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clinical medicine exam 3 > Musk: UE > Flashcards

Musk: UE Flashcards

1
Q

what rotator cuff is the most common involved in an injury

A

supraspinatus

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2
Q

which rotator cuff muscle provides internal rotation

A

subscapularis

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3
Q

which rotator cuff muscles provide external rotation

A

infraspinatus, teres minor

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4
Q

which rotator cuff muscle provides abduction

A

supraspinatus

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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

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6
Q

tendonosis

A

chronic degeneration of the muscles typically with age

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7
Q

tendonitis

A

inflammation associated with repetitive trauma associated with everyday movement of the shoulder

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8
Q

what can cause chronic rotator cuff tears

A
  • degeneration
  • impingement
  • overload

*usually seen in people with overhead occupations

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9
Q

an acute rotator cuff tear is often seen with what pathology

A

labral pathology

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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

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11
Q

what special testing can you do to check for impingement

A
  • Neer’s (pictured): subacromial impingement
  • Hawkin’s: supraspinatous tendon impingement
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12
Q

what is a major risk factor for impingement

A

repetitive overhead activity

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13
Q

chronic rotator cuff tears are most often seen in what patient population

A

men older than 40 years

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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

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15
Q

what tests can you do to check for rotator cuff tear

A
  • empty can: supraspinatous tear
  • drop arm: complete rotator cuff tear
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16
Q

what is the lidocaine injection test

A
  • distinguishes between tendinopathy and tear
  • 10mL of lidocaine is injected in the subacromial space
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17
Q

elevation of humeral head over 1 cm is highly suggestive of what condition

A

rotator cuff tear

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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)

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19
Q

what are the three main goals when treating a rotator cuff tear

A
  1. recover lost strength
  2. improve global shoulder function
  3. treat concurrent tenonitis
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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
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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
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22
Q

what is the final treatment option for patients with persistant rotator cuff symptoms

A

surgery

  • arthroscopic repair
  • joint replacement
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23
Q

what is the principle cause of rotator cuff tendonitis

A

shoulder impingement syndrome

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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

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25
Q

what hallmark physical finding points to impingement

A

pain reproduced by the painful arc of flexion-internal rotation maneuvers

  • Neer’s
  • Hawkins
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26
Q

how can you use Neer’s sign to find the degree of impingement

A
  • Pain at 90 deg: mild impingement
  • Pain at 60-70 deg: moderate impingement
  • Pain at 45 deg or below: severe impingement
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27
Q

treatment for impingement

A
  • Ice, NSAIDs, activity modification
  • **no arm sling recommended
  • PT referral
  • corticosteroid injection if pain persistant
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28
Q

what is adhesive capsulitis (frozen shoulder)

A
  • stiffened glenohumeral joint
    • loss of ROM
  • may develop adhesions
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29
Q

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
A

adhesive capsulitis

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30
Q

treatment for adhesive capsulitis

A

consult physical therapy

  • most cases are self-limited and respond to conservative therapy
  • less than 10% require surgical intervention
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31
Q

this mechanism of injury often causes what injury: fall onto the tip of the shoulder with the arm tucked into the side

A

acromioclavicular injury

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32
Q

clinical presentation

  • AC joint swelling and possible deformity
  • AC joint tenderness
  • pain aggravated by downward traction
  • pain with cross body adduction (cross-over-test)
A

acromioclavicular sprain

33
Q

what is the grade of AC sprain/seperation?

  • AC joint intact, ligament stretch, point tenderness
  • normal radiograph
A

grade I acromioclavicular sprain/seperation

34
Q

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
A

grade II

35
Q

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
A

grade III

36
Q

AC sprain: goals of treatment

A

reduce direct pressure and traction of AC joint to allow reattachement of the ligaments

37
Q

treatment for AC sprain

A
  • shoulder immobilizer 3-4 weeks
  • Ice, rest, NSAIDs
  • restriction of overhead reaching and weights
  • corticosteroid injection if not improving after 2-4 weeks
38
Q

70-80% of claviclular fractures occur in what portion of the clavicle

A

middle 1/3 clavicle

39
Q

if someone sustains a fracture to the proximal 1/3 of their clavicle, what do you need to rule out

A
  • sternoclavicular dislocation
  • physeal fracture
40
Q

treatment for clavicular fracture

A
  • 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
Q

when do you refer a clavicular fracture to ortho

A
  • displaced mid clavicular fracture
  • all proximal and distal 1/3 fractures
42
Q

what is subacromial bursitis

A
  • inflammation or degeneration of the bursa
  • cause: repetitive movement, injury
  • may result from systemic disease (gout, RA, sepsis)
43
Q

clinical presentation

  • pain with ROM and rest
  • occasional decreased ROM due to pain
  • localized tenderness to palpation
A

subacromial bursitis

44
Q

treatment for subacromial bursitis

A
  • ICE and NSAIDs
  • restriction of overuse
  • aspiration and corticosteroid injection
45
Q

what is biceps tendonitis

A

inflammation of the long head of the biceps tendon as it passes through the bicipital groove

46
Q

clinical presentation

  • pain anterior shoulder with abduction and external rotation
  • maximal point of tendernss along bicipital groove
  • popping sensation
  • weakness
    • Yergason’s and Speeds
A

biceps tendonitis

47
Q

how do you diagnose biceps tendonitis

A
  • often clinically
  • MSK U/S beneficial
48
Q

treatment for biceps tendonitis

A
  • NSAIDs
  • rest
  • PT
49
Q

clinical presentation

  • arm held in position of protection
    • sulcus sign, apprehension and relocation test
A

glenohumarl subluxation/dislocation

50
Q

what radiograph views are helpful when you suspect a glenohumeral subluxation/dislocation

A
  • AP
  • Y
  • axillary
51
Q

treatment for glenohumeral subluxation/dislocation

A
  • immediate reduction if needed
  • should immobilizer (sling and swathe x 2-4 weeks)
  • analgesics
  • PT
  • surgery if repeat dislocations
52
Q

bankart lesion

A

detachment of anterior labrum form glenoid rim

*consider in anterior shoulder dislocations

53
Q

Hills Sachs lesion

A

cortical depression of the posterolateral humeral head when humeral head is impacted by anterior rim of glenoid

*consider in anterior shoulder dislocations

54
Q

why would you check for in an anterior should dislocation in relation to the axillary nerve

A

decreased sensation lateral aspect of shoulder (mid deltoid) and decreased deltoid function

55
Q

medial elbow epicondylitis will have reproducible pain with which wrist motion

A

flexion

56
Q

lateral elbow epicondylitis (tennis elbow) will have reproducible pain with which wrist motion

A

extension

57
Q

acute treatment for elbow epicondylitis

A
  • sling, wrist brace, ice, anti-inflammatory
58
Q

treatment for recurrent elbow epicondylitis

A
  • steroid injections
  • surgery for debridement
59
Q

what is a bursa

A

sac of lubricating fluid that allows skin to freely move over bony prominences

60
Q

causes of olecranon bursitis

A
  • trauma
  • prolonged pressure (occupation)
  • infection
  • rheumatologic conditions
61
Q

treatment for olecranon bursitis

A
  • ice
  • NSAIDs
  • aspiration
  • abx for infection
62
Q

cubital tunnel syndrome affects what nerve

A

ulnar n

63
Q

clinical presentation

  • ulnar neuropathy
  • decreased grip strength
  • chronic: muscle wasting
A

cubital tunnel syndrome

64
Q

diagnostics for cubital tunnel syndrome

A

nerve conduction study

65
Q

treatment for cubital tunnel syndrome

A
  • NSAIDs
  • bracing
  • PT
  • surgery: cubital tunnel release
66
Q

carpal tunnel syndrome symptoms are often worse at what time of day

A
  • night
  • occurs 2-3 hrs after falling asleep because of wrist flexing and may awaken pt
67
Q

diagnostic studies for carpal tunnel syndrome

A
  • grip strength
  • nerve conduction study
  • electromyogram (EMG)
68
Q

treatment for chronic carpal tunnel syndrome

A
  • NSAIDs
  • local injection of corticosteroid
  • brace
  • PT
  • surgery
69
Q

what is a ganglion cyst

A
  • collection of synovial fluid within a joint or tendon sheath
  • herniation of synovial tissue from capsule or tendon sheath
70
Q

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
A

ganglion cyst

71
Q

treatment for ganglion cyst

A
  • NSAIDs
  • may resolve spontaneously
  • aspiration and steroid injection
  • surgery for recurrence
72
Q

clinical presentation

  • pain, swelling along dorsal radial wrist
    • Finkelstein test
  • pain aggravated by thumb and wrist motion (gripping)
A

De Quervain’s Tenosynovitis

73
Q

cause of Boutonniere deformity

A

ruptured central slip extensor tendon mechanism

*hyperextension at DIP

74
Q

cause of swan neck deformity

A

volar plate attenuation of PIP joint

*flexion of DIP joint

75
Q

hueston table top test

A
  • test for dupuytrens contracture
  • assessing ability to flatten hand on table
76
Q

treatment for dupuytren’s contracture

A
  • 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
Q

trigger thumb/finger cause

A

nodule forms at volar aspect of MCP

78
Q

treatments for trigger thumb/finger

A
  • NSAIDs
  • local corticosteroid injection
  • surgery to release A1 pulley

clinical medicine exam 3 (7 decks)

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