Ortho UE Flashcards by JHope .

What are classic shoulder injury symptoms?

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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What are DDX for shoulder pain

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

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Which tests for for Bicep tendon?

Speeds

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Which test for signs of impingement

NOT a diagnose
Jobe
Neer
Hawkins

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What test for AC jt

Cross body
Piano key
Compression

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When are diagnostic indicated?

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

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On XRay High riding humerus seen indicates?

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

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

Arthritic GH joint

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What is inital treatment for RTC tears?

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

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How can cortisone inj be diagnostic?

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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Who should not have steriod inj?

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

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Why should you not inject directly into the bicep tendon?

1st line- Oral NSAIDs, activiy mod, PT

Staph and step on skin

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What should be done for +Hawkin and Jobes?

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

PT for partial tear

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

Cortisone injection

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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?

Glenohumeral Dislocation

Guarding- carry angle INC
Traumatic

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

Subscapularis inury
Posterior capsule torn
LC

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What is important with any shoulder injury?

Assess neuro
Axillary nerve
Dermatomes
Pulses- Thoracic Outlet Syndrome

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What is key in XRay for traumatic shoulder injury?

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,

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

Ant. conservative

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

Posterior: Refer surgeon w/ MRI

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?

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

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

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

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.

Elevated Arm Stress Test (EAST):

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

TOS
WU- xrays
nerve conduction
electomyography
MRI

Tx- MSK and posture edu
No tight straps

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

Olecranon Bursitis

what is important to check with any joint swelling?

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

Pt c/c pain w/ extension and pronation of elbow | Extensor carpi radialis brevis tissue degeneration with fibroblast and microvascular hyperplasia.

Lateral epicondylitis | Tennis

Pt c/o pain with flx and supination. PE- ttp origin of flex | What is LC but occurs in golfer or bowlers?

Medial epicondylitis flexor/pronator muscles just distal to medial epicondyle

What is initial treatment of epicondylitis?

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

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

Cubital Tunnel syndrome- compression of ulnar nerve *2nd MC Dx- nerve conduction TX- padding, splint keep arm at 45deg NSAIDs Surgery - decompression or transpose

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

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

Which muscle is atrophied in carpal tunnel?

``` thenar muscles: FPB, ABD brevis, opponens Pronator quadratus FPL FDS lumbricals PL Pronater teres ``` DX- Durkan carpal compressin, PHalens, tinels

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

Treatment for Carpal tunnel

Ms. Jaynie has lump that fluctuate in size | painful w/ ROM, ttp. What is DX and TX

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

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?

+ 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

What are TX for this condition De Quervains?

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

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

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

What is important with Injection technique in the finger?

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

What causes non painful flexion contractures at MCP joint?

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**

Is workup needed for Dupuytren finger contracture?

NO | TX- surgery when>30deg flex or FLX of PIP jt

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

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

What is management w/ stable and unstable fX

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

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

Stable FX

What is liklehood of being in cast for longer?

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

``` 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 ```

Unstable fX