Ortho Block II Flashcards
Upper extremity shoulder rupture is common in what pts
Older with RTC Dz or young weight lifters/ throwers
( young more uncommon)
Popeye deformity is a sign of
Proximal biceps tendon rupture
PE findings in a proximal bicep rupture
- palpable deformity proximally
- Tenderness in the bicipital groove
- resisted bicep flexion worsens the deformity
Tx approach to Proximal biceps tendon rupture
Non op: ROM/ Strengthening
Op for young athletes/ young worker
Referral criteria for Proximal Biceps Tendon rupture
Young athletes
Young laborers
Concominant rotator cuff tear
What is the most common position for shoulder dislocation
Anterior DC is the most common
What is a TUBS instability
Traumatic, unilateral, Bankart, surgical
What is a AMBRI shoulder dislocation
Atraumatic, multi directional, bilateral, rehabilitate, inferior capsule
What are the 2 most common causes of Posterior shoulder Dislocation
Seizures and Electric shock
What are the ADE of shoulder dislocations
Axillary nerve injury
Chronic Instability
Glenohumeral OA
Posterior Dislocations present in what position
Adducted and internally rotated
What 3 test are used to evaluate shoulder instability/ dislocation
Sulcus sign (inferior) apprehension (anterior) jerk Test ( posterior)
What is the best MRI to order for shoulder instability
MRI with arthogram
Shows the Capsule, the laboral and the RTC
TX approach to Shoulder instability
NON op: acute reduction with sedation
AMBRI- rehab
TUBS- surgical op
Red flag referral foo shoulder instability
Irreducible
TUBS
What is a slap tear
Superior labrum anterior to posterior tear of the shoulder
The “slap” anchors the long head of the biceps
What is the best test to evaluate for a SLAP tear
O’Brien test
What is the gold standard to evaluate for a SLAP tear
MRI with arthrogram
What is the TX approach to slap tears
NSAIDS rehab, limit aggravation
Rehab failure= surgical repair
What are two uncommon bone formations that can lead to thoracic outlet syndrome
Cervical rib at C7 or long transverse process of C7
What are the clinical S/s of thoracic outlet syndrome
Neurologic:
- Diffuse, non-specific complaints of the entire UE
- Ulnar neuropathy
Vascular:
- Swelling and discoloration
- Fatigue and weakness
- Worse when arm overhead
What is the ADE of thoracic outlet syndrome
Chronic HEadache
Or loss of overhead ROM
What is the PE approach to Thoracic outlet syndrome
Check for a Bruit or MAss Evaluate distal pulses bilaterally Check Distal nerve function (Ulnar nerve) Roos Test- Aka Elevated arm stress test
When should you order an EMG in thoracic outlet syndrome
TO r/o ulnar nerve entrapment
What is the TX approach to Thoracic outlet syndrome
Non op: 3-6 months pt
Op: to remove variant bone formation or tumor
What are the ADE of Tx for thoracic outlet syndrome
Complex regional pain syndrome (use gabapentin)
Intercostal neuroma, frozen shoulder
Brachial plexus injury
PTX
A brachial plexus injury at birth manifests as what disorder
Neonatal Brachial plexus palsy
What is the most common palsy’s in neonatal brachial plexus palsy
Most common is erbs ( C5-6) Lumped palsy ( C8-T1)
What are the clinical S/s of neonatal brachial plexus palsy
Psuedo paralysis
Increased irritability associated with a clavicle/ numerous Fx
A baby with no spontaneous movement with decreased reflexes suspect?/
Neonatal brachial plexus palsy
Waiters tip position in a baby is a sign of.. ?
Erbs palsy ( neonatal brachial plexus palsy )
Shoulder adducted and IR, elbow extended, forearm pronated, wrist flexed
What is horners syndrome
A sign of poor palsy prognosis in a baby
- loss of sweating on the face
- Ptosis
- miosis
What is the Tx approach to neonatal brachial plexus palsy?
Non-operative-
Monitor nerve function
Prevent contractures/deformities
Physical therapy
Operative-
Surgical to address imbalance
What is Torticollis
Congenital- Unilateral sternocliomasiod contracture at birth
(Most common)
Acquired- eyes (nystagmus, superior oblique palsy), spine (atlantoaxial rotatory displacement), trauma, infection, neoplasms
How does AARD present in torticollis
Atlantic axial rotary displacement
Tilt will be the same as torticollis with a spasm on the unaffected side
What is the referral criteria for Torticollis
All pts with acquired and CMT for PhyTx
Tx approach to Torticollis
Non-operative-
Congenital= stretching
Acquired= treat reason
