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SUMMED2 > Ortho UE > Flashcards

Ortho UE Flashcards

1
Q

What are classic shoulder injury symptoms?

A 
overhead  
sleeping on affected side
Radiating pain into bicep and down into forearm
upper back and neck pain
Loss of strength- pain or neuro
Loss of shoulder range of motion
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2
Q

What are DDX for shoulder pain

A 
AC- jt
Neck
Scapula weak
RTC tear
Arthritis
MI
Tendinopathy
Bursitis
Bicep tendon
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3
Q

Which tests for for Bicep tendon?

A

Speeds

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4
Q

Which test for signs of impingement

A

NOT a diagnose
Jobe
Neer
Hawkins

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5
Q

What test for AC jt

A

Cross body
Piano key
Compression

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6
Q

When are diagnostic indicated?

A

Xray
MRI- if RTC tear non contrast
Contrast- if instability labrum, dislocation

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7
Q

On XRay High riding humerus seen indicates?

A

RTC tear
tissue shortens
Cause of impingement , scapula rotates ant. for protectin

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8
Q

On Xray dec joint space, white in color-sclerosis, major osteophytes on inferior humeral head

A

Arthritic GH joint

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9
Q

What is inital treatment for RTC tears?

A

Oral NSAID course -4-6 wks, activity modification,
1. PT ​FIRST​
2- Steroid inj- posteriorlateral soft spot

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10
Q

How can cortisone inj be diagnostic?

A 
Cortisone with lidocaine
If no pain for few days, in right spot
Inj take 3wk to dec inflammation
Repeat 3-4mo
NO improvement- MRI
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11
Q

Who should not have steriod inj?

A

DM uncontrolled
Inc risk of infx
Chronic steroid use-RA, SLE, Sarcoid

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12
Q

Why should you not inject directly into the bicep tendon?

A

1st line- Oral NSAIDs, activiy mod, PT

Staph and step on skin

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13
Q

What should be done for +Hawkin and Jobes?

A

MRI for RTC tear
Steroid inj-subacromial
Surgery- Pt choice

PT for partial tear

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14
Q

Ms. Williams Vb player 20ys, severe pain, no s/s of RTC. MRI show narrowed space. What is poss. initial TX?

A

Cortisone injection

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15
Q

What occur from ER or ABD force on the humerus, or
direct posterior force to the proximal humerus or posterolateral blow to the shoulder. Anterior capsule becomes stretched or torn?

A

Glenohumeral Dislocation

Guarding- carry angle INC
Traumatic

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16
Q

What is risk with adducted and internally rotated and force is applied to posterior force?

A

Subscapularis inury
Posterior capsule torn
LC

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17
Q

What is important with any shoulder injury?

A

Assess neuro
Axillary nerve
Dermatomes
Pulses- Thoracic Outlet Syndrome

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18
Q

What is key in XRay for traumatic shoulder injury?

A

Axillary view

Bankart lesion- glenoid rim fx. Bank of shore= glenoid

Hill sach lesion- compression fx POSTEROLATERAL humerus (on the hill/humerus)

This lesion high risk for instability/reoccurrence, surgery,

19
Q

Ms. Dominque has continued instability post 6m Anterior dislocation. What is management vs post?

A

Ant. conservative

  1. Immobile 1-2wk
  2. w/ PT strength, ROM
  3. LT - 3-5mo recovery
  4. MRI if no better

Posterior: Refer surgeon w/ MRI

20
Q 
Mr. Football landed on top o shoulder during a tackle. PE
ttp and swelling AC jt.
Cross body to painful to DNP
Xray- AP Bil shoulder
What are grades for this injury?
A

Acromiclaviular Joint sprain- Separation
G1- AC lig partial tear. No clavicle seperation
G2- Full tear AC lig+ coracoclavicular lig partial, partial clavicle seperation
G3- Both torn, full clavicle seperation

Tx- Immobilize, PT
G4-6- multiple tears, surgey

21
Q

What area exit under clavicle and related to the following sx;
Vague dull ache shoulder pain w/ AROM
distal nerver entrapment
skin discoloration

A

Thoracic Outlet syndrome
brachial plexus and/or subclavian vessels as they exit the space between the superior shoulder girdle and the first rib

Risk- W, congenital

22
Q

What is the test where shoulders ABD 90 deg and braced somewhat posteriorly have
patient open and close fists at moderate speed for 3 minutes.

Reproduction of neurologic and/or vascular
symptoms is a positive test.

Fatigue W/O neuro or vascular symptoms is inconclusive or negative.

A

Elevated Arm Stress Test (EAST):

23
Q

PT w/ neurovascular symptoms w/ AROM. what are diagnose and treatment steps?

A 
TOS
WU- xrays
nerve conduction
electomyography
MRI

Tx- MSK and posture edu
No tight straps

24
Q

Mr. Gout has local swelling and DEC ROM in elbow. These conditions Gout, rheumatoid arthritis, chondrocalcinosis, may cause?

A

Olecranon Bursitis

25
Q

what is important to check with any joint swelling?

A 
Fever
chills
N/V
Infxn
Cloudy fluid: send aspirate for cell count, cultures, gram stain and crystals
26
Q

Pt c/c pain w/ extension and pronation of elbow

Extensor carpi radialis brevis tissue degeneration with fibroblast and microvascular hyperplasia.

A

Lateral epicondylitis

Tennis

27
Q

Pt c/o pain with flx and supination. PE- ttp origin of flex

What is LC but occurs in golfer or bowlers?

A

Medial epicondylitis
flexor/pronator muscles just distal to medial
epicondyle

28
Q

What is initial treatment of epicondylitis?

A

NSAIDs, RICE, massage, topical creams
Activity modification
Bracing: elbow strap and or wrist brace
Cortisone injection: locate point of maximal tenderness for target spot to inject

Surgery: Poor outcomes debridement and possible release of tendon

29
Q

Ms. Softball c/c parathesia, numbness of L 4th and 5th digits. Especially at night, worse with flexion.
PE- atrophy of adductor pollicis, mid forearm flexor carpi ulnaris
+Tinel
+ Elbow flx

A

Cubital Tunnel syndrome- compression of ulnar nerve
*2nd MC

Dx- nerve conduction

TX- padding, splint keep arm at 45deg
NSAIDs
Surgery - decompression or transpose

30
Q

This is associated with pregnancy, flexor tenosynovitis, overuse, inflammatory conditions, trauma to the wrist, endocrine disorders and tumor, w/ repetitive radial deviation?

A 
Carpal tunnel
numb in fingers 1-3 only
CP- pain awaken at night.
Radiate up or down arm
Keyboard issues and driving
31
Q

Which muscle is atrophied in carpal tunnel?

A 
thenar muscles: FPB, ABD brevis, opponens
Pronator quadratus
FPL
FDS
lumbricals
PL
Pronater teres

DX- Durkan carpal compressin, PHalens, tinels

32
Q 
Bracing (esp nighttime, driving)
○ NSAIDs
○ Ergonomic modifications
○ Cortisone injection
○ Surgical release: open or endoscopic
A

Treatment for Carpal tunnel

33
Q

Ms. Jaynie has lump that fluctuate in size

painful w/ ROM, ttp. What is DX and TX

A

Ganglion cyst- thick, soft, MC hand wrist, from capsule, tendon synovial sheath

Dx- Xray for bony involvement
TX- No pain leave it alone. Painful aspirate-warning**volar wrist area, carpal tunnel

34
Q

Ms. Holley had R wrist pain postpartum 3 mo. Breast feeding 12x/day.
PE - pain of styloid process, thumb flex, ABD and ulnar deviation.
What test is performed?

A

+ De Quervains diagnosis
Finkelstein test​:
Flex thumb into palm and ulnar deviate the wrist

Swelling of sheath that surrounds 1st Dorsal compartment: abductor pollicus longus and extensor pollicis brevis
constriction of tendon as it moves through the sheath

35
Q

What are TX for this condition De Quervains?

A

Pt eduction. lactation specialist
NSAIDS, immobilzation, ACupuntcure, PT, activ mod
Steroid inj
Surgery

36
Q

Which finger are MC in trigger finger? What wu is need?

A 
Digits thumb, middle, ring
**NO work, simply clinically DX**
CP- pain catching, locking w/ flexion
Painful nodule +/- stuck behind tendon sheath
WHO-RA, DM
37
Q

What is important with Injection technique in the finger?

A

bathe tissue with anti inflammatory liquid ideally flexor sheath.
○ Use 1ml syringe with small needle
○ Do not inject fluid directly into tendon

Other Surgical release of A1 pulley no changes

38
Q

What causes non painful flexion contractures at MCP joint?

A

Dupuytren Dz-Nodular thickening on palmar surface of hand, flexor contractures at MCP
MC- finger 5,4,1 web space.

M older, DM, smoking, ETOH, whites, FH**

39
Q

Is workup needed for Dupuytren finger contracture?

A

NO

TX- surgery when>30deg flex or FLX of PIP jt

40
Q

Ms. Rema has difficulty opening her pill box and gripping. PE- CMC jt deformed, +grind test.
what is work up and treatment?

A 
Thumb Carpometacarpal Joint Arthritis 
Xray AP, latera, oblique of thumb
TX- NSAIDs, bracing
heat, topical cream
Steroid inj
Surgery
41
Q

What is management w/ stable and unstable fX

A

Stable- f/u 12-14d
Unstable 1-3d Ortho- Swelling is concern
**Alway check neurovasculature

42
Q

This patient has what kind of Fracture
F/u 12-14d for xray, dx, tX
Immobilized in cast or splint
Return 4wk from DOI for healing

A

Stable FX

43
Q

What is liklehood of being in cast for longer?

A

Poor healing d/t location scaphoid
Severe FX
12-14-poor blood supply

Small FX- sticky callus 2wks
4 wks healing signs ONLY XRAY
8-10 Healed

44
Q 
This patient has what kind of Fracture
F/u 1-3d for xray, dx, tX
4-6wk remove cast, replace
Return 1wk for alignment check
Typical NWB
A

Unstable fX

SUMMED2 (38 decks)

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