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Ortho Block 2 Cram Flashcards

1
Q

Define the 6 types of AC joint sprains

A

1- ligament sprain

2- joint widening w/ less than 100% elevation of AC joint

3- 100% superior displacement clavicle w/ inc CC interspace

4- superior and posterior clavicle displacement

5- 100-300% superior displacement clavicle w/ increased CC interspace

6- distal clavicle is in subacromial/subcoracoid space from arm abduction during injury causing clavicle to get stuck under short head of bicep

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2
Q

What images are ordered for AC joint injuries?

What are the adverse outcomes of this injury?

A

Bilateral AP to confirm Type 2-6
Weighted bilateral for Type 1-2

Deformity
Weakness
Pain
Numbness

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3
Q

What are the 4 types of shoulder arthritis?

A

Primary- age w/out trauma/Fx
Secondary- Hx of trauma/Fx
Rhematoid- bilateral, multiple joints across midline
Crystaloid- unicorn of shoulder

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4
Q

Define Shoulder arthritis

What type of ostephyte is associated w/ shoulder arthritis?

A

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

Goats beard- inferior spur in glenoidhumeral ligament

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5
Q

What will be seen on x-rays of shoulder arthritis?

Superior migration of the humeral head develops in associated w/ ? which leads to ?

A

Flattened humeral head
Inferior osteophyte
Posterior glenoid erosion
Superior migration

Rotator cuff tears
Causes loading of glenoid leading to rotator arthropathy

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6
Q

What would be seen on x-ray of RA in the shoulder?

How are shoulder arthritis cases Tx non-surgically?

A

Periarticular lesions
Osteopenia
Central glenoid wear

RICE, NSAID, Heat/Ice
CCS injection w/ posterior approach, max of 3

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7
Q

What are adverse outcomes of shoulder arthritis surgical Tx?

When are they referred to Ortho?

A

Thrombophlebitis
Emoblus

Intolerable pain
Dec functional range of motion after 3mon of non-surg Tx

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8
Q

What is the most common MOIs of transient brachial plexy?

A

Upper/middle trunks (C5-7): Traction force on shoulder w/ head tilted to opposite direction
Post-ganglionic

Lower trunks (C8-T1):
Nerves stretched w/ arm abducted/ hanging
Pre-ganglionic, poor prognosis

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9
Q

What is a unique finding of pre-ganglionic brachial plexy?

What is the cornerstone of an accurate diagnosis of Burners/Stingers?

A

Horners- ipsilateral myosis, anhidrosis, enophthalmos

Neuro exam

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10
Q

What type of images are ordered for burners/stingers?

What unique presenting Sxs can post-ganglionic burner PTs present w/ ?

A

X-rays of C-spine and shoulder girdle

Painful rhomboids and anterior serratus muscles

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11
Q

What is the first step to management of PTs w/ burners presenting with bilateral upper/lower extremity radicular Sxs?

What are 4 things required prior to a person returning to sports/duty after having a burner?

A

Treat as spinal cord injury until proven otherwise

Resolution of pain/neuro Sxs
Normal neuro exam
Full cervical ROM

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12
Q

How are brachial plexus burners Tx non-surgical

What additional study could be ordered to assess nerve function?

A

Strength/stretch
Splint to maintain PROM

Nerve conduction study:
Electromyogram- motor function
Velocity- tests speed of signals

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13
Q

What do recurrent episodes of burners/stingers suggest?

What are the adverse outcomes of this condition?

A

Cervical stenosis
Inc risk for spinal cord injury

Pain
Sensation loss
Weakness
Amputation

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14
Q

What is an indication to refer a PT w/ a burner/stinger to Ortho?

Frozen shoulder is AKA ? and defined as ?

A

Worsening neuro Sxs

Adhesive capsulitis
Idiopathic (non-traumatic) loss of A/PROM

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15
Q

What is the are most common risks of adhesive capsulitis?

Where is the pain located for these PTs?

A

Type 1 DM
Hypothyroid
Dupuytren Dz

At deltoid insertion

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16
Q

How is Frozen Shoulder movement limitations different than arthritis limitations?

What term is pathognomonic of this condition?

A

Worse w/ external rotation

Contracture of coracohumeral ligament which limits external rotation

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17
Q

What findings would be see on MRI of a frozen shoulder?

How are these cases Tx nonsurgically?

A

Contracted capsule
Loss of inferior pouch

NSAID, heat, stretching

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18
Q

How are frozen shoulders Tx w/ surgery?

How long does it take for a shoulder to freeze and release?

A

Arthroscopic capsule release

Freeze in 48hrs
Thaw in 6-24mon

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19
Q

What happens to frozen shoulder PTs who take therapy too aggressively?

When do these PTs need to be referred?

A

Fx of humerus

No pain/movement improvement after 3mon

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20
Q

What muscle is the primary raiser of the arm?

This muscle is pulled under what structure during movement?

A

Supraspinatus

Under coracoacromial arch

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21
Q

What are the two causes impingement?

Where do these PTs have their pain localized to?

A

Loss of blood supply and mechanical damage

Lateral shoulder under acromium
Worse w/ abduction between 90-120* and lowering arm

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22
Q

PTs with impingement usually have what 3 positive tests during PE?

These 3 tests only indicated there’s an issue where?

A

Neers, Hawkins, Jobes

Supraspinatus

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23
Q

What tests are done during PE to differentiate between impingement, rotator cuff or AC joint origin?

What is the goal of PT for these PTs?

A

Drop arm- r/o rotator
Cross arm- r/o AC joint

Perform overhead movements w/out pain

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24
Q

What is the non-traumatic trifecta leading to rotator cuff tears?

What type of motion changes will be seen?

A

Degeneration, impingement, dec blood supply

Normal PROM, dec AROM

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25
Q

How quickly do traumatic rotator tears need to be surgically repaired?

PTs w/ rotator cuff tears will have pain localized where?

A

W/in 6wks

Insertion of supraspinatus on lateral arm

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26
Q

What are the goals of PT for rotator cuff tears?

The term ‘torn rotator cuff’ includes a tear to what 2 muscles?

A

Reduce pain
Inc strength, ROM
Restore function

Supra and Infraspinatus

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27
Q

Acute roator tears are often associated with a ? tear

When are these PTs referred to Ortho for surgery?

A

Splitting- parallel to tendon fibers

Acute tears, less than 6wks

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28
Q

What type of PT is more likely to have a proximal bicep tear?

Where will these PTs have TTP?

A

Older w/ rotator cuff dz

Over bicep groove

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29
Q

What movement can be done to accentuate proximal bicep tendon tears?

What is an adverse outcome of this condition?

A

Ludington test

Loss of 10% of elbow flexion/forearm supination (screwdriver)

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30
Q

When are PTs with proximal bicep tendon tears considered for surgery?

Which head of bicep is the long/short head?

A

Under 40y/o athletes
Older PT w/ concomitant rotator tear and persistent Sxs

Lateral- long
Medial- short, attaches to coracoid

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31
Q

What image is ordered after a + Lundington test?

Where is a ruptured proximal bicep tendon screwed back into the arm during surgery?

A

MRI ASAP

Distal to surgical neck of humerus

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32
Q

What are the most common directions of shoulder dislocation?

What does TUBS and AMBRI stand for?

A

Anterior and Multidirectional

Traumatic Unidirectional Bankart lesion Tx w/ surgery

Atraumatic, Multidirectional, Bilateral, Rehab preferred, Infierior capsule shift

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33
Q

Bankart lesion is a tear of ?

How is the arm placed in order for a posterior dislocation to occur?

A

Anterior glenoid labrum

Adduction and internally rotated

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34
Q

PTs that can voluntarily dislocate shoulders are indicative of ?

Subluxation of the shoulder is more associated w/ ?

A

Multidirectional instability
Poor surgical Tx prognosis

AMBRI

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35
Q

What nerve needs to be assess before and after shoulder dislocation/reductions?

What type of force creates a Hill-Sachs lesion?

A

Axillary- assessed for deltoid dysfunction and lateral arm numbness

Compression Fx from posterior humeral head pressing on anterior edge of glenoid

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36
Q

Ant, Post, Inf disloactions are associated w/ ?

What are the adverse outcomes from this type of injury and who is more likely to have this outcome?

A

Ant- most common
Inf- multi-directional instability
Post- seizure, shock

Axillary dysfunction
Osteoarthritis
Persistant dislocation- younger PT or w/ multiple episodes

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37
Q

What kind of x-rays are ordered to assess shoulder dislocations?

First time dislocations are Tx ?

A

Scapular Y-views

3wk immobilization in neutral rotation
PT w/ supraspinatus strengthening

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38
Q

How should PTs w/ AMBRI be Tx?

When do these PTs need to be referred to Ortho?

A

Nonsurgical w/ aggravation avoidance

Two or more dislocations inside of 3mon of shoulder rehab program
Intolerable multi-directional Sxs

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39
Q

What makes the bicep anchor?

What tests are done during PE for suspected SLAP tears?

A

Long head tendon confluency w/ labrum at superior glenoid labrum

Speeds
Resisted Supin/Rotation

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40
Q

What is the gold standard for viewing SLAP tears?

How are they Tx non-surgically?

A

MRA w/ gadolinium

NSAID
Rotator/periscapular stabilization
Capsule stretches
Strengthening

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41
Q

What is the only surgical option for SLAP tears that don’t respond to non-surgical Tx?

What is the most common outcome of Tx?

A

Dx shoulder arthroscopy

Shoulder stiffness

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42
Q

What can cause TOS?

This can present mimicking ?

A

Compression of brachial plexus/subclacian vessels from cervical rib, large C7 transverse process, anomalous fibromuscular band

Ulnar nerve entrapment w/ paresthesia of little/ring finger

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43
Q

What images are ordered for TOS?

What are two rare outcomes of this syndrome?

A

AP/Lat- assess ribs/processes
PA/Lat- r/o apical tumor/infxn

Ulcers
Raynaud’s

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44
Q

What types of activities need to be avoided when Tx TOS at home?

What are the 4 types of arthritis in the elbow?

A

Avoid overhead activities
Strenuous aerobics
Sleeping on affected side

Primary OA- age
Secondary OA- trauma/Fx
Rheumatoid- most common cause of elbow destruction
Crystaloid- gout/pseudogout

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45
Q

Most PTs with rheumatoid elbow arthritis will also have ?

Which one will present with swelling and warmth?

A

Bilateral shoulder, wrist, and hand in 90% of PTs

Non-rheumatoid inflammatory arthritis

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46
Q

If effusions are present in elbow arthritis, what are they aspirated and tested for?

How is RA of the elbow Tx?

A

WBC, Culture, Gram, Crystals

DMARDs
CCS injections
Rehab/Surgery

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47
Q

What will be seen on x-ray of Primary OA in the elbow?

What will be seen x-ray of RA in the elbow?

What will be seen in crystaline arthropathy?

A

Narrowed joint space
Sub- chondral cyst
Articular bone spur

Osteopenia
Erosion at bone margins at synovium

Sub-chondral erosion
Peripheral bone spurs

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48
Q

What are the primary reasons to refer elbow arthritis PTs to Ortho?

What muscle originates at the site of Lateral Epicondylitis?

A

Loss of ability to self care/daily activity completion

Extensor Carpi Radialis Brevis

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49
Q

How do PTs w/ lateral epidcondylitis present?

How do PTs present w/ medial epicondylitis?

A

Pain in lateral elbow with gripping and wrist extension

Pain in medial elbow w/ wrist flexion and forearm pronation

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50
Q

What are the non-surgical Tx options for epicondylitis?

What mis-diagnosed nerve entrapment syndromes can lead to surgical Tx failures of epicondylitis?

A

Modify/stop movement is most important
Protein Rich Plasma injection w/ buffy layer
Dry needling

PIN w/ lateral
Ulnar w/ medial

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51
Q

What are the 4 stages of humeral epicondylitis Tx?

What is the most common adverse outcome of surgical Tx?

A

Reduction of overload
Promotion of strength
Return to activity
Maintenance

Incomplete pain relief

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52
Q

What is the difference in Tx of Medial and Lateral epicondylitis?

Why is the olecrananon easily irritated and inflamed?

A

Medial Txs done by Ortho

Superficially located on extensor side of elbow

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53
Q

How are different size olecranon bursitis cases Tx?

A

Small/mild Sxs- NSAID, activity modification

Sxs- aspiration for Dx and therapeutic relief

Non-septic- elastic compression bandage

Septic- ABX w/ PCN resistant Staph A coverage and decompression

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54
Q

When do olecranon bursitis cases need to be referred?

Define the Cubital Tunnel

A

Recurrence w/ 3 or more drainage

Passage of the ulnar nerve on the posterior side of medial epicondyle between humeral and ulnar heads of flexor carpi ulnaris muscle

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55
Q

Define the Radial tunnel

Define Pronator Syndrome

A

Spit of radial nerve at lateral elbow, most common is PIN compression

Compression of median nerve at elbow

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56
Q

What are the top two most common nerve entrapments of the upper extremity?

What can cause ulnar palsy?

A

Carpal tunnel syndrome
Ulnar nerve compression

Repetitive subluxation or dislocation of ulnar nerve on elbow flexion

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57
Q

PIN causes ? Sx and is commonly mis-Dx as ?

What does the PIN innervate?

A

Lateral elbow pain
Lateral epicondylitis

Thumb, finger, extensor carpi ulnaris

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58
Q

Where is the PIN most commonly compressed and what usually compresses it?

What causes Pronator syndrome to be Dx late?

A

Fibrous bands between supinator muscle heads of radial tunnel

Vague Sxs
Frequently w/ workers com claims

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59
Q

What is the most common cause of Cubital Tunnel Syndrome?

What are two common causes?

A

Hyperflexion of elbows

Sleeping on elbows
Resting arm while driving for long periods

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60
Q

How is radial compression Sxs different than lateral epicondylitis Sxs?

What is a late Dz issue?

A

Radial compression TTP distal to condyle

Weak extension of fingers

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61
Q

What tests are done when evaluating median nerve compression?

What Sxs will not be associated w/ this compression syndrome?

A

Pronation movements

Nerve is motor only, no numbness/tingling

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62
Q

What special tests are done for nerve compression syndromes of the elbow?

What further studies can help differentiate these?

A

Tinels
Elbow flexion test
Middle finger resistance test for radial tunnel

Electromyographic/conduction study

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63
Q

What is the most important step of elbow nerve compression syndrome Tx?

When are PTs w/ ulnar compression syndrome referred for surgery?

A

Modifying activities/reducing pressure

Bothersome Sxs after 3-4mon of non-surgical Tx

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64
Q

When are PTs w/ radial/pronator compression syndromes referred for surgery?

What are the red flags for referral of the compression syndromes?

A

Discomfort after 3-6mon of non-surgical Tx

Weakness/atrophy of intrinsic muscles
Inc numbness
Persistent/debilitating Sxs

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65
Q

What are the adverse outcomes of a distal bicep tendon rupture?

What PTs are not Tx w/ surgery?

A

15% loss of strength
50% loss of supination

Older/sedentary lifestyle not requiring flexor/supinator strength

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66
Q

What are the adverse outcomes of distal bicep tendon rupture surgical Tx?

How quickly does surgical repair have to be done?

A

Damaged radial nerve
Hetertropic ossification
Chronic pain

1-2wks from injury

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67
Q

What is the primary elbow structure that resists valgus stress?

What is a common Sx seen?

A

Ulnar collateral ligament

Paresthesia along ulnar nerve during throwing motion

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68
Q

What PE finding during assessing ulnar collateral ligament tear can mislead to a Dx of Primary Ulnar Neuritis?

What imaging is used for Dx?

A

+ ulnar nerve Tinel sign

MRI w/ contrast

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69
Q

What is a rare adverse outcome of an ulnar collateral ligament?

What Otho Tx step needs to be avoided?

A

Hindered daily living

UCL tear

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70
Q

What is the name of the procedure used to correct a torn UCL?

What is the most common cause of wrist arthritis?

A

Tommy John

Previous trauma- Fx
RA

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71
Q

Typical OA findings of wrist arthritis

What would be seen w/ RA?

A

Joint narrowing, subchondral sclerosis, bone spurs

Osteopenia, Erosion at capsule

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72
Q

What is a unique lab ordered when working up wrist arthritis depending on geography?

What lab tests are done to test for RA in the wrist?

A

Lyme Dz titer

ESR, Rheumatoid factor, Anti-nuclear Abs, Uric acid

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73
Q

When are wrist arthritis PTs surgical candidates?

When are these PTs referred for red flags?

A

Dec hand function
Unstable joint
Failed non-surgical Tx

Infection in wrist
Advanced Dzs
Non-surgical Tx failure

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74
Q

What is the most common compression neuropathy of the upper extremity?

What are common precipitating issues that can lead to this common syndrome?

A

Carpal tunnel syndrome

Tenosynovitis of adjacent flexor tendons
Pregnancy (bilateral)
DM
Thyroid dysfunction

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75
Q

How do PTs w/ carpal tunnel present?

What is the most useful Dx test but is rarely used?

A

Numbness in thumb, index, long finger
Pain worse at night
Thenar atrophy

Electophysiologic testing

76
Q

What tests can be done during PE for carpal tunnel?

Define de Quervain tenosynovitis

A

Reverse/Phalen test
Carpal compression test
Tinel’s

Swelling of sheath around abductor pollicis longus and extensor pollicis brevis

77
Q

How is de Quervain tenosynovitis Dx’d?

What images need to be done?

A

+ Finklestein test

PA/Lat x-ray to r/o radial styloid deformity

78
Q

How is de Quervain tenosynovitis Tx non-surgically?

What is the most common soft tissue tumor of the hand?

A

Splint- forearm/thumb spica
NSAID
CCS injection- max of 3

Wrist ganglion

79
Q

What type of fluid is inside of ganglion cysts?

What is a key factor to distinguish a ganglion from other soft tissue tumors?

A

Thick, clear, mucinous identical to joint fluid

Variation in size

80
Q

Where do mucus cysts usually grow?

What is the most common site for ganglions to grow?

A

Extensor tendon at DIP

Palmar side near A1 pulley near MCP joint

81
Q

When is a MRI ordered for ganglion cysts?

Define Kienbeck Dz

A

Volar cyst near radial nerve/artery and prior to surgery

Osteonecrosis of lunate, usually in men 20-40y/o

82
Q

What type of ganglion cyst should never be aspirated?

How do PTs w/ Kienbeck Dz present?

A

Dorsal cysts on fingers

Inability to grasp heavy objects
Stiffness/swelling

83
Q

What will be seen on x-rays early/late in Kienbock Dz?

What imaging is usually used to stage the Dz?

A

Early- inc density (white)
Late- fragmentation/collapse of bone

MRI

84
Q

When are Kienbock wrists splinted for Tx?

What is the top 3 most common benign soft tissue tumors?

A

Normal radiograph/significant sclerosis w/ NSAIDs

Ganglia, Giant Cell tumor, Epidermal inclusion cyst

85
Q

What is the most common benign neoplasm of the hand bones?

What is the most common malignant neoplasm of the hand?

A

Enchondroma- cartilage didn’t change into bone development

Squamous cell carcinoma

86
Q

What are the most common primary malignant bone tumor of the hand?

Where/why are malignant melanomas seen?

A

Chondrosarcomas

Upper arm from sun exposure

87
Q

Most tumors of the hand are painless w/ ? exception?

How can you differentiate ganglions, inclusion, giant, glomus cysts on PE?

A

Glomus tumor- pain w/ pressure or cold

Ganglion- transilluminate
Inclusion- swelling/white tuft at end of finger
Giant- firm, non-tender at IP joint of first 3 fingers
Glomus- finger nail changes

88
Q

Where are lipomas most commonly seen?

Where are enchondromas most commonly seen?

A

Thenar emminence

Proximal phalynx associated w/ patholgical Fx

89
Q

Where would a carpal boss be seen?

What types of x-rays need to be ordered for hand/finger masses?

A

Immovable mass on dorsal hand

PA/Lat- finger
PA/Lat/Oblique- hand

90
Q

When do PTs w/ hand masses need to be referred?

What usually causes ulnar entrapment of the hand?

A

Painful/expanding mass
Interferes w/ function
Pigmented subungual lesion

Lipoma, ganglion, ulnar artery aneurysm or muscle anomaly

91
Q

What is the path of the ulnar nerve through the hand?

What is innervated from this nerve?

A

Wrist, past psiform, under hamate hook and branches to senosry/motor branch

Sensor- to pinkly
Motor- thenar muscles

92
Q

What special test is done during PE of ulnar nerve entrapment?

What are the most common animal bites but which ones are more likely to cause infection?

A

Allen’s test

Dog, then cat
Cat causes more infection due to deeper/sharper injury

93
Q

What type of microbe is most commonly associated with dog/cat bite infection?

What are the other microbes that can cause an infection?

A

Pasteurella multocida

A-hemolytic strep
Staph A
Anaerobics- Bacteroides and Fusobacterium

94
Q

If an animal bite presents w/ purulent drainage, this indicates the bite is at least ?hrs old

What makes dog or cat bites characteristic?

A

10-12hrs

Dogs grab and tear
Cats puncture and let go

95
Q

Red streaks seen days after an animal bite indicate ?

What lab tests are usually ordered for animal bites?

A

Lymphangitis

CBC, ESR, CRP, Gram stain, Culture

96
Q

How are animal bites that don’t have nerve, tendon or bone injury managed?

How are bites on a finger managed?

A

Debridment, Irrigate w/ 500-1000mL NS, out patient ABX

Anesthetic block for debridement

97
Q

How are animal bites on the back of a hand managed?

What is the standard ABX for animal bites?

A

3-10mL of anesthetic infiltrated into the wound

Amoxicillin-Clavulanate 875mg PO BID

98
Q

What IV ABX are used for infected animal bites?

When are PTs w/ animal bites referred?

A

Empiric IV ampicillin sulbactam 1.5-3g q6hrs

Tendon, nerve, joint capsule or Fx

99
Q

What are the most common causes of arthritis of the hand and wrist?

What would be seen on on x-ray for the 2 major ones?

A

2* OA from FxHx
RA
Pseudogout
1* OA- dec ROM, pain, swelling

OA- Narrowing, Spurs, Sclerosis
RA- Osteopenia, erosion @ capsule/bone margin

100
Q

When are wrist arthritis PTs T non-surgical and surgical/red flag referred?

What lab tests can be done to confirm a Dx of hand arthritis?

A

Non Surg= splint
Surg- dec function, unstable joint, non-surg failure
Red- infection, advanced degeneration, splint/NSAID Tx failure

ESR, CRP, RF, Anti-nuclear Ab, Anti-cyclic Citrulinated peptide Ab

101
Q

What meds can be used for hand RA?

What joints are more likely impacted by OA and RA?

A

NSAID
Etanercept/Infliximab
CCS injections

OA: DIP, PIP, CMC
RA: wrist, MCP

102
Q

What PT population is more likely to have thumb CMC arthritis?

What is the most common Sx they present with?

A

Female 40-70y/o

Opposition: pain at base of thumb w/ grip/pinch activities

103
Q

What is the hallmark of thumb CMC arthritis?

What test can be done during PE for this?

A

Tenderness over palmar/radial joint aspects

Grind test- palm facing up and back of hand on table, thumb is pushed down with other joints extended

104
Q

How are thumb CMC cases Tx non-surgically?

Define Boutonniere deformity

A

NSAID
Spica cast
OT

Central portion of extensor tendon rupture at insertion in middle phalynx causing PIP to extend/DIP hyperflex

105
Q

What PE finding is indicative of a rupture of the central slip of the extensor tendon?

What movement will accentuate/worsen the deformity

A

PT lacking 15-20* extension at PIP

Palm closer to volar surface (wrist flexion)

106
Q

What is the adverse outcome of an untreated Boutonniere?

How are these Tx non-surgically?

A

Flexion contracture of PIP and extension of DIP joints

Young PT- splint extended x 6wks
Older PT- splint extended x 3wks

107
Q

Define Dupuytren contracture

Since this is usually a dominant genetic issue, who is it seen in?

A

Nodular thickening/contraction of palmar fascia

Northern European men +50y/o in the ring finger

108
Q

What are the associated risk factors with a Dupuytren contracture?

How are they Tx?

A

DM, Epilepsy, Pulmonary Dz, Alcoholism, Vibration trauma

Splints will slow progression
Collagenese injections is FDA approved Tx

109
Q

When are Dupuytren cases considered for surgery?

What are the 3 fingertip infections?

A

30* flexion of MCP towards palm
10* deformity of PIP

Both in pulp of finger:
Felon- bacteria infxn
Whitlow- viral infxn

Paronychia- either side of nail

110
Q

What usually causes fingertip infections?

Why is correctly identifying felons/whitlows important?

A

Staph Aureus
Whitlow- HSV

I&D of whitlows are c/i
I&D of felons is recommended

111
Q

What preceding factor usually causes the development of a paronchyia?

Felons and paronchyia usually have what 3 Sxs with them?

A

Manicure or hangnail

Tender, Red, Fluctuance

112
Q

Felons and paronchyia usually stop at the distal digit crease, but if they pass that crease what issue is considered?

Felons can be drained w/ block and tourniquet through what 2 types of incisions?

A

Infectious flexor tenosynovitis

Central volar longitudinal
Dorsal midaxial
UNLESS- puncture causing the felon is in the finger pulp, then incision includes puncture hole

113
Q

How are finger amputations in kids under 6y/o managed?

When is replantation a consideration?

A

Composite grafting w/ 4 or 5 chromic/plain gut sutures

Thumb amputation at/proximal to IP joint
Amputation proximal to middle of middle phalanx
Multiple fingers amputated

114
Q

What two injuries immediately cause a loss of flexion in PIP and DIP?

Where doe the flexor tendons of the fingers insert and what kind of movement is allowed if one is cut?

A

Flexor digitorum sublimis
Flexor digitorum profundus

FDP in distal phalanx
FDS in middle phalanx
Cut FDP= PIP, MCP flexion
Cut FDS= DIP, PIP, MCP flexion

115
Q

What happens in the traumatic rupture of the FDP in a finger?

These ruptures are often missed because they resemble ?

A

Ring finger caught and profundus tendon avulses from insertion

Jammed finger

116
Q

What is the first and second test done during assessment of a flexor tendon injury?

Flexor tendons of the fingers are enclosed in sheath that extends from ? to ?

A

Active flexion
Strength of flexion

Distal palm
DIP

117
Q

What tracking method is used for flexor tendon infections?

A 
Kanavel signs
1- swollen finger (sausage digit)
2- held in passive flexion
3- pain to percussion/palpation of sheath
4- pain w/ passive extension
118
Q

What kind of ABX are used for flexor tendon infections?

What microbe is most common in human bite infections?

A

Staph and Strep coverage

Eikenella corrodens
A-hemolytic strep
Staph A

119
Q

If drainage is present in a human bite wound, what needs to be collected for lab?

What procedure is done if there is a possibility of joint infection?

A

A/naerobic cultures, WBC, ESR, CRP

Arthrotomy to irrigate

120
Q

What type of ABXs should be sued for human bite infections?

Define Mallet Finger

A

PCN, 1st Gen Cephalosporins

Deformity of insertion of extensor tendon at base of distal phalynx causing PT to present w/ resting in flexed position and lack of extension

121
Q

When are Pts w/ mallet finger referred to Ortho?

A

Subluxation of joint, suggesting collateral ligament involvement
Avulsion Fx larger than 1/3 of surface area of distal phalynx

122
Q

How are subungual hematoma, nail bed lacerations and nail avulsions Tx?

A

Subungual- decompression
Bed- only remove nail if it’s floating and ready for removal
Avulsion- replace and suture in place through poximal fold to pull nail bed through

123
Q

When do nail bed injuries need to be sent to ortho?

Trigger finger is AKA ?

A

Complex lacerations, Loss of tissue, Injury to germinal matrix, Open Fx

Stenosing tenosynovitis of flexor tendons

124
Q

What causes trigger finger?

What are these often seen in conjunction with?

A

Thickening of flexor tendon near A1 pulley most commonly of long/ring finger

Middle aged women w/ RA*, DM, Hypothyroid
Higher association w/ Carpal tunnel and De quervains

125
Q

What finger do kids develop trigger finger?

If they develop trigger finger anywhere other than this finger it’s usually due to ?

A

Thumb

Metabolic d/o

126
Q

What happens during the creation of a nurse maid elbow?

What is done during PE?

A

Axial pull on radius
Radius head pulled out from annular ligament
Annular ligament becomes trapped in radiocapitellar joint

Neurovascular
Pronation/supination
TTP

127
Q

How are nurse maid elbows reset?

Define Congenital Deficiency
Define Congenital Deformity

A

Full supination
Push on radial head medial
Flex hand to head

Ficiency- missing parts (hypoplasia, congenital d/os)
Formity- psindactyle,

128
Q

Define Little League elbow

Define Osteochondritis dissecans

A

Traction apophysitis of medial epicondyle/olecrenon

Osteonecrosis of capitellum, rarely the radial head

129
Q

Define Panner Dz

What imaging modality is used to confirm OCD, Panner or UCL injuries?

A

Under 12y/o w/ focal avascular lesion of capitellum

MRI

130
Q

Neonatal brachial plexus palsy is AKA and what is the most common pattern?

What type of movement issues are seen?

A

Obstetric palsy
C5-6 Erbs Palsy

Weak elbow flexion, shoulder abduction, flexion and external rotation

131
Q

Define Klumpke Palsy

PTs with this have poor prognostic factors that include ?

A

Neonate brachial palsy at C8-T1

Entire plexus
Horner (preganglionic, sympathetic)
Root avulsions

132
Q

What happens during Torticollis?

What can cause ocular torticollis?

A

SCM contraction pulls head to affected side and rotated to unaffected side
Mandibular flattening on affected side
Occipital flattening on unaffected side

Nystagmus
Superior oblique palsy

133
Q

What is the most common bony injury?

What type of x-ray is needed to confirm this?

A

Clavicle Fx

AP and 10* cephalic

134
Q

What type of image is needed to confirm Fx/dislocations of the medial end of clavicles?

How are most midshaft clavicle Fx treated?

A

CT

Non-surgically

135
Q

What type of PT exercises are started with clavicle Fx?

When are these Fxs referred for surgery?

A

Pendulum swings at 2wks

Shortened
Open
Neurovascular compromise
Painful nonunion at 4mon

136
Q

What nerve is injured with Fx of humerus?

How many degrees of angulation is acceptable for non-surgical Tx?

A

Radial- inability to extend wrist/fingers, loss of sensation on back of hand at first dorsal web space

Less than 20* of apex anterior/lateral angulation
Less than 2cm of shortening w/ U-shaped coaptation splint

137
Q

Define Floating Elbow

PTs in a Sarmiento Splint need to have what education piece upon release?

A

Distal humerus Fx
Proximal forearm Fx

Sleep upright, will feel sensation of suffocation if not upright

138
Q

When are humeral Fxs referred to ortho?

What are the 4 segments of a proximal humerus Fx?

A

Non-union at 3mon

Greater tuberosity- supra, infra, teres minor
Lesser tuberosity- subscapularis attachment
Humeral head
Shaft

139
Q

What is the most common Fx of the proximal humerus?

How does these Fx usually occur?

A

Two part Fx of the surgical neck, distal to tuberosities

Motion w/ torsion

140
Q

What unique view of x-ray is needed for proximal humerus Fx?

How are these type of Fxs Tx?

A

Scapular Y-view

Sling for full 6wk healing period
ROM at 3wks

141
Q

When are proximal humerus Fxs Tx non-surgical?

When are these Tx w/ surgery?

A

Less than 1cm displaced

> 1cm of displacement
45* of angulation

142
Q

When are proximal humerus Fxs referred to ortho?

What are scapula Fxs associated w/?

A

Displaced 2 part Fxs
All 3 and 4 part Fxs

Polytrauma due to high energy MOI

143
Q

Injuries to the Superior/Lateral aspect of the scapula need to go to ? for assessment?

How are they Tx?

A

CT

Sling and ROM at 1wk

144
Q

What type of scapula Fx has the PT admitted for observation?

When are scapula Fxs Tx w/ surgery?

A

Body Fx

Displaced >2mm of articular step off
Neck of scapula w/ >30* angulation
Acromiom Fx w/ impingement

145
Q

What are the most common elbow dislocations?

What structure is always torn?

A

Posterolateral

LCL

146
Q

What is the terrible triad of the elbow?

What is the MOI for these injuries?

A

Radial collateral ligament
Dislocation
Coronoid/radial head Fx

FOOSH w/ elbow partially bent

147
Q

What step must be done after elbow dislocation reduction?

What position are these arms splinted in after reduction?

A

CT to assess coronoid

Elbow 90* w/ arm fully pronated

148
Q

If there are no Fxs/Terrible Triad, how long after elbow dislocations can they start PT?

When are these PTs referred to Ortho?

A

1wk

Terrible triad
Instability
Neurovascular injury

149
Q

What are the 3 landmarks of the lateral elbow for introducing needles?

Which bone is screwed when surgically correcting a Terrible Triad?

A

Radial head
Lateral epicondyle
Tip of olecranon

Coronoid

150
Q

What is a bad type of elbow Fx to occur in Peds?

How is this Fx assessed and cleared?

A

Supracondylar Fx

Bilateral x-rays w/ normal arm used for assessment

151
Q

What step do all PTs w/ distal humerus and olecranon Fxs receive?

What is the MOI for olecranon Fxs?

A

Refer to Ortho

Fall onto flexed elbow

152
Q

PTs w/ olecranon Fxs will get repeat x-rays to assess the amount of tricep pull every ? days?

How are these PTs Tx non-surgically?

A

1-2

Splinted w/ elbow at 45*
ROM at 2-3wks

153
Q

What is the classification system used for Fx of radial head?

A

Mason
1- non displaced
2- >2mm displaced or angled enough to create mechanical block
3- severely comminuted Fxs of radial head and neck

154
Q

Define a Lessex Lopresti Fx

What x-ray view is used to view the radial head?

A

Proximal radial head Fx dislocation down interosseous membrane to distal radial/ulnar joint w/ medial ulnar dislocation/deviation

Greenspan

155
Q

When are radial head Fxs referred for surgery?

Define a Bennett Fx
Define a Rolando Fx

A

Mechanical block
>2mm step off at articular surface

B: oblique Fx of thumb metacarpal as it enters CMC joint w/ one small and one large piece
R: Y shaped intra-articluar Fx at base of thumb metacarpal

156
Q

What is the primary concern of Bennet/Rolondo Fxs?

What causes Hook of Hamate Fx?

A

Secondary CMC OA

Holding objects and forces hitting the object

157
Q

What PE finding is seen w/ Hook of Hamate Fxs?

What view is used on x-ray to assess the bones?

A

Ulnar compression Sxs

Carpal tunnel view

158
Q

What type of cast are used on hamate Fx?

Define Colles Fx

A

Short arm cast (no thumb component) x 6wks

Most common Fx of distal radius when distal radisu Fx fragment tilts dorsally

159
Q

Define Smith Fx

Define a Barton Fx

A

Opposite of Colles Fx
Distal radius Fx fragment tilted volarly

Fx of intra articular Fx associated w/ subluxation of carpus w/ displaced fragment of radius

160
Q

Define Chauffeurs Fx

Define a Die-Punch Fx

A

Oblique Fx through base of radial styloid

Depressed Fx of articular surface opposite the lunate/scaphoid bone

161
Q

When are Fxs of the distal radius sent for surgery?

A

> 5* dorsal angulation
15* radial angulation
2mm articular step off

162
Q

Define Boxers Fx

What Fx is this the most common of?

A

Fx of distal end of 5th metacarpal

MC Fx of hand

163
Q

What type of phalangeal Fx is the most commonly injured?

When are Boxer’s Fxs sent to surgery?

A

Distal

> 40* angulation

164
Q

When are metacarpal Fxs sent to surgery?

A

Multiple Fxs
Shortening
Intra-articular Fx >1mm
>40% of articular surface involved

165
Q

Where are the 3 scaphoid Fxs more likely to occur?

This is the most common ? Fx

A

60%- waist/middle
20% at proximal/distal pole

Carpal Fx

166
Q

Since scaphoid Fxs are usually occult, when do they f/u?

What is done if they’re f/u is normal but w/ pain?

A

7-10 days for x-rays

Spica thumb cast

167
Q

What is Gamekeeper’s Thumb

What is it AKA?

A

Torn thumb ulnar collateral ligament from hyper extension

Skier thumb

168
Q

How are hand collateral ligement injuries Tx?

How are volar plate injuries Tx?

A

Splint/thumb spica cast x 6wks

Refer to ortho

169
Q

What is the 4 most common elbow Fxs in kids?

What bone connects w/ the radius in the elbow?

A

Supracondylar
Lateral condyle
Medial epicondyle

Capitellum

170
Q

What finding is useful for pediatric occult elbow Fxs?

When can peds elbow Fxs be treated w/ casts?

A

Posterior fat pad- hemearthrosis indication

Radial neck Fx w/ less than 30-45* angulation and kid is under 10y/o

171
Q

What type of pediatric elbow Fx requires repeat x-rays?

What is the most common type of proximal humerus Fx in peds?

A

Condylar

SALTAR 2

172
Q

How are neonatal clavicle Fxs treated?

How are proximal humerus Fxs Tx?

A

Left alone

Swath and pinned

173
Q

How are young kids w/ clavicle/proximal humerus Fxs treated?

How are adolsecents Tx?

A

Under 5, <70*
5-12, 40-70*
+12, <40*

More than 2cm shortening= surgery
Humerus angulation 30-40* w/ <50% apposition

174
Q

Define Galeazzi Fx

Define Torus/Greenstick Fx

A

Distal radius Fx w/ ulnar dislocation

Fx of distal forearm

175
Q

Define Monteggia Fx

A

Radial head dislocation w/ Fx of ulna

176
Q

How are replaced finger nails post-sutures wrapped and wound cared?

Flexor tendons of the fingers glide under ? annular and ? cruciform pulleys which keep them from ?

A

Ointment, non-adhesive gauze, sterile gauze, splint

4A, 3C
Keep tendons from bowstringing

177
Q

What digits are more likely to be affected by trigger finger?

In pediatric UE x-rays, the radial head should be directed towards the ? on all views?

A

Ring, long

Capitellum

178
Q

What type of x-ray can be useful when searching for subtle Fxs of the UE in a Peds PT?

Kids who have a positive posterior fat pad but no evidence of a Fx only have a ?% chance of having a bony injury and need ? support

A

Comparison view of uninjured elbow

80%
Posterior long arm splint/long arm cast

179
Q

What is the most common elbow injury to kids under 5?

What can happen to the medial epicondyle in kids 8-12 compared to what can happen when they’re 12-14y/o?

A

Nurse maid’s elbow

Fragmentation: 8-12
Avulsion: 12-14

180
Q

In Peds UEs, the medial side of the humerus is AKA the ? side and the lateral side is AKA the ? side?

What is the most common physical finding in little league elbow?

A

Medial- tension
Lateral- compression

TTP

181
Q

Babies w/ brachial plexus palsy tend to have a poor prognosis if what 3 findings are seen?

What are signs that Erb’s palsy occurred at a pre-ganglionic location?

A

Panplexus palsy
Horner syndrome
Nerve root avulsion

Horner Syndrome
Phrenic nerve paralysis
Long thoracic, Dorsal scapular, Suprascapular, Thoracodorsal nerve involvement (TDSL)

182
Q

What is the cornerstone of neonatal brachial plxus palsy treatment?

What must be suspected in infants that present with sudden loss of function in an extremity that was functioning at birth?

A

Assessment and monitoring

Sepsis
Abuse

183
Q

What is the most common error when assessing a Fx of the proximal hymerus?

How are these types of Fx Tx non-surgically?

A

Missed Dx of shoulder dislocation

Less than 1cm displaced w/ sling and PT at 3wks

184
Q

When do proximal humeral Fxs need surgical repair?

A

More than 0.5cm separation of tuberosity
2 parts through humeral neck
All 3 and 4 part Fxs

185
Q

What do 4 part proximal humeral Fxs need surgery?

A

Interrupted blood supply, need prosthetic replacement

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