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IPAP JUNIOR SEM. > Osteo Block 2 > Flashcards

Osteo Block 2 Flashcards

1
Q

What is a type 1 AC injury

A

No seperation

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2
Q

What is a type IL AC seperation

A

Sepeartion at the Acromion Claviluar ligament only

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3
Q

What is a type III AC injury

A

Seperation of the AC ligament and Coracoid ligmanets

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4
Q

What is type IV AC shoulder joint ligament

A

Coracoid ligament seperation only

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5
Q

What is a grade V AC injury

A

Coracoid ligament tear with Anterior Displacement of the Clavicle

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6
Q

What is an type VI AC injury

A

AC displacemtn with posterior displacemtn of the clavicle

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7
Q

Which AV types will have an obvious deformity

A

Types III-VI

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8
Q

What are the ADE of AC injuries

A 
Deformity 
Weakness with aBduction 
Chronic Pain 
Arm numbness 
Arthiritis
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9
Q

What pain will the patient present with in an AC injury

A

Pain with abduction of the arm

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10
Q

What are two imagin studies you order for AC injury

A

Plain fims- Bilateral weighted

MRI non-contrast

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11
Q

What is the TX approach to AC injuries

A

Type 1-2 Non op rehab, goal: to decrease pain, prevent further injury, and restore function

Type 3: based on work field, may require surgery

Type 4-6 surgical

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12
Q

What are the two ADE of AC injury TX outcomes

A

Stiffness from sling- immobility

AC joint arthritis

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13
Q

What is a Burners/ Stingers Brachial Plexus

A

C5-C6 nerve root ( brachial plexus injury)

From a traction force

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14
Q

Which has better prognosis, a preganglionic or postganglionic brachial plexus injury

A

Preganglionic poor prognosis

Postganglionic better prognosis

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15
Q

A pt with Burners/ Brachial plexus presents with what clinical S/s

A

Upper trunk C5-6-7 shoulder depression with a lateral tilt of the head away from the injury

Lower trunk: C8-T1 Sharp burning shoulder pain with stretch with arm in abduction

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16
Q

What must be ruled out in a brachial plexus injury

A

R/ o C spine- injury

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17
Q

What is Horners syndorme

A

(ipsilateral ptosis, myosis, anhidrosis, enophthalmos)

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18
Q

Upper trunk brachial plexus affects what the most

A

Most commonly postganglionic

Rhomboids and serratus anterior

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19
Q

Lower trunk brachial plexus most commonly effects

A

Most commonly preganglionic

Horner’s syndrome (ipsilateral ptosis, myosis, anhidrosis, enophthalmos)

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20
Q

What is the TX approach to Burners/ Brachial plexus injury

A

Order Plain films of spine and shoulder,

If films AbNML then oder MRI
(Or with persitent S/s)

Tx:
Non OP; C spine precautiong

Normal Exam : RTD
Decreased Functional Impact: Rehab

Operative: neurosurgery

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21
Q

What is the referal critera for Brachial Plexus injuries

A

Persisnet, recurrent, bilateral S/s with concominant injuries or a severe worse PE

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22
Q

What is frozen shoulder

A

Adhesive capsulitis

Idiopathic loss of AROM,PROM

Women, 40-60 years old

Diabetes

(hypothyroid, Dupuytren disease, cervical disc herniation, Parkinson disease, cerebral hemorrhage, tumors)

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23
Q

What are the clinical findings of Frozen shoulder

A

Idiopathic pain and decreased ROM

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24
Q

How will Frozen shoulder present on plain flims and MRI

A

Plain film-NML

MRI- Contracted joint apsule and loss of inferior pouch

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25
Q

What is the Tx approach to Frozen shoulder

A

Initial Tx for ALL pts in NSAIDS, moist heat, and a gentle stretching program

Operative: Arthroscopic capsular release
(only for conservative Tx failure)

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26
Q

What are the ADE of humerus Fx

A

Tendon tear or humerus Fx

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27
Q

What is the Referral critera for Frozen shoulder

A

No improvement after 3 months of Tx

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28
Q

What is the definition of Shoulder impingment

A

Wither suprspinatus or subacromial bursa inflammation

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29
Q

What are the clincial S/s of shoulder impingment

A

Ant/Lat shoulder pain

And deceased overhead ROM

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30
Q

What are the ADE of a shoulder impingment

A

Chronic pain

Rotator cuff tear

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31
Q

What are the special tests for shoulder impingment

A

Neer
Hawkins
And Jobe test

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32
Q

Pts with shoulder impingment will have pain when the shoulder is abducted at what degree

A

At 90 -120 degrees of abduction

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33
Q

What is the Tx apprach to Shoulder Impingment

A

Non operative : Nsaids, stretching, and Inj to subacromical bursa
(Diagnotstic and thearputic)

Operative Tx only after non op Tx failure

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34
Q

What is the most common and most imporatnt muscle in rotator cuff injureis

A

The supraspinatus

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35
Q

What are the 4 muscles of the rotator cuff

A

Supra and Infrspinatus
Subscapularis
And teres minor

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36
Q

What are the three fxs that lead to shoulder rotator cuff injuries

A

Age related, External impingemtn, or decreased blood supply

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37
Q

What are the clinical S/s of a rotator cuff injury/ tear

A

Pain, w/ difficult sleeping of the affected side

Weakness with overhead ROM

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38
Q

What are 4 ADE of a Rotator Cuff Tear

A

Decreased ROM
Chronin Pain
Weakness of the joint
Glenohemeral OA

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39
Q

What are the special test for a Roator Cuff injury

A

Drop arm test and Jobe Test

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40
Q

A pt presents with atrophy to the shoulder, with decreased ROM over the shoulder yet full passive ROM, +tenderness to the greater tuberosity

What special tests should be done, what do you suspect

A

Drop arm test, and Jobe Test

Suspect: Rotator Cuff injuries

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41
Q

How will Rotator cuff injuries present on Plain films and MRI

A

Plain films will show Acromial variations, with a high ridinig humerus

Order and MRI!

MRI will show: detachment of the tendons

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42
Q

What is the Tx approach to Rotator cuff injuries

A

Non-operative-
NSAIDS, rehabilitation
Injection (Subacromial = glenohumeral)

Operative-
Acute, traumatic tears

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43
Q

What are the referral critera for R. Cuff Tears

A

Failure of 6 weeks of non-operative treatment

Acute, traumatic tear (<6 weeks)

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44
Q

Older pts with RTC Dz at an increased RSK of what bicep D/o

A

Proximal biceps tendon rupture

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45
Q

A pt presents with a bicep deformity with an audible snap and pain, + popeyes deformity

A

Proximal Biceps Tendon Rupture

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46
Q

What is the precentage of foreamr supination strenght loss with a proximal biceps tendon rupture

A

10 %

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47
Q

What is the TX approach to Proximal Biceps Rupture

A

Plain flims will be normal
Order MRI ASAP

NonOP: ROM/ Streghtening

OP: Young athletes and Young Laborers

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48
Q

What is the referral critera for a Proximal Biceps Tendon Rupture

A

Young athlestes
Young laboreres
Concominat Rotator cuff tear

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49
Q

What is the most common postion for shoulder dislocation/ instability

A

Anterior Dislocation

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50
Q

What does TUBS mean

A

Trumatic, unilateral, bankart lesion, surgery

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51
Q

What does AMBRI mean

A

Atruamatic, multidirectioanal,

Bilateral, rehabilitate, inferior capsule (surgery procedure)

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52
Q

What are the most common causes of posterior displacement of the shoulder

A

SZR and electric shock

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53
Q

What are the ADE of shoulder instability

A

Axial nerve injury
Insabitliy
Blenohumeral OA

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54
Q

A pt presents with an adducted and internally rotated shoulder position …

A

Posterior dislocation of the shoulder

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55
Q

How will a pt with chronic shoulder instabiltuy present?

A

Hypermobile

W/ + sulcus sign, +Apprehension test, + Jerk Test

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56
Q

What imaging views should be ordered for a shoulder instability

A

Y view on X ray

MRI w/ Anthrogram

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57
Q

What is a slap tear

A

Superior Labrum, Anterior to Posterior

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58
Q

A pt presents with a positve Obrian test, Crank test, Clunk Test, and Speeds test
With tenderness at the bicpital groove

A

SLAP tear

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59
Q

What is the gold standard imaging for a SLAP test

A

MRI arthrogram

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60
Q

What is the Tx approach to a SLAP tear

A

Non-operative-
Initial treatment (NSAIDS, rehab)
Limit bench press, overhead press and curls
Limit throwing

Operative-
Non-operative treatment failure
High level athletes

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61
Q

What are two anatomical malformations that lead to thoracic outlet syndrome

A

Cervical rib at C7 or a Long transerve process of C7

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62
Q

A pt presents with ulnar neuropathy + diffuse non specific complaints of the entire UE, edmea, discoloration, with fatige, weakness worse with arm overhead, think..?

A

Thoracic outlet syndrome

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63
Q

What are the ADE of Thoracic outlet syndrome

A

Weakness, Chronic Headache, loss off overhead ROM

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64
Q

What is the PE exam test for thoracic outlet syndrome

A

Roos test

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65
Q

A pt that presents with carotid bruit, mass in the neck or shoulder, with distal pulses differnent between arms, and ulnar nerve nueropathy.. think?

A

Thoracic outlet syndorme, will have a postive roos test

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66
Q

What is the Tx approach to thoracic outlet syndome

A

Non op: 3-6 month of PT and activity modificaiton

Op: removal of antomical variant or tumor

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67
Q

What are the ADE of thoracic outlet syndrome

A

Complex regional pain syndrome,

intercostal neuroma

frozen shoulder

brachial plexus injury

pneumothorax

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68
Q

What is the referral critera for thoracic outlet syndrome

A

Neuro-vasc changes
Anatomical variant
Or failure of nonop tx

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69
Q

What is neonatal brachial plesux palsy

A

Typically from injury at birth

UE motor and senory deficit

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70
Q

What is Erbs palsy

A

Most common neonateal brachial plexus palsy at C5-C6

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71
Q

What is Klumpke palsy

A

A neonatal brachial plexus injury at C8-T1

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72
Q

What 3 things would signal a poor prognosis of a neonatal brachial plexus injury

A

Entire plexus involment
Horner Syndrome
Nerve Root Avulsion

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73
Q

An infant presents with pseudoparalysis and irratabilty ( may have waiters tip sign)

A

Neontal brachial plexus

74
Q

An infant with erbs brachial plexus injury will have what postion

A

Waiter tips position

75
Q

Neonatal brachial plexus injury with signs outside of the UE signal ..

A

Poor prognoisis

76
Q

What is the Dx and Tx approach to Neonatal Brachial Nerve Plexus

A

Dx: radiogrpahs to r/o clavicle and humerus fracture

Nerve conduction studies

Tx: monitor nerve funtion, prevent contractures and deformiteis and physical therapy

Op: surgical to address imbalances

77
Q

What is congenital torticollis

A

Unilateral sternocleidomastoid contracture at birth

78
Q

An infant with nystagmus, superior oblique palsy (CNIV)

Atlantoaxial rotary displacment of the spine +- truama +- infection +- neoplasms think?

A

Acquired torticollis

79
Q

What is the imaging and Tx approach to torticollis

A

C spine rads
+ nuero signs= MRI

Tx
Non op:
Congenital- stretching
Acquired- treat underlying reason

Op: only for acquired

80
Q

Referral criteria for Torticollis

A

All pts with Acquired

81
Q

What is tennis elbow

A

Lateral epicondylitis

82
Q

A pt presents with pain with resisted flexion, and pain with index finger extenstion, +tenderness at the lateracl 1cm distal joint of the elbow (orgin of the extensor carpi radiallis brevis) think’./

A

Lateral epicondylitis

83
Q

What is golfers elbow

A

Medial Epicondylitis

84
Q

A pt presents with pain with resisted flexion, and index finger flexion
+ tenderness 1cm distal to the joint at the tendinous orgin of the felxor and pronator muscels of the medial elbow think>?

A

Medial epicondylitis

85
Q

What is the Tx approach to epicondylitis

A

Activity modification
NSAIDS
Rehab
Steroid injections

86
Q

What are the causes of olecranon bursitis

A

Acute= fall/direct blow or septic bursitis

Chronic= propping

87
Q

A pt presents with a red hot swollen elbow think?

A

Toxic joint or olecranon bursitis

Investigate with transillumination

And measure the area

88
Q

What is the Dx approach and Tx approach to olecranon bursitis

A

Plain films- r/o fx
Labs: aspirate- Dx and Tx

Tx: compresion, aspiration
Operative: in non op tx fails or chronic

89
Q

What is the referral criteria for olcranon bursitis

A

Septic

Or recurrance after multipe aspirations

90
Q

What is cubital tunnel syndrome

A

Ulnar nerve compression

2nd most common UE entrapment

91
Q

What is PIN compression

A

Radial nerve compression

92
Q

What is pronator syndomre

A

Median nerve compression at the elbow

93
Q

A pt presents with small finger dysesthesias, hypothena ache think?

A

Ulnar nerve comression at the elbow

94
Q

A pt that present with lateral epicondylitis s/s 4-5 cm more distal think..

A

Radial tunnel compression

95
Q

A pt with vague discomfort and numbness in the medial nerve.. think

A

Pronator compression

96
Q

What is the Dx test for nerve compression syndoromes

97
Q

What is the Tx approach to nerve compression syndromes of the elbow

A

Non-operative
Initial treatment- activity modifications, splinting, NSAIDS

Operative
Non-operative treatment failure
Decompression, transposition

98
Q

Where does the long head of the biceps insert

A

Radial tuberosity

99
Q

What age group of men are more likely to have distal biceps tendon ruptures

A

Men older than 40

100
Q

What is the loss of supination and loss of flexion with a distal biceps tendon rupture

A

Loss of supination 50%, loss of flexion 15%

101
Q

What does the hook test at the elbow evaluate

A

Distal biceps insertion

102
Q

What is the Dx (imaging) and Tx approach to distal beicps tendon ruptures

A

Plain films may be NML or show an avulsion

Order a MRI ASAP will show avulsion vs rupture at the junction of the elbow

Tx: operative within 2 weeks
(Can be non op if older sedentary pt)

103
Q

What are the ADE of distal biceps tendon ruptures

A

Decreased strenght,
Radial nerve injury,
Chronic pain
Heterotpic ossification

104
Q

What is the function of the Ulnar colateral ligament

A

Resist valgus stress in the elbow

105
Q

A pt presents with elbow instability and medial elbow pain, +/- ulnar nerve distribution dysestheias think?

A

Ulnar collateral ligament tear

106
Q

What is the Dx and Tx approach to Ulnar collateral ligament tears

A

Plain films r/o fracture and ossification

MRI with Arthrogram Dx
Tx:
Non op: no throwing mod and NSAIDs with Rehab

OP: for competitive throwers

107
Q

What is nurse maids elbow

A

Elbow injury in a pt younger than 5 (most common elbow injury in children)

Radial head subluxed out of the annular ligamnet

108
Q

What is the Tx approach to nursmaids elbow

A

Full supination and press at the radial head then fully flex

(SOS)

Option sling for comfort

109
Q

What is little leagers elbow

A

A throwing injury in kids aged 8-14

8-12 is usually a fragmentation
12-14 usually an avulsion

Greater than 12 years old usalaly has capitellar OCD w loose bodies

110
Q

What is panner dz

A

Avulsion lesion in less than a 12 year old child (little leagers elbow)

111
Q

What is the Tx appraoch to little leaguers elbow

A

Non op 2-6 months restriction from throwing

OCD= 12 month restriction with physical therapy

Operative: if loose bodies

112
Q

What is the the common pathogen in animal hand bites

A

Pasteurella multocida

Possible rabies

113
Q

What are the ADE of animal hand bites

A 
Septic arthritis 
Abscess, 
Septic teosynovitis, 
Osteomyelitis, 
Rabies

Possible decreased ROM and weakness, decreased sensation, and lymphedema

114
Q

What is the Tx approach to hand animal bites

A

Non op: tx for rabies
Wash with 1L fluids under block, oral ABX

DO NOT SUTURE CLOSED

If infected: IV ABX
( ppossible tetanus)

OP: infection related

115
Q

What are the ADE of hand animal bites after Tx

A

Infection after closure, or allergy to ABX

116
Q

What are the ADE of Animal hand bites

A

Tendon or nerve violation

joint capsule violation

Fractures

Infections

117
Q

What is a boutonniere deformity

A

Rupture of the central postion of the extensor tendon at the PIP

118
Q

A finger that is flexed at the PIP and extended at the DIP is

A

A boutonniere deformity

119
Q

What are the ADE of boutonniere deformites

A

Contracture

120
Q

What is the DX and Tx approach to a boutonniere deformtity

A

Plain films r/o avulsion fx

Tx:

Nonop: PIP in full extension for 6 weeks
And referral to OT

121
Q

What is the most common UE compression neuropathy

A

Carpal tunnel syndrome

122
Q

What is Carpal tunnel syndrome

A

Median nerve compression in the wrist

123
Q

What are common causes of carpal tunnel syndrome

A

Space competition in the tunnel

  • Tenosynovitis
  • RA
  • Tumors
  • Pregnancy
  • DM
  • Thyroid issues
124
Q

A pt presents with numbness in the thumb, 1st and 2nd fingers, thenar ache, that is worse at night.. think/

A

Carpal tunnel sydrome

125
Q

What is the PE test for carpal tunnel syndrome

A

Phalens and Tinels sign

126
Q

A pt with carpal tunnel has 2 point discrimintion greater than

127
Q

What is the Tx approach to Carpal tunnel syndrome

A

Initial treatment: splinting, ergonomics, and steroid injections

128
Q

What is de querains tenosynovitis

A

Lateral wrist tendonopathy
(Swelling of the sheath)

Effects the abductor pollicis longus and extenson pollicis brevis

Common is women that are postpartum

129
Q

A pt with lateral wrist pain at the radial styloid
Pain with thumb extension and abduction

(Sometimes is a mother with young children)

A

De quervains tenosynovitis

130
Q

What is finklesteins test

A

A test for Dequervains tenosynovits

Make a fist with thumb inside hand and felx the tumb tendon

131
Q

Dequervains present with tenderness in what comparmtent

A

In the dorsal first comparment

132
Q

What is the Tx approach to De quervains tenosynovitis

A

Non op: NSAIDs, splint, and steroid injectios

No op: only after Tx failure

133
Q

What is the ADE of Dequervians tenosynovitis

A

Radial sensory nerve injury

134
Q

What is a dupuyterns contracture

A

Nodular thickening and contraction of the palmar fascia

Common in men over 50

Associated with

Epilepsy
Diabetes
Pulmonary disease
Alcoholism
Smoking
Repetitive trauma
135
Q

A pt presents with MCP contracture and deformity with limits in extension and grasp of the hand

Most common in the ring finger
Think

A

Dupuytrens contracture

136
Q

What is the Tx approach to Dupuytrens contracture

A

Nonop: night splints, collangenase injections

Operative:
If greater than 30 degress fixed flexsion at the MCP or greater than 10 degrees at the PIP

137
Q

What are the common infectious agents of finger tip infections

A

S. Aureus or Herpes ( autoinfection)

138
Q

What is paronychia

A

Inflation around the nail bed

139
Q

What is the felon/ whitlow portion of the finger

140
Q

Whitlow infections are..

A

From herpes and are clear vesicles on a red base found on the fingers

141
Q

What are the ADE of fingertip infections

A

Osteomylitis

And Septic Tenosynovitis

142
Q

What are the Tx approaches to Fingertip infections

A

Non op:
Felon involvmentL digit bloc and drainage, clean and pack, DONT Suture

ParonychiaL Soaks and oral ABX
If severe remove nail

143
Q

What are the ADE of fingertip infeciton Tx

A

Neuroma, nail deformity, continured/ repeated infection

144
Q

What are the Referral criteria for fingertip infections

A

+osteomylitis

+septic tenosynovitis

145
Q

What is the Tx approach to fingertip amputations

A

Goals= soft tissue coverage, sensation, conserve length

Subungal hematoma :
Drain by drilling through nail

No bone= 
Irrigation and debridement
Suture NO tension or leave open
Wet to dry dressing with splint
ROM, OT

Bone= Ortho

Tetanus? Oral ABX

146
Q

What are the referral criteria for fingertip amputations

A

Younger that 6 years old

Thumb at or proximal to the IP joint

Proximal to middle of the middle phalanx
Multiple finger amputations

147
Q

What is the most common flexor tendon injury

A

Jersey finger to the ring finger

148
Q

What is the Tx approach to flexor tendon injuries of the hand

A

Non op
Splint with ends together
Irrigation or superfical closure (if laceratin)

repair within 1 week

149
Q

What is the referral criterai for flexor tendon injuries

A

All ruputres and lacs
Add description of the zone
1-2-3-4-5

150
Q

Where does the flexor tendon sheath of the hand extend to

A

Extends from the DIp to the MCP joint

151
Q

A pt that presents wtih 24-48hr of severe pain post punture, with flexor sided finger pain.. think?

A

Flexor tendon infection

( limb threatening)

152
Q

What are the kanavel signs

A

1: sausage digit- uniform swelling along enitre finger
2: pain to percussion/ palpation to the flexor tendon sheath
3: finger held in passive flexion
4: pain with passive extension

153
Q

What is the Tx approach to a flexor tendon infection

A

Washout URGERNT!

IV ABX for staph and strep
Reeval in 12-24 hrs
Continue 24-72 then Oral ABX for 7-14 days

154
Q

What is the most common bacteria from human hand bites

A

Eikenella Corrodens

More common is Alpha hemoyltic Strep and S. Aurues

155
Q

What are the ADE of Human hand bites

A 
Tendon ruptures 
Abcess formation 
Osteomyliteis 
Septic Arthritis 
Septic Tenosynovitis
156
Q

What must be R/o in a human hand bite

A

R/o ascending infection

157
Q

What is the Tx apprach to a human hand bite

A

Non op: (no joint, no tendon involment and less than 8 hours post bite)
Block, irrigate, debride, explore, DO NOT SUTURE, dress and oral ABX

Reeval in 24hr

Operative: IF INFECTED
Surgical I&D, IV ABX

158
Q

What are the ADE of human hand bite Tx

A

Infections, amputation, ABX allergy

159
Q

When should you refer a human hand bite

A

infection
Joint capsul involvment
Tendon rupture
Bone involvement

160
Q

What is keinbock disease

A

Osteonecrosis of the lunate bone

Common in men 20-40 years old

With a Hx of trauma

161
Q

A male pt comes in with Hx of truama to the hand/ wrist (punching)
With dorsal wrist pain, stiffnes or diffuse swelling
+weakness and inability to grasp heavy items
Think..?

A

Keinbock disease

162
Q

What are the ADE of keinbock

A

Secondary OA

163
Q

What is the Tx approach to Keinbock disease

A

Non op: splint and referral
NSAIDS for pain

Operative: Manage secondary OA and Necrosis

164
Q

What is mallet finger

A

Rupture, lac, or avulsion of the extensor tendon at the DIP

165
Q

What is a swank neck deformity

A

Hyperextended at the PIP and flexed at the DIP

Opposite of boutenires

166
Q

How will a mallet finger present on plain films

A

+/- avulsion fx

Volar displacemtn on the flexor pully

167
Q

What is the Tx appraoch to mallet finger

A

No op: continuous splint x 6 wks

OpL occupations with repitive tasks

168
Q

What is the ADE of wearing a finger splint for 6 wks

A

Skin breakdown at the proximal nail

169
Q

What is the referral criteria for a mallet finger

A

DIP subluxation or avulsion greater than 1/3 the surface of the finger

170
Q

A fx involving the nail bed is what type of Fx

171
Q

What is the Tx approach to nail bed injuries

A

Non op: subungal hemotoma= drill through the nail
Nail bed lac: block, I&D, explore, absorbale suture, dress, splint
Nail avulsion= germinal matrix under fold

172
Q

What is the referral criteria for nail bed injuries

A

Physeal injuries or Open fxs

173
Q

What is trigger finger

A

Thickening at the A1 pulley
Limtis tendon excursion
(Catching)

174
Q

What fingers are most commonly affected by trigger finger

A

Long and ring fingers

175
Q

What Dz are assoc. with trigger finger

A

RA, DM, hypothyroid

176
Q

A pt presents with pain, locking, and “catching” with finger flexion, +/- a nodule a the finger

Think?

A

Trigger finger

177
Q

TTP at the MCP think

A

Trigger finger

178
Q

What is the Tx approach to trigger finger

A

No op: splinting, steroid injections

Op: only for non op tx fail

179
Q

What are the ADE of trigger finger Tx

A

Tendon ruptures, nerve injury, infection

180
Q

What is the referral critera for trigger finger

A

Contracture or comorbid RA (increased flexor tendon rupture risk)

IPAP JUNIOR SEM. (43 decks)

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