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IPAP > Ortho Block 2 > Flashcards

Ortho Block 2 Flashcards

1
Q

Define Type 1-6 AC injuries

What is the most common mechanism of injury?

A

1: joint sprain
2: widening w/ less than 100% elevation
3- 100% superior displaced clavicle w/ inc CC interspace
4- superior/posterior clavicle displacement
5- 100-300% superior displaced clavicle
6- distal clavicle in subacromical subcoracoid space

Fall onto lateral shoulder

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2
Q

Types 3-6 will present to exam with what differentiating finding?

Radiographs with weighted bilateral films are needed for AC injury types ? and regular films are needed for ?

How are these injuries treated non-op?

A

Visible elevation of distal clavicle, pain w/ arm abduction

Bilateral weighted for 1, 2
Normal for 2-5

Type 1 and 2- wear slings until pain ends
Type 3 can also be treated non-op

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3
Q

When are AC injury PTs surgical candidates?

What are the ? types of shoulder arthritis?

A

Young doing heavy overhead work w/ Type 3
Generally Type 4-6 refer

Primary- most common, age and no HxFx/Trauma
Secondary- trauma, FxHx
Rhematoid- multiple joints involved and crosses midline
Crystaline- zebra of shoulder

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4
Q

When are AC injuries referred for further eval?

How is shoulder arthritis characterized?

A

4-6
Athletes/throwers
Laborers w/ Type 3
Chronic pain

Destruction of joint cartilage w/ pain, lost joint space, and function

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5
Q

How do PTs w/ shoulder arthritis present?

What type of osteophyte is associated with OA of the shoulder?

A

Diffuse/deep pain in posterior
Limited ROM
Pain w/ daily living activities

Goat’s beard

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6
Q

What does a Hx of Fx/dislocation in a PT w/ suspected shoulder arthritis suggest?

What happens in these PTs that also have long-standing rotator cuff tears w/out Tx?

A

Osteonecrosis/Post-traumatic arthritis

Superior migration of humeral head leading to loading of glenoid, leading to rotator cuff tear arthropathy

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7
Q

Shoulder arthritis has pain located where?

What type of ROM do they have?

A

Deep anterior pain, radiates to posterior shoulder

Dec A/PROM equally

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8
Q

What findings on an x-ray support a Dx of shoulder OA?

What would be seen if rheumatoid arthritis was present?

A

Flattened humeral head
Inferior osteophyte
Posterior erosion of glenoid

Periarticular erosions, osteopenia, central wear of glenoid

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9
Q

What are the long term risks for shoulder arthritis that goes w/out Tx?

How is this Tx?

A

Chronic pain
Loss of strength
Loss of motion
All of these even w/ joint replacement

Non-surgical w/ NSAIDs, heat, ice
Corticosteroid injection, injection from posterior for best access to glenoid space
Mild-mod: Arthroscopy debrisment/capsule release for

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10
Q

How are advanced cases of shoulder arthritis Tx?

What are two possible adverse outcomes of this Tx method?

A

Total shoulder replacement or hemiarthroplasty if advanced

Thrombophlebitis
Embolus

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11
Q

When do PTs w/ shoulder arthritis get referred?

Burners/stingers are medically called?

A

Intolerable pain
Dec motion (unable to do bra/occupation)
3mon of non-surg Tx

Transient brachial plexopathy

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12
Q

Define Burners of Brachial Plexus

What causes transient brachial plexopathy

A

Transient stretch injury to upper trunk of brachial plexus at C5-6 roots

High energy MVA, fall, gunshot down to athletic injuries

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13
Q

What is the most common MOI for the two types of Brachial Plexus Burners?

A

Upper trunk: burner/transient
forceful shoulder depression w/ head/neck are tilted away
MC Post-ganglionic (C5-6)
Painful rhomboids, serratus snterior

Lower trunk injury: longitudinal stretch w/ arm in abduction
MC pre-ganglionic (C8-T1)
Horner Syndrome- ipsilateral ptosis, myosis, anhidrosis, anophthalmos

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14
Q

The cornerstone of a good Dx for Burners/Stingers and ones that are recurrent suggest what underlying issue?

What are the adverse outcomes of this Dz?

A

Neuro exam
Cervical stenosis
Risk for severe spinal cord injury

Pain, 
Sensory loss 
Paresthesias 
Weakness 
Paralysis 
Amputation
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15
Q

Bilateral upper extremeties or radicular Sxs of burners/stingers should be treated as ?

What PE findings are required prior to releasing athletes to return to play?

A

Spinal cord injury until proven otherwise

Resolution of pain
Resolution of Neuro Sxs
Normal neuro exam
Cervical spine full ROM

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16
Q

Frozen shoulder is AKA ? and defined as ?

What are the common risk factors and what issue can NOT be associated with it?

A

Adhesive capsulitis- idiopathic loss of AROM and PROM

DM Type 1, Hypothyroid, Dupuytren Dz
No trauma relation

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17
Q

Where is pain usually located in Frozen Shoulders?

What is seen on PE?

A

Deltoid insertion site

+50% loss of A/PROM
Loss of external rotation due to contracture of coracohumeral ligament (unique and differentiates from arthritis)

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18
Q

What phrase is pathognomonic for frozen shoulder?

How does MRI/CT confirm a frozen shoulder Dx?

A

Contracture of coracohumeral ligament

Shows contracted capsule, loss of inferior pouch

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19
Q

How are frozen shoulders Tx non-surgically?

How are these Tx w/ surgery?

A

NSAIDs/non-opiate analgesics, moist heat, stretch

Arthroscopic capsule release

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20
Q

What are the goals for frozen shoulder rehab?

What can be an adverse outcome of this Tx method?

A

Reduce pain
Increase glenohuemeral and scapula mobility

Fx of humerus

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21
Q

When do frozen shoulder PTs need to be referred?

What type of treatment/therapy needs to be avoided in these PTs?

A

No improvement after 3mon

Multiple cortisone injections

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22
Q

What is the primary muscle that raises the arm?

Flexion of this muscle causes the rotator cuff to slide under what structure?

A

Supraspinatus

Coracoacromial arch

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23
Q

What are the characteristic PE findings of a shoulder impingement?

What movement causes the most pain?

A

Lateral pain exacerbated w/ overhead activity
+ Nears, Hawkin, Jobes

90-120* abduction and lowering

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24
Q

What finding on PE of an impingement is indicative of a long standing rotator cuff teat

How are impingement’s Tx?

A

Narrowing between humeral head and acromion space +7mm

Stretching, injections
Don’t repeat injection if relief for 4-6wks was NOT achieved

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25
Q

Narrowing between what two structures suggests a long standing rotator cuff tear

What differentiates impingement from AC arthropathy?

A

Humeral head, under surface of acromiom

Cross arm test

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26
Q

What type of motion limitation is seen in rotator cuff tears?

What finding can be elicited by the provider?

A

Normal PROM, limited AROM

Can’t hold arm elevated when parallel to ground
TTP insertion of supraspinatus on greater tuberosity
+ Drop arm, Jobes test

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27
Q

What type of x-ray findings may be seen in old/long standing rotator cuff tears?

What is the Tx exception to non-surgical repair?

A

AP show high riding humerus Lack of subacromial bursa

Acute traumatic tear, surgery 6wks after MRI evaluation

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28
Q

What are the 4 goals of rotator cuff tear PT?

Proximal bicep tendon tears usually occur in what PT population?

A

Reduce pain
Inc strength/ROM
Restore overhead function

Long Hx of shoulder pain secondary to rotator cuff Dz

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29
Q

Where does the proximal bicep tendon pass through in it’s last/most proximal area?

What test can PTs do to accentuate a tear here?

What term is attached to these injuries but lack specificity of which end is torn?

A

Intertubercular groove, is intra-articular for proximal 3cm

Ludington test- supination and flexion enhances bulge

Popeye’s arm/bulge

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30
Q

What is an adverse outcome for PTs who don’t seek Tx of proximal bicep tears?

When is surgical repair considered and what intervention step is done here?

A

Loss of 10% elbow flexion and forearm supination strength

MRI evaluation stat
Young athletes
PTs younger than 40y/o
Screwed back in distally to surgical neck of humerus

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31
Q

What type of shoulder instability is more common?

Define TUBS
Define AMBRI

A

Anterior (most common)
Multidirectional

Traumatic Unidirectional / Bankart lesion needing surgery- tear of anterior glenoid labrum

Atraumatic Multi-directional, Bilateral sign of laxity, Rehab is preferred Tx, Inferior capsular shift- procedure of surgery
Usually subluxation

32
Q

What position is that arm in for a posterior dislocation of the shoulder to occur?

A PTs ability to voluntarily dislocate a shoulder is associated with ? and indicates ? prognosis

A

Adduction, internal rotation from seizure/electrical shock

Multidirectional
Poor

33
Q

What nerve in particular needs to be assessed in shoulder dislocations?

What 4 tests need to be performed on PTs w/ suspected recurrent instability?

A

Axillary in anterior shoulder girdle

Aprehension/Relocation test- anterior stability
Sulcus test- inferior laxity
Jerk- posterior laxity
General laxity- thumb to volar surface

34
Q

Define Hill-Sach/Bankart lesion and what causes them?

What type of nerve issue is commonly seen but self resolved?

A

Compression Fx of posterior humeral head hitting against anterior/inferior edge of glenoid best seen on scapular Y view

Axillary nerve- deltoid dysfunction and lateral arm numbness

35
Q

What PT population will have a higher risk of recurrent instability

How are PTs with a first time dislocation Tx?

A

Young w/ multiple episodes of dislocation

Neutral immobilization x 3wks
Rehab rotator/subscapularis strength

36
Q

How are PTs w/ atraumatic/voluntary shoulder instability Tx?

What type of shoulder dislocations need referral for red flags?

A

Avoid aggravating movements/actions
Rehab

Closed manipulation fails to reduce acute dislocation
Two or more dislocations in 3mon despite rehab
Intolerable Sxs in multi-directional instability

37
Q

SLAP tears involve injury to what 2 structures?

What does the bicep anchor composed of and originate from?

A

Superior glenoid labrum
Bicep anchor

Long head of tendon originating from superior aspect of glenoid labrum

38
Q

What tests are performed during PE for a SLAP lesion?

What imaging modality is the gold standard for assessing SLAP lesions?

A

Resisted supination/external rotation
Speed
Compression, Crank/Clunk tests

MRA w/ gadalinium contrast

39
Q

What are the non-surgical rehab methods for SLAP lesions?

What is the only alternative if these methods fail?

A

NSAID
Rotator/periscapular stabilization
Posterior capsule stretching

Dx shoulder arthroscopy

40
Q

What are the two goals of SLAP lesion rehab?

What is the most common adverse effect following surgical repair of SLAP lesions?

A

Reduce pain
Protect from further damage

Shoulder stiffness

41
Q

What causes thoracic outlets syndrome

What are the congenital causes of this syndrome?

A

Compression of brachial plexus and/or subclavian vessels as they exit between superior girdle/clavicle and first rib

Normal variants: Cervical rib
Long C7 transverse process

Abnormal: Pancoast tumor, Anomalous fibromuscluar band

42
Q

What causes most of the presenting Sxs of TOS?

What can these presenting Sxs mimic?

A

Compressed brachial plexus

Distal entrapment of ulnar nerve*

43
Q

What tests are performed during PE of TOS?

How is this syndrome Dx?

A 
Roos test
Palpate supraclavicular fossa
Auscultation for buit
Compare distal pulses bilateral
Assess sensory and motor function of all arm nerves

AP/Lat- for bone causes
PA/Lat- r/o apical lung tumor

44
Q

What are two rare but possible adverse outcomes of TOS?

How are most of these PTs treated in 3-6mon?

When do they need to be referred?

A

Ulcerations
Raynaud

At home exercise w/ posture education

Normal variant alteration
Neurovascular

45
Q

How is arthritis of the elbow Dx?

If there is an effusion present in the elbow, the fluids needs to be aspirated and assessed for ?

What would be seen on x-ray of primary OA, secondary OA, RA and crystaline in the elbow?

A

AP/Lat x-ray

WBC, Crystals, Gram stain, Culture

1*- Joint space narrowing
Sub-chondral cyst
Articular bone spurs
2*- Hx of trauma with Sxs of primary
RA: osteopenia, margin  margins
Crystaline- subchondral bony erosion, peripheral bone spurs
46
Q

What ROS answers will be common in PTs w/ elbow RA?

What will be seen on PE or elbow RA?

How is RA and Crystaline of the elbow treated?

A

Bilateral shoulder, wrist and hand arthritis

Lateral swelling
Boggy joint

RA: DMARDs
CCS injection
Surgery

Crystal- alopurinol, colchicine
Injections

47
Q

What is an indication a PT needs a surgical procedure for Sx relief of elbow arthritis?

What muscle originates from the lateral epicondyle of the humerus and what issue arises from this origin?

A

Loss of daily living ability
Arthroscopic debrisment and removal of loose bodies

Extensor carpi radialis brevis
Lateral epicondylitis/tennis elbow

48
Q

What muscle originates from medial humerus epicondyle?

What movement replicates the pain in medial and lateral epicondylitis?

A

Flexor/pronator muscle
Golfer/Bowler elbow

Lateral- Gripping w/ wrist extension
Medial- gripping w/ wrist flexion and forearm pronation

49
Q

What imaging modality helps confirm a medial/lateral epicondylitis Dx?

Why do Dx’s of involving medial/lateral epicondye need to be accurate?

A

MRI

Surgical failure if mis-Dx
Entrapment syndromes- posterior interosseous nerve in lateral epicondylitis; ulnar nerve in medial epicondylitis

50
Q

What is the most important step in Tx of lateral epicondylitis and what can be done?

What are the 4 stages of Tx in humeral epicondylitis?

A

Stopping activities that hurt
CCS, PRP injection w/ buffy layer, dry needling
Medial Tx done by Orthopod under US guidance

Reduction
Promotion
Return
Maintenance

51
Q

What is the most common adverse outcome of humeral epicondylitis surgery?

What makes the olecranon bursitis so susceptible to irritation and inflammation?

A

Incomplete pain relief despite adequate release

Superficial location on extensor side of elbow

52
Q

What can be done for Dx and Therapeutc relief for large elbow bursitis?

What is the job of the bursa in the shoulder?

A

Aspiration for WBC, Gram stain, culture and crystals

Pad greater tubercle and acromion

53
Q

How are small/barely Sx elbow bursitis Tx?

If there are no S/Sxs of septic bursitis, what type of wrap can be applied?

A

Left alone, activity modification, NSAID

Compression bandage w/ 8cm circular foam

54
Q

How are septic olecranon bursitis cases Tx?

How are chronically inflamed aseptic bursitis cases Tx?

A

ABX w/ penicillin resistant Staph A coverage
Surgical drain/daily aspiration

Avoid excision/chronic drainage to avoid sinus infection

55
Q

When are olecranon bursitis cases referred?

What are the first and second most common nerve entrapment syndromes in the UE?

A

Recurrent despite 3 or more drainages

Carpal tunnel syndrome
Compression of ulnar nerve

56
Q

What are the 2 most common sites for ulnar nerve compression?

How do chronic cases develop?

A

Cubital tunnel on posterior aspect of medial epicondyle
Passage site between humeral and ulnar head of flexor carpi ulnaris muscle

Prolonged pressure on nerve from leaning or prolonged elbow flexion

57
Q

How does ulnar nerve palsy develop?

What is a common cause of a mis-Dx of lateral epicondylitis?

A

Instability from repetitive subluxation or dislocation of ulnar nerve

Compression of posterior interosseous nerve causing lateral elbow pain

58
Q

What does the posterior interosseous nerve innvervate?

What is the most common cause of this nerve being compressed?

A

Thumb and finger extensor
Extensor carpi ulnaris

Fibrous bands between two heads of supinator muscle in the radial tunnel

59
Q

Define Pronator Syndrome

Why is this difficult/rarely Dx?

A

Muscular compression of median nerve in proximal forearm

Vague Sxs
Common in worker comp claims

60
Q

What are the presenting Sxs of ulnar, radial, posterior interosseious nerve compression syndrome?

A

Ulnar- pain in medial elbow, numbness of ring/little finger

Radial- pain similar to tennis elbow but distal in origin

Posterior- only motor fibers; late finding is difficulty innervating finger/thumb

61
Q

What special tests can be done when assessing nerve compression syndromes of the elbow?

What is the difference in location of pain with Posterior Interosseous nerve compression and radial tunnel syndrome?

A

Tinel sign
Resisted pronation

PIN- tenderness over radial tunnel
RTS- pain in proximal forearm elicited by middle finger test

62
Q

When is decompression of the radial tunnel of pronator syndrome w/ surgery considered?

What amount of movement is lost if distal bicep tears are not treated in a timely manner?

A

Discomfort after 3-6mon of non-surg Tx

30-50% loss of strength in elbow flexion and forearm supination

63
Q

Cubital Tunnel Syndrome

A

Ulnar nerve compression
Pain/weakness along pinky/ring finger
Ache/pain in hypothenar muscle
MC from hyperflexion of elbow or can be from resting arms when driving

64
Q

Radial nerve compression

Median Nerve Compression

A

Lateral elbow pain distal to lateral epicondylitis pain site
Late Dz sign= PIN pain/difficulty w/ thumb/finger extension

Pronator Syndrome
Vague Sxs
Pain w/ pronator movement/resistance

65
Q

What is done during PE for elbow nerve compression issues?

What imaging/tests can be done for nerve issues in the elbow?

A

Neurovasular tests
Tinels signs
Resisted pronation

Electomyographic/nerve conduction velocity study

66
Q

What are the long term adverse outcomes of nerve compressions in the elbow?

How are some rarely Tx?

A

Dec strength/sensation

Ulnar- OT/avoidance of compression, surgical relocating nerve to anterior elbow
Radial/Median- OT, surgical release

67
Q

When do elbow nerve compression cases need to be referred to Ortho?

A

Weakness, Inc numbness, Persistant Sxs

68
Q

Distal Bicep Tendon Rupture

A

Inserts on radial tuberosity, rupture is proximal to insertion

Older PT who shouldn’t be curling but w/ more pain than proximal rupture
X-ray, MRI ASAP
Greater loss of supination/flexion movement
Tx w/ surgery
Adv: radial nerve injury, heterotrophic ossification across interosseous membrane between radius/ulna (bony bar)
Refer everyone

69
Q

Ulnar collateral ligament tear

A

Located on medial elbow
Connects humerus medial condyle to tubercle between coranoid/olecranon
Avoids valgus stress- throwing stabilizer
Pain w/ palpation/valgus stress w/ 30* flexion
Xray, MRI
Adv= dec ROM
Tx, non-surg= rest, RICE, NSAID, PT
Tx, surg= competitive athlete w/ Tommy John procedure

70
Q

Wrist arthritis causes

4 labs to be ordered

A

Secondary OA
RA
Psuedogout
Primary OA

ESR
Rheumatoid factor
Antinuclear Abs
Uric acid
Lyme Dz
71
Q

When are wrist arthritis cases referred to ortho?

A

Non-surgical Tx failure

Septic arthritis

72
Q

Carpal Tunnel

A

Entrapment of medial nerve, most common nerve compression neuroapthy
Occurrence during pregnancy= bilateral, self resolving
PE- thenar atrophy, Reverse/Phalens, Carpal compression, Tinels
Test- electric conduction velocity
Tx- splint, education; surgery= carpal tunnel release
Refer= fine motor loss, neuropathy, near constant Sxs

73
Q

de Quervains Tenosynovitis

A

Lateral wrist pathology w/ pain during ulnar deviation
Seen in mothers w/ young kids from picking them up
PE- TTP @ 1st dorsal compartment, proximal to snuff box, + FInklestein test (pain at radial styloid)
Tx- thumb spica cast, surgical nerve release

74
Q

Ganglion cyst of the wrist

A

Most common soft tissue tumor of the hand, most commonly at center of dorsal wrist, second most common site- volar surface near median nerve/radial artery
Hand- A1 pulley on palmar side
Finger- DIP/PIP called mucus cyst
Transilluminates but reqs MRI prior to surgery
Tx- aspirate, surgery (never aspirate finger cyst)
Adv Tx: recurrence, neurovascular damage, loss of extension
Refer: abnormal location, failed aspriation, septic joint

75
Q

Kienbock Dz

A

Osteonecrosis of lunate bone due to trauma, presenting w/ TTP and dec grip strength
Xray shows sclerosing/focal density of lunate bone

IPAP (212 decks)

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