ortho - shoulder/ elbow/ hand Flashcards
common non-traumatic disorder
- Rotator cuff syndrome
- Tennis elbow
- Golfers elbow
- Carpal tunnel syndrome
- Rheumatoid wrist and hand
common traumatic disorder
- Montaggia & Galeazzi fracture dislocation
- Colles, Smith & Barton fracture
- Scaphoid fracture
- Bennetts fracture
- Gamekeepers thumb
- Boxers fracture
- Jerseyfinger
rotator cuff syndrome
- Commonest cause of shoulder pain
- arise from repetitive compression or rubbing of the tendons (mainly supraspinatus) under the coracoacromial arch
A spectrum - rotator cuff
- Impingement
- Tendinitis
- Partial tears
- Complete tears * Arthropathy
impingement test
- The painful arc
- Neer’s impingement sign * Hawkins–Kennedy test
cuff test
- Supraspinatus–the‘emptycan’
test - Infraspinatus – resisted external rotation
- Infraspinatus and posterior cuff – the ‘lag sign’
- Subscapularis – ‘the lift-off’ test
conservative rx rotator cuff
- NSAIDs
- Physiotherapy - Active exercises in position of freedom
- Corticosteroid injection
surgical rx rotator cuff
- Acromioplasty
- Rotator cuff repair
- Arthroplasty
tennis elbow
- Lateral epicondylitis
- Tendinitis of extensor carpi radialis
brevis - Not limited to tennis players
- Pain & tenderness on the lateral aspect of the elbow
- Difficulty lifting weights away from the body
conservative rx tennis elbow
- NSAIDS
- Cortisone injection
- Tennis elbow band
- Wrist extension splint
surgical rx tennis elbow
- Surgical release
carpal tunnel syndrome
- 9 tendons and the median nerve in the tunnel
- Most common nerve entrapment
carpal tunnel syndrome risk factors
- Pregnancy – water retention
- Inflammatory synovitis – Rheumatoid arthritis
- Diabetes
- Hypothyroidism
- Gout
- Work related
- Idiopathic
carpal tunnel. syndrome symptoms
- Pain -after midnight – after activity
- Tingling in median n. territory
- decreased sensation median n
- wasting of thenar muscles - advanced
- Phalen test +
- Tunnel sign +
conservative rx carpal tunnel syndrome
- Anti-inflammatory medication – reduce inflammation
- Control systemic disease (diabetes, rheumatoid arthritis)
- Splinting
- Cortisone infiltration
surgical rx carpal tunnel syndrome
carpal tunnel release
* Failure of conservative treatment
* Advanced stage
rheumatoid wrist & hand typical deformities
- Radial deviation of the wrist
- Caput ulnae
- Ulnar deviation & volar sublaxation of fingers
- Boutonniere deformity
- Swan neck deformity
- Z-deformity of thumb
rheumatoid wrist & hand deformity causes
- Ligament rupture
- Tendon ruptures
- Loss of supporting bone
RA medical rx
- NSAIDS & DMARDS –mainstay of
treatment - Cortisone infiltration
RA physical rx
- Splinting – prevent & correct deformities
- Modification of home & work setup
- Assistive devices
RA surgical rx
- Synovectomy-tendons & joints
- Tendon repair, graft, or transfer
- Joint excision
- Joint fusion
- Joint arthroplasty
traumatic disorder - montaggio #
- Fracture dislocation of radius and ulna
- Fracture of proximal ulna
- Dislocation of radial head
- Always fixed surgically
traumatic disorder - galeazze #
- Fracture dislocation of radius &
ulna - Fracture of distal radius
- Dislocation of ulna head
- Always fixed surgically
traumatic disorder - distal radius #
- Colles fracture is the most common ~ 90%
- Dinner fork deformity
- Smith fracture > Barton fracture
- Smith–reverse Colles
- Barton–fracture dislocation/ sublaxation of the wrist
traumatic disorder - distal radius # rx
- Below elbow cast
- 6 weeks – undisplaced
Surgery
* Displaced fractures Colles & Smith
* Barton
* Poor results in intra-articular fractures
traumatic disorder - scaphoid #
- Most common carpal fracture
- Poor blood supply-covered by cartilage
- Can be missed initially
- Repeat x-rays after 2 weeks
- Flawed with complications
-Non-union
-Avascular necrosis of scaphoid
traumatic disorder - scaphoid # rx
- Scaphoid cast – 6 weeks (non-displaced fractures)
- Surgical fixation with a screw
- Displaced fractures
- Fractures with local associated injuries
- Vertical fractures
- Nonunion
traumatic disorder - boxers #
- Fracture at the neck of 5th metarcapal
- Mechanism of injury consistent with boxing (punching)
Treatment
* POP slab if minimally angulated
* Surgical fixation if angulated >40
traumatic disorder - Bennet’s #
- Affects the base of the thumb
- A fracture
dislocation/ sublaxation - Bigger fragment pulled by the long abductor of the thumb
- Always fixed surgically with a screw or wire
traumatic disorder - game keepers thumb
- Rupture of ulna collateral ligament of the thumb at MCPJ
- Partial or complete rupture
- Complete – interposition of adductor pollicis aponeurosis
- Partial – splinting for 4-6 weeks
- Complete – repair and splint
traumatic disorder - jersey finger
• Avulsion of flexor digitorum profundus at insertion site
• With or without bone fragment
• Rugby, fall, axial injury with the ball
Requires repair
