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Semester 3 > Orthopedic Pathology 300 (Upper extremity pathologies) > Flashcards

Orthopedic Pathology 300 (Upper extremity pathologies) Flashcards

1
Q

Glenohumeral hypermobility

A

“Hypermobility is when the humeral head translates to a greater degree” ????

Due to physiological laxity of the CT

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2
Q

Glenohumeral instability

A

Instability is the inability to maintain the humeral head in the glenoid fossa

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3
Q

instability (and hypoermobility?) can be described as

A

Can be classified as Anteriorly, Posteriorly, or Multi-directional

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4
Q

instability can also be classified as…

A

Can be further classified as Traumatic or Atraumatic

Atraumatic is seen as either: Congenital or Repetitive injury (overhead activities)

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5
Q

repetitive stress instability

A

…

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6
Q

static vs dynamic stabilizers

A

Static Stabilizers:

Superior Glenohumeral Lig
Middle Glenohumeral Lig
Inferior Glenohumeral lig
Glenoid Labrum
Negative intra-articular pressure

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7
Q

static vs dynamic stabilizers 2

A

Dynamic Stabilizers:

Rotator Cuff muscles
Deltoid
Long head of Biceps Brachii

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8
Q

negative intraarticular pressure

A

“is the pressure in the synovial fluid (not that between the contact areas of the articulating surfaces)”

“Negative intra-articular pressure (IAP) is a passive stabilizer during joint movement.”

“In humans, negative intra-articular pressure is a considerable factor in the maintenance of shoulder stability.”

“In particular, it helps to prevent inferior displacement and keep the humeral head positioned in the center of the glenoid.”

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9
Q

gh instability clinical presentation

A

Clinical Presentation

Pain
Clicking

Dead arm syndrome

Feeling of instability/apprehension/possible dislocation

Sulcus sign (multidirectional instability)

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10
Q

dead arm syndrome

A

“Description. “Dead Arm” is characterized by a sudden sharp or ‘paralyzing’ pain when the shoulder is moved forcibly into a position of maximum external rotation in elevation or is subjected to a direct blow.”

“Dead arm syndrome is a condition that affects the shoulder. It’s caused by repeated movements, which place stress on the joint.”

“Dead arm syndrome is pain or weakness that occurs in the upper arm when doing a throwing movement.”

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11
Q

sulcus sign

A

“The sulcus sign tests for inferior glenohumeral instability. With the patient sitting or standing, the examiner grasps the patient’s arm and pulls inferiorly. The test is positive if a dimple or sulcus appears beneath the acromion as the humeral head is translated inferiorly.”

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12
Q

GH instability tx

A

Rehab; strengthening shoulder stabilizers
Surgery

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13
Q

AC joint separation (shoulder separation)

A

Separation of the acromioclavicular joint

Technically a dislocation/subluxation

also considered ligament sprain/tear

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14
Q

how ACJ sep

A

Usually from a traumatic fall/hit to the shoulder

Direct: Hit to acromion; hockey, rugby, football

Indirect: FOOSH, fall on elbow

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15
Q

ACJ sep grades

A

Graded by the extent of damage to AC jt and surrounding ligaments

Grade 1: tearing of the AC joint capsule

Grade 2: tear of the AC joint capsule and acromioclavicular ligaments

Grade 3: tear of the joint capsule, the acromioclavicular ligaments, and coracoclavicular ligaments (conoid and trapezoid ligaments)

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16
Q

3 grades, other definition (mistake on slides @ previous card???)

A

“The original grading system had three grades; non-displaced sprain (type 1), partially dislocated joint (type 2) and completely dislocated (type 3).”

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17
Q

GH dislocation

A

Most commonly dislocated joint in the body

Anterior dislocation
= most common

MOI: excessive abduction and external rotation or hyperextension

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18
Q

GH posterior dislocation

A

MOI: excessive flexion, adduction and internal rotation

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19
Q

GH dislocation tx

A

Reduction (tractioning?)

Rest/sling

Rehab

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20
Q

reduction define

A

“the action of remedying a dislocation or fracture by returning the affected part of the body to its normal position.”

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21
Q

bicipital tendinitis (bicep tendinitis)

A

Degenerative changes in the tendon of the long head of the biceps muscle

Common with overhead activities

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22
Q

bicep tendinitis – SSx

A

Local tenderness in the groove

Resisted elbow flexion

Pain with passive abduction
(LONG HEAD DOES ABD)

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23
Q

rupture of biceps tendon

A

Due to pre-existing degenerative changes in the proximal tendon of the long head of the biceps muscle

(COULD ALSO BE DISTAL TENDON)

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24
Q

how rupture (bb tend)

A

May rupture during active flexion against a resistance

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25
Q

bb tendon rupture – SSx

A

Immediate pain and “give away”

Long head of the BB contract into a ball that is more distal than normal
—> (IN PROXIMAL TENDON RUPTURE)

—> in distal tendon rupture, ball is more proximal

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26
Q

frozen shoulder (adhesive capsulitis)

A

A painful and significant restriction of active and passive range of motion at the shoulder joint.

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27
Q

which movement most affected (adhesive capsulitis)

A

Usually affects all movements of the shoulder

Most significant are abduction and external rotation

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28
Q

adhesive capsulitis – who?

A

2 - 3% of the population may experience frozen shoulder

10 – 20% of the diabetic population

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29
Q

adhesive capsulitis – gender

A

Women are more likely to be affected than men

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30
Q

adhesive capsulitis – age?

A

Most commonly occurs between 40 – 70 years of age

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31
Q

adhesive capsulitis – etiology

A

Largely unknown/unclear

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32
Q

adhesive capsulitis – primary vs secondary

A

Can be classified as Primary or Secondary

Primary:
idiopathic

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33
Q

secondary adhesive capsulitis

A

Secondary:

Intrinsic: impingement, bursitis, rotator cuff pathology, etc.

Extrinsic: myocardial infarction, pulmonary disorders, breast surgery

Systemic: Diabetes, Thyroid disease

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34
Q

secondary adhesive capsulitis and blood flow (?)

A

may have something to do with reduced bloodflow ??

E.g.
diabetes, MI, impingement

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35
Q

why breast cancer and frozen shoulder?

A

“Why would breast cancer treatment predispose women to frozen shoulder syndrome? Because inactivity predisposes patients to developing frozen shoulder, and inactivity is common in breast cancer patients: Patients are recommended to limit use of the arm following surgery.”

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36
Q

why limit movement of arm in breast cancer patients?

A

“Protecting the arm on the side of the surgery is very important after breast surgery. Poor drainage of the lymphatic system can cause that arm to be more at risk of infection and less sensitive to extreme temperature. Be aware of activities that put too much pressure on the affected arm.”

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37
Q

frozsen shoulder vs collagen production?

A

“The exact cause of frozen shoulder is unknown. However, the condition is thought to be related to an overproduction of collagen in the shoulder”

“It is thought to be caused by scar-like tissue (adhesions) forming in the shoulder joint.”

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38
Q

adhesive capsulitis pathogenesis

A

Disagreement over underlying pathological condition:

—> Inflammatory, fibrosis, neurological (?)

39
Q

frozen shoulder — which structures invovled

A

Joint capsule is primarily involved with secondary involvement of surrounding structures

Affects the anteriosuperior joint capsule, axillary recess and coracohumeral ligament

Contracture of rotator cuff interval

40
Q

frozen shoulder phases

A

acute, subacute, chronic

41
Q

acute frozen shoulder phase

A

aka freezing phase or painful phase

This stage can last 2 – 9 months

Gradual onset of pain
—> @ Lateral area of shoulder

Pain may be more severe at night; can’t lay on that side.

Inflammation is present in joint capsule

Muscle spasms may be present in rotator cuff

42
Q

subacute frozen shoulder phase

A

aka frozen phase or stiffening phase

This stage can last 4 – 12 months

Severe pain begins to diminish and stiffness becomes the main complaint

—> Pain is still present at the end ranges of motion.

Atrophy may be seen in surrounding muscles d/t disuse
—> Deltoid, rotator cuff

43
Q

chronic frozen shoulder phase

A

aka thawing phase or resolution phase

May resolve spontaneously after two years

Some studies show as long as 5 – 10 years

Full range of motion is not always regained

Length of the acute phase corresponds to the length of the overall recovery time

44
Q

chronic phase prognosis/resolution (?)

A

Motion and function gradually return to normal

Lateral shoulder pain and night pain continue to diminish

45
Q

adhesive capsulitis Treatment (MEDICAL MANAGEMENT)

A

Corticosteroids

Manipulation under anesthetic (E.g. high velocity chiropractic adjustments)
—> can lead to possible iatrogenic complications

Surgery
—> arthroscopic capsular release

Nerve blocks
—> Suprascapular nerve

Distention arthography

NSAIDs

46
Q

nerve block?

A

the production of insensibility in a part of the body by injecting an anesthetic close to the nerves that supply it.

47
Q

arthroscopic capsular release (?)

A

Arthroscopic capsular release is a minimally-invasive surgery used to help relieve pain and loss of mobility in the shoulder from adhesive capsulitis (frozen shoulder).

“Capsular release is an arthroscopic (keyhole) procedure to cut the tight capsular tissues surrounding the shoulder joint”

“A radiofrequency (RF) probe is inserted into the shoulder. The probe uses RF waves to cut the tissue capsule that surrounds the shoulder joint, allowing the shoulder to move more freely.”

48
Q

distention arthography (?)

A

“Arthrographic distension is a procedure where fluid is injected into the shoulder joint to break up the adhesions that might be restricting the shoulder’s movement and causing disability.”

49
Q

adhesive capsulitis Treatment (CONSERVATIVE MANAGEMENT)

A

Patient education

Massage

Modalities
—> US, electric stim, laser

Manipulation/mobilization

Pain free ROM/stretching

Rehab

50
Q

is there a definitive treatment for adhesive capsulitis ??

A

Thedefinitive treatment for adhesive capsulitis remains uncleareven though multiple interventions have been studied

“Previously published prospective studies of effective treatment have demonstrated conflicting results for improving shoulder range of motion in patients with this condition”

“There is little evidence to support or refute the use of any of the common interventions listed for adhesive capsulitis”

“There are also no studies with objective data supporting the timing of when to switch to invasive treatments”

51
Q

impingement syndrome

A

Inflammation, pain and edema in the tissues of the subacromion space

Within the coracoacromial arch and between the acromioclavicular and glenohumeral joints

52
Q

NOTE CORACOACROMIAL ARCH (vs coracoacromial lig)

A

“The coracoacromial ligament (CAL), which restrains superior displacement of humeral head, is a component of coracoacromial arch”

53
Q

impingement syndrome and rotator cuff tendons (esp supraspin)

A

Painful compression of the rotator cuff tendons may occur when the humerus is abducted against the acromion

—> Most commonly supraspinatus tendon

—> May also affect subacromial bursa

—> and long head tendon of biceps brachii

54
Q

impingement syndrome can be classified as

A

structural vs functional

55
Q

structural impingement syndrome

A

Reduction of the subacromial area

Can be caused by:

—> thickening of coracoacromial ligament,

—> osteophytes from degeneration of AC joint

—> or hooked acromion process

56
Q

functional impingement syndrome

A

Caused by shoulder instability or muscle imbalances

57
Q

Impingement syndrome – clinical presentation

A

..

58
Q

impingement syndrome – age

A

Typically seen in 40-60 year old age group

Can also be seen in younger individuals: usually athletic population

59
Q

impingement syndrome — SSx

A

Aching sensation in the shoulder
—> May go down arm along biceps

Pain when abducting arm
—> @ Anterior and lateral shoulder

Catching sensation when lowering arm (like catching @ medial meniscus injury)

Worse with overhead activities

Pain at night when lying/rolling on shoulder

60
Q

shoulder impingement test

A

painful arc test (70-120 degrees)

61
Q

three stages of shoulder impingement

A

Stage 1 – edema and hemorrhage of subacromial bursa

Stage 2 – tendinitis and fibrosis

Stage 3 – complete or incomplete tendinous rupture (surgery)

62
Q

which stages reversible?

A

Stage 1 and 2 are reversible with conservative care

63
Q

ELBOW

A

…

64
Q

elbow dislocation

A

Posterior dislocation of the elbow

65
Q

how elbow disl?

A

Can be due to a fall on hand with the elbow slightly flexed or severe hyperextension of the elbow(foosh, sports, mva)

Usually requires significant amount of force (elbow is quite stable)

Radius and ulna dislocate posteriorly and always with severe soft tissue injuries

Frequently associated with fractures

66
Q

olecranon bursitis

A

Aka “Student’s elbow”

Can be due to a hard impact on the elbow or constantly leaning on the elbow
—> over-use vs trauma

Constant pain at olecranon

Painful swelling

Limited mobility

67
Q

what is other mechanism of olecranon bursitis – other than trauma and over-use (elbow on table)

A

May also be d/t infection or inflammatory conditions (RA, PA, Gout)

68
Q

lateral epicondylitis

A

Aka tennis elbow

Thought to be a premature degeneration in the flat tendinous origin of the forearm extensor muscles from the lateral epicondyle of the humerus

Cause:
—> Local injury
—> Repetitive overuse of extensors

69
Q

lateral epicondylitis features

A

Pain over or near the lateral aspect of the elbow

Radiation of pain down forearm

Aggravated by use or stretch of extensor muscles origin

Discrete point of local tenderness is present just distal to the lateral epicondyle

70
Q

medial epicondylitis

A

Aka golfer’s elbow

Involves the common flexor tendon near the medial epicondyle

Cause:
Repetitive flexion movements of the wrist
—> Golfing, pitching a ball, grasping, lifting heavy objects

71
Q

medial epicondylitis is associated with…

A

Often associated with ulnar nerve problems (due to proximity)

72
Q

WRIST AND HAND

A

…

73
Q

lunate dislocation

A

Anterior dislocation is common

Result of falling on a dorsiflexed wrist (FOOSH)

74
Q

lunate dislocation – what happens? Sx

A

Lunate is squeezed out of place towards the palmar surface into the floor of the carpal tunnel

Wrist is swollen, experience pain when trying to extend fingers,

can compress median nerve

75
Q

lunate dislocation – Tx

A

Traction with strong force on lunate (reduction?)

Surgery

76
Q

lunate dislocation – COMPLICATIONS

A

Avascular necrosis

Median nerve compression

DJD

77
Q

Dequervain’s tenosynovitis

A

Inflammation of the abductor pollicis longus and extensor pollicis brevis tendon sheaths.

Usually caused by repetitive use microtrauma from repeated thumb use, repetitive radial/ulnar deviation and forceful gripping.

More common in women.

Usually 30 – 50 years of age

78
Q

Dequervain’s tenosynovitis – management (Conservative)

A

Bracing (6 weeks)

Avoid aggravating activities
NSAIDS, Ice

Massage, stretching, strengthening

Corticosteroid injection

79
Q

Dequervain’s tenosynovitis – management (Surgical)

A

Endoscopic release of 1st dorsal compartment

80
Q

Trigger Finger

A

Excessive thickening of common fibrous sheath that surrounds deep and superficial flexor tendons

flexor digitorum profundus/superficialis

Idiopathic and spontaneous

Most common in middle-aged women

Thickening produces a constriction in the tunnel (stenosis)

81
Q

trigger finger – what happens

A

Tendons become secondarily enlarged

Unable to actively extend

Passive finger extension “snaps”

Active flexion “snaps”

82
Q

trigger finger – Tx

A

Treatment includes immobilization in extension, steroid injections, surgery

83
Q

trigger finger – “finger snaps”

A

“Overview. Trigger finger makes a finger get stuck in a bent position. It may straighten suddenly with a snap. The fingers most often affected are the ring finger and the thumb, but the condition can affect any finger.”

“Trigger finger occurs when the pulleys that help bend your fingers become too thick, leading to a popping or catching feeling as well as pain.”

84
Q

trigger finger – pathologies linked to progression/development

A

RA, PA, gout

85
Q

Mallet finger

A

Injury to the distal IP joint

Commonly occurs during sporting injury

86
Q

mallet finger – MOI

A

Active finger extension and forced distal phalange flexion

(when extending, tendon contracting and tight, so when distal phalanx hyperflexion, more likely to avulse bone)

87
Q

mallet finger – i.e.

A

Ext. Digitorum
Avulsion fracture

88
Q

mallet finger – features / SSx

A

Failure of active extension

Can extend entire fingers except affect DIP

Painful, swollen around DIP joint

89
Q

mallet finger – Tx

A

Splinting 6 weeks
—> Removal before healed = finger perm. Bent

Tendon will self heal

90
Q

Gamekeeper’s thumb

A

A tear or complete rupture of the ulnar collateral ligament at the 1st MCP joint

Due to abduction and extension of the thumb

Treatment – immobilization or surgery

91
Q

Jersey Finger

A

Aka rugby finger

Rupture of the flexor digitorum profundus tendon

Occurs when DIP is actively flexed and is then forced into extension

92
Q

Volkmann’s Ischemic Contracture

A

Permanent flexion contracture of the hand and fingers

Typically caused by fractures of the arm/forearm, leading to ischemia and necrosis of the distal tissues

93
Q

Dupuytren’s Contracture

A

Contracture of the palmar fascia

Leads to permanent flexion of one or more digits
—> Most commonly the 4th digit

Idiopathic:
“It may be linked to cigarette smoking, alcoholism, diabetes, nutritional deficiencies, or medicines used to treat seizures”

94
Q
A

Semester 3 (32 decks)

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