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Clin med sem 2 > Ortho- upper extremity > Flashcards

Ortho- upper extremity Flashcards

1
Q

Rotator Cuff Injury pathophysiology

A

Partial thickness vs Full thickness

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2
Q

Rotator Cuff Injury - cause

A

Lateral fall onto shoulder
Lifting/pulling a heavy object
Wears out - elderly

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3
Q

Rotator Cuff Injury - S/S & PE

A

Cant abduct the arm
Watch them take off their shirt
Usually - no major neuro issues
Partial - pain w/ abduction, weak RC testing

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4
Q

Rotator Cuff Injury- treatment

A

> 50% will need surgery

  • arthroscopically
  • open repair
Non surgery:
PT 
- shoulder stabilization
- stretching 
- postural strengthening - retraining
NSAIDs- make sure no CV issues
Injections - medium acting steroid
- 3 inj in 1 year
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5
Q

Impingement syndrome- pathophysiology

A

Tendons of rotator cuff and subacromial bursa are pinched by acromion
-> tendons and bursa become inflamed and swollen

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6
Q

Impingement syndrome - cause

A 
Repetitive overhead movement
Anterior translation of humeral head with poor posture
Acromial hook 
- Type I-III - live with it 
- Type IV - VI - will need to be burred  down ->acromioplasty
Degerative change
Trauma
Micro trauma to supraspinatus/bursa
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7
Q

Impingement syndrome - S/S & PE

A 
Pain worse when abducted
Localized inflammation
Pain
Limited ROM -> frozen shoulder
Affect on ADLs
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8
Q

Impingement syndrome- diagnosis

A

Hx of painful arc
PE - pain w/ impingement testing
Injection
Imaging

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9
Q

Impingement syndrome- labs & imaging

A

Injection - lidocaine/steroid
Imaging:
- xray - trauma, OA, acromial hook
- MRI - fraying, degenerative change of rotator cuff, inflammation of bursa

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10
Q

Impingement syndrome- treatment

A

Injection - Lidocaine/cortisone
PT - strengthen/stretching
NSAIDs
Surgery - severe acromial hook or supraspinatus fraying

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11
Q

AC Separation- cause

A

Lateral fall
FOOSH
Contact sport injury
MVA

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12
Q

AC Separation- treatment

A

Grade I-III

  • Sling
  • NSAIDs
  • RICE

Grade IV-VI
- surgical repair - instable

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13
Q

Adhesive Casulitis (frozen shoulder)- pathophysiology

A

Inc collagen
Fibrotic growth factors - transforming growth factor - beta
Inflammatory cytokines - tumor necrosis factor alpha, interleukins
B cells, T cells, Macrophages
Active fibroblastic proliferation

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14
Q

Adhesive Casulitis (frozen shoulder)- cause

A

Period of immobilization - surgery or mastectomy

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15
Q

Adhesive Casulitis (frozen shoulder)- epidemiology

A

40-60y

F>M

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16
Q

Adhesive Casulitis (frozen shoulder)- S/S & PE

A

Spontaneous or gradual onset

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17
Q

Adhesive Casulitis (frozen shoulder)- treatment

A

PT

Manipulation under anesthesia

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18
Q

Bicep Tendonitis- cause

A

Hx of receptivity use, trauma, poor egronomics
Anterior translation of humerous - postural weakness
Old age

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19
Q

Bicep Tendonitis- S/S & PE

A

Pain over proximal long head of bicep tendon

Pain with - flexion, pronation, supination, speeds test

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20
Q

Bicep Tendonitis- treatment

A

PT

  • postural strengthening
  • stretching
  • iontophoresis

Inject - cortisone/lidocaine

Surgery - bicep tenodesis
- cuts biceps tendon, attaches to humerus bone

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21
Q

Bicep Tendon Subluxation- pathophysiology

A

Tearing or stretching of transverse humeral ligament

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22
Q

Bicep Tendon Subluxation- epidemiology

A

Athelets - pitchers

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23
Q

Bicep Tendon Subluxation- S/S & PE

A

Yerasons test - bicep tendon pop out of bicipital groove

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24
Q

Bicep Tendon Subluxation- treatment

A

Surgery - if fully torn

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25
Q

Instability -> Dislocation- pathophysiology

A

Anterior instability - most common

Anterior Dislocation - more common

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26
Q

Instability -> Dislocation - cause

A

Trauma

Genetics

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27
Q

Instability -> Dislocation - S/S & PE

A

Positive apprehension test
Positive sulcus sign

Hill Sachs lesion - depression in posterolateral head of humerus
- results from forceful impact of humeral head against anteriorinferior glenoid rim -> when disloacted anteriorly

Bankart Lesion - anteroinferior glenoid labrum
- due to anterior dislocation

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28
Q

Instability -> Dislocation- treatment

A

Reduction

  • MUST - prereduction/post reduction films
  • CHECK - axillary nerve injury
  • sling pt after

PT
Surgery

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29
Q

Instability -> Dislocation - prognosis

A

Complications

  • labral tear
  • Hill sachs
  • Bankart
  • axillary nerve injury
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30
Q

Axillary nerve lesion- pathophysiology

A

Deltoid and teres minor m paralyzed

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31
Q

Axillary nerve lesion - cause

A

Downward dislocation of humeral head in shoulder

Fracture of surgical neck of humerus

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32
Q

Axillary nerve lesion- S/S & PE

A

Cant abduct shoulder
Paralyzed deltoid wastes rapidly
Loss of sensation over lower half of deltoid

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33
Q

Superior Labral Anterior Posterior (SLAP) tear- pathophysiology

A

Where bicep tendon anchors to labrum

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34
Q

Superior Labral Anterior Posterior (SLAP) tear- cause

A

MVA
FOOS Arm
Forceful pulling on arm - catch heavy object
Rapid or forceful movement of arm - when above level of shoulder
Shoulder dislocation

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35
Q

Superior Labral Anterior Posterior (SLAP) tear- S/S & PE

A

Painful catching or clicking

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36
Q

Superior Labral Anterior Posterior (SLAP) tear- labs & imaging

A

MRI arthrogram - Gold Standard

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37
Q

Superior Labral Anterior Posterior (SLAP) tear- treatment

A

Surgery

Recovery in shoulder immobilizer - longer then RC tear recovery

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38
Q

Pectoralis Major Rupture- S/S & PE

A

Acute pain with lifting, bench press, etc

Bruising, declivity in m

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39
Q

Pectoralis Major Rupture- treatment

A

Surgery

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40
Q

Bicep Tendon Rupture- pathophysiology

A

lever to lift forearm

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41
Q

Bicep Tendon Rupture - epidemiology

A

M

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42
Q

Bicep Tendon Rupture - S/S & PE

A

Popeye sign

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43
Q

Bicep Tendon Rupture- diagnosis

A

MRI

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44
Q

Bicep Tendon Rupture- treatment

A

Surgery

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45
Q

Fracture of Humerus- cause

A

Fall

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46
Q

Fracture of Humerus- epidemiology

A

Osteoportic W

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47
Q

Fracture of Humerus- treatment

A

Sling - non displaced and no concerns for bone healing

ORIF - open reduction internal fixation

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48
Q

Lateral Epicondylitis - tennis elbow- pathophysiology

A

Extensor tendons of forearm of lateral epicondyle

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49
Q

Lateral Epicondylitis - tennis elbow - cause

A

Supination injuries

50
Q

Lateral Epicondylitis - tennis elbow - treatment

A

Hard to treat - hard to not use these

OT, iontophoresis
Tennis elbow strap, compression sleeve, 
Stretching, strengthening, 
Rest, ice
Inject - cortisone
Surgery 
Warn - will take awhile to heal
51
Q

Medial Epicondylitis- pathophysiology

A

Irritation of flexor tendons of forearm - medial epicondyle

52
Q

Medial Epicondylitis - cause

A

Pronation injury

53
Q

Medial Epicondylitis - treatment

A

Hard to treat - hard to not use these

OT, iontophoresis
Tennis elbow strap, compression sleeve, 
Stretching, strenthing, 
Rest, ice
Injct - cortisone
Surgery 
Warn - will take awhile to heal
54
Q

Ulnar Nerve Issues- pathophysiology

A

Cubital tunnel syndrome - ulnar nerve entrapped

Ulnar nerve sublux - pops in and out of cubital tunnel

55
Q

Ulnar Nerve Issues- epidemiology

A

baseball pitchers

56
Q

Ulnar Nerve Issues- S/S & PE

A

Chronic Pain, paresthesia
Electric shock
weakness

57
Q

Ulnar Nerve Issues- treatment

A 
OT
NSAIDs
Rest
Inject
Surgery - cubital tunnel release or ulnar nerve repositioning
58
Q

Olecranon Bursitis- cause

59
Q

Olecranon Bursitis - treatment

A 
Conservatively at first
Drain 
Cortisone
Wrap
Ice, rest, elevations, NSAIDs
60
Q

Elbow Fractures- pathophysiology

A

Radial head - most common

61
Q

Elbow Fractures- S/S & PE

A

Fat Pad/sail sign - cortical disruption of distal humerus fracture, bleeding
- due to joint effusion via fracture

62
Q

Elbow Fractures- treatment

A

Splint/Sling
ORIF
Be aware - soft tissue damage

63
Q

Distal Radius fractures- cause

64
Q

Distal Radius fractures- epidemiology

A

young and old

65
Q

Distal Radius fractures- S/S & PE

A

Watch for - nerve trauma, ligament injury in carpal area

66
Q

Distal Radius fractures- treatment

A

Cast

Surgery

67
Q

Radial Nerve Palsy- pathophysiology

A

Saturday night palsy

68
Q

Radial Nerve Palsy- S/S & PE

A

Cannot extend hand

69
Q

Ganglion Cyst- pathophysiology

A

Fluid filled cyst - benign
Over joint or area of high mobility
- flexor or extensory surface

70
Q

Ganglion Cyst- epidemiology

71
Q

Ganglion Cyst- S/S & PE

A

Allen test

72
Q

Ganglion Cyst- treatment

A

Resolve on own

Excision - if compressing a nerve or vessel

73
Q

Scaphoid Fracture- S/S & PE

A

Tenderness - over snuffbox

74
Q

Scaphoid Fracture- labs & imaging

A

Xray - get scaphoid view

75
Q

Scaphoid Fracture- treatment

A

Xray neg? - still splint, have pt repeat xray in 1 week

76
Q

Scaphoid Fracture- prognosis

A

Complications - avascular necrosis - backwards vasculature

77
Q

Wrist ligamentous Injury- cause

78
Q

Wrist ligamentous Injury - S/S & PE

A

Chronic pain

Instability

79
Q

Wrist ligamentous Injury- diagnosis

A

Xray - neg, but has pain over carpals

MRI ARTHROGRAM!!

80
Q

Scapholunate injury- pathophysiology

A

Most common carpal injury

81
Q

Scapholunate injury - cause

A

2nd to tear of scapholunate interosseous ligament

Arthrisi

82
Q

Carpal Tunnel Syndrome - pathophysiology

A

Median Nerve impingement

83
Q

Carpal Tunnel Syndrome - cause

A

Repetitive movements - hands in awkward positions, vibrations

84
Q

Carpal Tunnel Syndrome - S/S & PE

A

Pain in front of wrist
Numbness/tingling - thumb, index, middle, 1/2 of ring finger
Weakness in hand - drop objects
Inc pain and tingling at night or sleeping

Atrophy - wont get back
- release before this happens

85
Q

Carpal Tunnel Syndrome - labs & imaging

A

Not getting better - electromyelogram nerve conduction study (EMG/NCVS)

86
Q

Carpal Tunnel Syndrome - treatment

A 
Night splints - prevent chronic flexation of wrists
NSAIDS
OT
Inject
Ergonomic eval

Surgery - open, endoscopic

87
Q

Thoracic outlet syndrome/ Brachial Neuritis - pathophysiology

A

Brachial plexus

88
Q

Thoracic outlet syndrome/ Brachial Neuritis- S/S & PE

A

UE pain/ paresthesia

Hand goes to sleep when doing hari

89
Q

De Quervains Tenosynovitis - pathophysiology

A

Stenosing tenosynovitis of APL and EPB tendons at styloid process of radius
-> inflammation -> thickening and stenosis of synovial sheath

90
Q

De Quervains Tenosynovitis - epidemiology

A

New Mothers
Tree trimmers

30-50yo

91
Q

De Quervains Tenosynovitis - S/S & PE

A

Finklestein test

92
Q

De Quervains Tenosynovitis - treatment

A

Splint - thumb spica
NSAIDs
Heat
Ice

OT
Inj
Surgery

93
Q

Mallet finger- pathophysiology

A

Distal Extensor tendon injury

94
Q

Mallet finger- treatment

A

Stack splint x 6 w 24h

- if you remove it - have to start over

95
Q

Duputrevyn’s Contracture- pathophysiology

A

Thickening under the skin

96
Q

Duputrevyn’s Contracture- cause

A

4th and 5th fingers - most common

97
Q

Duputrevyn’s Contracture- epidemiology

A

M>F

European descent

98
Q

Duputrevyn’s Contracture- treatment

A

OT, splint, inject, surgery

99
Q

Stenosing Tenosynovitis - trigger finger- pathophysiology

A

Flexor tendon become too thick - cant slide through tendon sheath
-> cause catching

100
Q

Stenosing Tenosynovitis - trigger finger- epidemiology

A

RA
Gout
DM
Repeated gripping

101
Q

Stenosing Tenosynovitis - trigger finger- treatment

A

OT, injection, tendon sheath release

102
Q

Boutenniere Deformity- pathophysiology

A

Tear in extensor tendon -> flexion of PIP and extenion of DIP

103
Q

Boutenniere Deformity - cause

A

Jammed’ injury

104
Q

Boutenniere Deformity - epidemiology

A

Ehlers Danlos Syndrome

105
Q

Boutenniere Deformity - S/S & PE

A

Cant flex finger

106
Q

Boutenniere Deformity- treatment

A

Figure 8 splint

107
Q

Swan Neck Deformity - pathophysiology

A

Hyperextension of PIPJ and flexion of DIPJ

108
Q

Swan Neck Deformity - epidemiology

109
Q

Swan Neck Deformity- treatment

A

Splint

Surgery

110
Q

Palm Laceration - pathophysiology

A

TOO MUCH IMPORTANT STUFF

111
Q

Palm Laceration - treatment

A

EMERGENT SURGERY - refer to Hand

112
Q

Tuft Fracture - cause

A

Smash/Crush injury

113
Q

Tuft Fracture - treatment

A

Splint
Remove Nail
TETANUS

114
Q

CMCJ OA- pathophysiology

A

Erosive changes of joint

Flattening of trapezius

115
Q

CMCJ OA- epidemiology

116
Q

CMCJ OA- treatment

A

NSAIDs
OT
Splinting

LRTI - ligament reconstruction and tendon interposition
- if treatment fails

117
Q

Skiers thumb - pathophysiology

A

Stretch or tear of ulnar collateral ligament

- forceful abduction

118
Q

Skiers thumb- treatment

A

Splint

Ligament repair

119
Q

Bennett’s Fracture- cause

A

Thumb flexed when injured

120
Q

Bennett’s Fracture- treatment

A

Surgery
Refer
OT - regain ROM

Clin med sem 2 (30 decks)

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