioclavicular sprain
33
what is the grade of AC sprain/seperation?
* AC joint intact, ligament stretch, point tenderness
* normal radiograph
grade I acromioclavicular sprain/seperation
34
what is the grade of AC sprain/seperation?
* seperation of superior and inferior AC ligaments, coracoclavicular ligaments intact
* radiograph show inferior margin of distal clavicle lies above the margin of the acromion, but below the superior margin
grade II
35
what is the grade of AC sprain/seperation?
* seperation of superior and inferior AC ligaments AND coracoclavicular ligaments
* radiograph show inferior margin of distal clavicle at or above the superior margin of the acromion
grade III
36
AC sprain: goals of treatment
reduce direct pressure and traction of AC joint to allow reattachement of the ligaments
37
treatment for AC sprain
* shoulder immobilizer 3-4 weeks
* Ice, rest, NSAIDs
* restriction of overhead reaching and weights
* corticosteroid injection if not improving after 2-4 weeks
38
70-80% of claviclular fractures occur in what portion of the clavicle
middle 1/3 clavicle
39
if someone sustains a fracture to the proximal 1/3 of their clavicle, what do you need to rule out
* sternoclavicular dislocation
* physeal fracture
40
treatment for clavicular fracture
* conservative treatment for non-displaced or minimally displaced in adults and nearly all pediatrics
* sling/swathe vs figure of 8 harness
* sleep upright inititally for comfort
41
when do you refer a clavicular fracture to ortho
* displaced mid clavicular fracture
* all proximal and distal 1/3 fractures
42
what is subacromial bursitis
* inflammation or degeneration of the bursa
* cause: repetitive movement, injury
* may result from systemic disease (gout, RA, sepsis)
43
clinical presentation
* pain with ROM and rest
* occasional decreased ROM due to pain
* localized tenderness to palpation
subacromial bursitis
44
treatment for subacromial bursitis
* **ICE** and **NSAIDs**
* restriction of overuse
* aspiration and corticosteroid injection
45
what is biceps tendonitis
inflammation of the long head of the biceps tendon as it passes through the bicipital groove
46
clinical presentation
* pain anterior shoulder with abduction and external rotation
* maximal point of tendernss along bicipital groove
* popping sensation
* weakness
* + Yergason's and Speeds
biceps tendonitis
47
how do you diagnose biceps tendonitis
* often clinically
* MSK U/S beneficial
48
treatment for biceps tendonitis
* NSAIDs
* rest
* PT
49
clinical presentation
* arm held in position of protection
* + sulcus sign, apprehension and relocation test
glenohumarl subluxation/dislocation
50
what radiograph views are helpful when you suspect a glenohumeral subluxation/dislocation
* AP
* Y
* axillary
51
treatment for glenohumeral subluxation/dislocation
* immediate reduction if needed
* should immobilizer (sling and swathe x 2-4 weeks)
* analgesics
* PT
* surgery if repeat dislocations
52
bankart lesion
detachment of anterior labrum form glenoid rim
\*consider in anterior shoulder dislocations
53
Hills Sachs lesion
cortical depression of the posterolateral humeral head when humeral head is impacted by anterior rim of glenoid
\*consider in anterior shoulder dislocations
54
why would you check for in an anterior should dislocation in relation to the axillary nerve
decreased sensation lateral aspect of shoulder (mid deltoid) and decreased deltoid function
55
medial elbow epicondylitis will have reproducible pain with which wrist motion
flexion
56
lateral elbow epicondylitis (tennis elbow) will have reproducible pain with which wrist motion
extension
57
acute treatment for elbow epicondylitis
* sling, wrist brace, ice, anti-inflammatory
58
treatment for recurrent elbow epicondylitis
* steroid injections
* surgery for debridement
59
what is a bursa
sac of lubricating fluid that allows skin to freely move over bony prominences
60
causes of olecranon bursitis
* trauma
* prolonged pressure (occupation)
* infection
* rheumatologic conditions
61
treatment for olecranon bursitis
* ice
* NSAIDs
* aspiration
* abx for infection
62
cubital tunnel syndrome affects what nerve
ulnar n
63
clinical presentation
* ulnar neuropathy
* decreased grip strength
* chronic: muscle wasting
cubital tunnel syndrome
64
diagnostics for cubital tunnel syndrome
nerve conduction study
65
treatment for cubital tunnel syndrome
* NSAIDs
* bracing
* PT
* surgery: cubital tunnel release
66
carpal tunnel syndrome symptoms are often worse at what time of day
* night
* occurs 2-3 hrs after falling asleep because of wrist flexing and may awaken pt
67
diagnostic studies for carpal tunnel syndrome
* grip strength
* nerve conduction study
* electromyogram (EMG)
68
treatment for chronic carpal tunnel syndrome
* NSAIDs
* local injection of corticosteroid
* brace
* PT
* surgery
69
what is a ganglion cyst
* collection of synovial fluid within a joint or tendon sheath
* herniation of synovial tissue from capsule or tendon sheath
70
clinical presentation
* common locations: dorsal radial and volar aspects of wrists
* **soft, mobile mass**
* fluctuates in size, often with activity
* may restrict motion or become painful with repetitive activity
ganglion cyst
71
treatment for ganglion cyst
* NSAIDs
* may resolve spontaneously
* aspiration and steroid injection
* surgery for recurrence
72
clinical presentation
* pain, swelling along dorsal radial wrist
* + Finkelstein test
* pain aggravated by thumb and wrist motion (gripping)
De Quervain's Tenosynovitis
73
cause of Boutonniere deformity
ruptured central slip extensor tendon mechanism
\*hyperextension at DIP
74
cause of swan neck deformity
volar plate attenuation of PIP joint
\*flexion of DIP joint
75
hueston table top test
* test for dupuytrens contracture
* assessing ability to flatten hand on table
76
treatment for dupuytren's contracture
* observation
* surgical referral recommended
* flexion contracture of \>30 deg at MCP or any PIP flexion is noted
* inability to perform Hueston Table top test
* glucocorticoid injection if becomes painful
77
trigger thumb/finger cause
nodule forms at volar aspect of MCP
78
treatments for trigger thumb/finger
* NSAIDs
* local corticosteroid injection
* surgery to release A1 pulley
