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Pathophysiology - UE Dysfunction Flashcards

test 2

1
Q

T or F?
The upper extremity consists of the shoulder complex, elbow and forearm complex, and wrist and hand.

A

True

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2
Q

How many articulations are there in the shoulder complex?

A

4 - between the humerus, sternum, scapula, and clavicle

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3
Q

What are the three synovial joints of the shoulder?

A

GH (ball and socket), SC (saddle), and AC (plane/gliding)

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4
Q

Which joint is an articulation between the medial end of the clavicle, clavicular notch of manubrium of sternum, and cartilage of first rib?

A

sternoclavicular joint

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5
Q

What movements does the SC joint have?

A

Elevation/depression
Protraction/retraction
Upward/downward rotation
Winging and tipping

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6
Q

What kind of joint is AC joint?

A

Gliding or plane joint

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7
Q

What serves as the main articulation that suspends the upper extremity from the trunk and is the joint about which the scapula moves?

A

AC Joint

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8
Q

What are the motions of the AC joint?

A

Upward/downward rotation
Rotation in horizontal plane
Rotation in sagittal plane

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9
Q

T or F?
GH joint is relatively stable and doesn’t rely on the muscles and structures (ligaments, labrum) around it.

A

FALSE - GH is unstable and relies on muscles, ligaments, and joint capsule around it

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10
Q

How many bursae of GH joint?

A

12

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11
Q

What is the scapulohumeral rhythm?

A

For every 2 degrees of shoulder abduction, scapula must upward rotate 1 degree

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12
Q

What condition is an alteration in the normal position or motion of the scapula during scapulohumeral movements?

A

Scapular dyskinesis

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13
Q

Scapular dyskinesia should be suspected in patients with what and is classified by what?

A

Scapular dyskinesis should be suspected in pts with a shoulder injury and can be identified and classified by specific physical exam

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14
Q

What type of scapular dyskinesis is characterized by prominence of the inferior medial scapular border?

A

Type 1

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15
Q

What type of scapular dyskinesis is characterized by the entire medial border protruding?

A

Type 2

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16
Q

What type of scapular dyskinesis is characterized by superior translation of the entire scapula and prominence of the superior medial border?

A

Type 3

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17
Q

What condition refers to pain and weakness most commonly experienced with movements of the shoulder ER and elevation as a consequence of excessive load on rotator cuff tissues and is commonly referred to as “subacromial impingement syndrome”?

A

Rotator cuff tendinopathy

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18
Q

T or F?
In rotator cuff tendinopathy, acromial irritation may not be the primary cause of symptoms

A

True

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19
Q

What are the 2 main conditions that can lead to rotator cuff tendinopathy?

A

Primary: intrinsic degenerative process when the top of the RC is compressed by the surrounding bone and soft tissue b/c decreased subacromial space

Secondary: results from GH instability and/or tensile overload of the RC resulting in poor control of the humeral head during overheard activities (pts here are usually under 35 yo and have traumatic instability, posterior defect of humeral head, and damage to glenoid labrum)

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20
Q

What is the cause of internal glenoid impingement?

A

Caused by impingement of the posterior edge of the supraspinatus and anterior edge of the infraspinatus against the posterior-superior glenoid and glenoid labrum

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21
Q

What is the mechanism of injury for internal glenoid impingement?

A

Extension, abduction, and ER

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22
Q

What condition is a common cause of posterior shoulder pain in throwing or overheard athletes and is commonly misdiagnosed as rotator cuff tendinopathy?

A

Internal glenoid impingement

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23
Q

What is internal glenoid impingement also called?

A

Posterior-superior glenoid impingement or posterior impingement

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24
Q

What are some factors in rotator cuff tendinopathy?

A

Position of arm during activities, age capsular tightness, condition of the AC joint, correct function of dynamic stabilizers, amount of vascularization to the cuff, and poor endurance of scapular pivots (sustained or repetitive overhead activities)

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25
Q

What is the primary intervention for rotator cuff tendinopathy?

A

Active exercise therapy to relieve pain, reduce mm spasm, promote tendon healing, restore normal shoulder movement, and improve function

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26
Q

T or F?
Conservative care is implemented first before surgical options of RC tendinopathy

A

True

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27
Q

What is occurring in tradition open rotator cuff repair?

A

Vertical incision over anterior shoulder, deltoid is divided to allow access to RC and subacromial space, and an anterior and inferior acromioplasty is done to reduce acromion

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28
Q

During what surgical option for RC repair is an anterior and posterior acromioplasty performed?

A

Traditional open RC repair

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29
Q

What is occurring in a mini open surgical repair of RC?

A

Arthroscopic subacromial decompression with deltoid splitting

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30
Q

What are benefits of doing and arthroscopic procedure for RC repair over surgery?

A

smaller incision, get to inspect GH joint, can treat intra-articular lesions, you avoid detaching the deltoid, less soft tissue dissection, and less pain

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31
Q

T or F?
Regardless if during an open arthroscopic procedure to fix RC tendinopathy, post surgical rehab is the same because the TENDON TO BONE HEALING stays the same?

A

True. Speed of progression of healing depends on the status of the deltoid muscle, size of tear, and ability to move shoulder without injuring tissues

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32
Q

For a small tear in the RC, how long do you have to wear a sling?

A

1-3 weeks

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33
Q

For a medium tear in the RC, how long do you have to wear a sling?

A

3-6 weeks

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34
Q

For a large/massive tear in the RC, how long do you have to wear a sling?

A

6-8 weeks

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35
Q

ER beyond neutral is restricted for the first ___ weeks after a fix of a RC tear?

A

4 weeks

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36
Q

T or F?
Some patients may require an abduction orthosis if the tension through the repair site is minimal or not with the arm in 20-40 degrees of abduction

A

True

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37
Q

What is the term for abnormal symptomatic motion of the GH joint that affects normal joint kinematics and results in pain, subluxation, or dislocation of the shoulder?

A

Glenohumeral instability

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38
Q

T or F?
The more unstable the GH joint, the less use, and therefore the more shoulder dysfunction

A

True

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39
Q

What are some causes of GH joint instability? (3)

A
  1. Genetics
  2. Biochemical (collagen)
  3. Biomechanical factors
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40
Q

What is the characteristic complaint of glenohumeral instability?

A

Shoulder slipping or popping out during overheard activities

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41
Q

What is the most common direction of GH instability?

A

Anterior instability

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42
Q

How does anterior GH instability occur?

A

When the abducted shoulder is repeatedly place in anterior position of ER and horizontal abduction.

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43
Q

Pts with anterior GH instability may have pain with what movements?

A

Overhead movements due to inability to control their laxity using their muscles.

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44
Q

What can occur unilaterally from acute traumatic events that cause secondary lesions such as Bankart (avulsion of anteroinferior labrum from glenoid rim and requires surgery) and Hill-Sachs lesions (depression fracture on posterior humeral head at site where humeral head impacted the inferior glenoid rim)?

A

Anterior GH instability

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45
Q

T or F?
Chronic, recurrent dislocations of the shoulder is not something that can lead to degenerative arthritis

A

FALSE - chronic, recurrent dislocations of the shoulder can lead to degenerative arthritis

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46
Q

Who is most likely to have a RC tear with a GH dislocation?

A

An older person

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47
Q

T or F?
Recurrent subluxations can cause dysfunction and GH instability

A

True

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48
Q

What is the typical method of injury resulting in GH instability?

A

FOOSH (fall on outstretched hand) this forces into abduction, extension, and ER

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49
Q

What type of GH instability is rare?

A

Posterior instability

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50
Q

What type of GH instability is often associated with a seizure, electric shock, MVA, or diving into a shallow pool?

A

Posterior GH instability

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51
Q

Pts with posterior GH instability have sx’s with the arm in what position?

A

Forward flexed and adducted

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52
Q

What are the three classifications of posterior GH instability?

A

Subacromial, subglenoid, and subspinouse (most common)

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53
Q

What is the classic sign of posterior GH instability?

A

A loud clunk as shoulder is moved from flexion to abduction and ER

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54
Q

What type of GH instability is uncommon?

A

Inferior GH Instability

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55
Q

How can inferior GH instability occur?

A

From carrying heavy objects at your side or hyperABDuction forces that cause levering of the humeral neck against the acromion

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56
Q

T or F?
Inferior sublux is common in pts with inferior GH instability after CNS injury secondary to weakness of shoulder girdle and scapular stabilizers

A

True - RC mms do not have strength to hold humeral head in labrum, so inferior sublux occurrs

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57
Q

What is the term for symptomatic GH instability in more than one direction where rehab is the primary intervention to restore GH stability?

A

Multidirectional GH instability

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58
Q

What does SLAP lesion mean?

A

Superior Labral lesions that are both Anterior and Posterior

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59
Q

What condition is occurring when people performing overhead movement may develop a “dead arm” with a painful shoulder?

A

SLAP lesions

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60
Q

What is the MOI of a SLAP lesion?

A

FOOSH, sudden deceleration or traction forces (catching a heavy falling obj), MVA, chronic anterior and posterior instability

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61
Q

SLAP lesions - which is fraying and degeneration of edge of superior labrum and the pt loses ability to horizontally abduct and ER with forearm pronated w/o pain?

A

Type 1

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62
Q

SLAP lesions - which is a vertical tear of the labrum similar to a bucket handle tear of meniscus?

A

Type 3

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63
Q

SLAP lesions - which is a pathologic detachment of the labrum and biceps tendon anchor resulting in loss of stabilizing of labrum and biceps?

64
Q

SLAP lesions - which is an extension of the bucket handle tear into the biceps tendon, and portions of the labral flap and biceps tendon displaceable into GH joint?

65
Q

What is the conservative approach to heal SLAP lesions?

A

avoid positions that make dislocation, scapular stability exercise, closed-chain exercises, and exercises to rehab scapulohumeral rhythm

66
Q

What are surgical interventions for SLAP lesions?

A

Bankart (reattachment of torn capsule)
capsulorrhapy (tightening of capsule)
electrothermally assisted capsulorraphy
SLAP lesion repair

67
Q

What condition is a chronic inflammatory process in pts with a painful, stiff shoulder?

Underlying pathologic changes are synovial inflammation w/subsequent reactive capsular fibrosis

A

Frozen shoulder/adhesive capsulitis

68
Q

T or F?
Frozen shoulder is an inflammatory and fibrosing condition, depending on the stage of disease

69
Q

What are characteristics of primary frozen shoulder?

A
  • Provoking chronic inflamm. in musculotendinous or synovial tissues like RC, biceps tendon, or jt capsule
  • occurs between 40-60 yo
  • characterized by progressive and painful loss of AROM and PROM in shoulder
  • inflamm. and pain causing mm guarding w/o true fixed contracture of jt capsule
  • disuse, leading to loss of shoulder mobility and continued disuse can lead to impingement
70
Q

T or F?
With time, there is resolution of pain with a stiff shoulder with severe limitation of function in primary frozen sholder.

71
Q

What is a secondary frozen shoulder characterized by?

A

Significant restriction of both active and passive shoulder motion that occurs in absence of a known intrinsic shoulder disorder

72
Q

What are the stages of adhesive capsulitis/frozen shoulder?

A
  1. Freezing - intense pain even at rest, loss of ER and ABD, lasting 10-36 wks
  2. Frozen - pain only w movement, and resolves but leave a pain-free stiff shoulder
  3. Thawing - slow, steady recovery of some of the lost ROM resulting from capsular remodeling; minor improvements
73
Q

What condition is an injury to the nerves and soft tissues of the UE and cervical spine that occurs during birth, specifically at upper C5-C6 trunk of the brachial plexus?

A

Erb’s palsy

74
Q

In Erb’s palsy, how is the arm usually situated?

A

Adducted and medially rotated, elbow is extended, and forearm is pronated

75
Q

How can a SC joint sprain occur?

A

From MVA and sports

76
Q

SC joint sprain types

A

Type 1: sprain of SC ligament
Type 2: sublux, partial tear of ligaments
Type 2 A/B: anterior (most common) and posterior sublux
Type 3 A/B: anterior and posterior dislocation
Type 4: habitual dislocation (rare)

77
Q

Is pain localized or diffused in an SC joint sprain?

78
Q

What movements create pain with an SC joint sprain?

A

Shoulder elevation, horizontal abb/abd, and you have hypo/hypermobility

79
Q

Who are AC joint sprains most commonly seen in?

80
Q

How does and AC joint sprain occur?

A

Falling on to shoulder with arm adducted to side

81
Q

How many types of injuries of AC joint sprains are there based on direction and amount of displacement?

A

6 - see Dutton p. 497

82
Q

In an AC joint sprain, is pain localized or diffused?

83
Q

In an AC joint sprain, what movements cause pain?

A

Pain with shoulder elevation, horizontal add/abd, and you have hyp/hypermobility

84
Q

What do clavicle fractures typically result from?

A

FOOSH or less commonly, from direct blow

85
Q

T or F?
With a clavicle fracture, you have a hard time elevating the arm above 60 degrees

86
Q

What movement causes pain when you have a clavicle fracture?

A

Pain with horizontal adduction

87
Q

T or F?
Clavicular fractures typically involve a clavicular deformity and tenderness with palpation

88
Q

What is the most common fracture of the humerus and typically results from a direct blow to the anterior, lateral, or posterolateral part of the humerus or FOOSH injury?

A

Proximal humeral fracture

89
Q

Displaced or nondisplaced proximal humeral fracture?

Majority are stable w/no significant displacement of the feature

A

nondisplaced

90
Q

What are common complaints/features of proximal humeral fractures?

A

Pain and loss of function of the arm, swelling, and discoloration of the shoulder and upper arm

91
Q

What is the intervention for a non displaced proximal humeral fracture?

A

Conservatively, control distal edema and stiffness and early motion. Use a sling until pain is gone (2 weeks)

92
Q

What is the intervention for a displaced proximal humeral fracture?

A

Surgery including closed reduction, ORIF, proximal humeral head replacement, or long period of immobilization

93
Q

What is the term for a shoulder replacement?

A

Total shoulder arthroplasty

94
Q

T or F?
A total shoulder arthroplasty is a surgical option for old people with shoulder arthopathy

95
Q

T or F?
Shoulder arthopathy occurs as a result of superior translation of the humerus in the shoulder due to deficient RC

96
Q

What are some other diagnoses that require a total shoulder arthroplasty?

A

Bone tumors, RA, Paget’s disease, avascular necrosis of humeral head, fx dislocations, recurrent dislocations

97
Q

What is a reverse arthroplasty?

A

The ball and socket are reversed

98
Q

What serves as the intersection of the humerus, radius, and ulna?

99
Q

What are the 3 articulations of the elbow?

A

humeroulnar (olecranon of ulna and trochlea of humerus)

humeroradial (concave radial had with convex capitulum of humerus)

radioulnar joint (where pronation and supination occur)

100
Q

What are the 3 ligaments of the elbow?

A

Medial (ulnar) collateral ligament (protects against valves stress)

Lateral (radial) collateral ligament (provides stability to lateral part of elbow)

annular ligament (maintain relationship between head of radius on humerus and ulna)

101
Q

What is the ER of the arm when the elbow is flexed to 90 due to?

A

ER of the trochlea

102
Q

T or F?
Trochlea is usually tiled, giving the carrying angle of 10 for men and 13 or women.

103
Q

What condition occurs either at the musculotendinous junction or radial tuberosity being avulsed partially or completely but majority at the shoulder?

A

Biceps tendon rupture

104
Q

Does biceps tendon rupture at elbow occur mostly in males or females?

105
Q

What are sx’s of a biceps tendon rupture?

A

Sharp, tearing-type pain with an acute injury or swelling and activity related pains in the antecubital fossa from chronic injury

106
Q

T or F?
Triceps tendon ruptures occur usually with a deceleration force during extension to uncoordinated contraction of triceps against flexing elbow

107
Q

What is the treatment for biceps and triceps tendon ruptures?

108
Q

What results from repetitive hyperextension of the elbow with pronation OR repetitive flexion combined with stressful pronation/supination

A

Bicipital tendinopathy

109
Q

Bicipital tendinopathy is common in who?

A

Weightlifters, bowlers, gymnasts

110
Q

What are the complaints of bicipital tendinopathy?

A

Pain at anterior part of distal arm

111
Q

What motions created pain with someone with bicipital tendinopathy?

A

Pain with resisted elbow flexion and supination + pain with passive shoulder and elbow extension

112
Q

What does triceps tendinopathy result from?

A

Repetitive extension

113
Q

What are sx’s/complaints of triceps tendinopathy?

A

Tenderness local to the triceps insertion at elbow and worsened by resisted elbow extension

114
Q

T or F?
Brachialis strain is pretty rare but can occur from overuse activities like heavy lifting

115
Q

T or F?
Brachialis strain indicated by a painless, enlarging mass which is a RED FLAG and pain in anterior part of distal arm

116
Q

Is a brachialis strain prone to myositis ossificans (pathologic bone formation) b/c it is likely to hemorrhage when injured?

117
Q

What are the two types of epicondylitis and where are they?

A

Tennis elbow - lateral epicondyle
Golfer’s elbow - medial condyle

These are overuse injuries

118
Q

What condition is characterized by being at the origin of extensor muscles, often degenerative and not inflammatory, pain on lateral part of a elbow, is from overuse, and as sx’s of ashiness and morning stiffness?

Palpation is tender over the Extensor Carpi Radialis Longus Brevis

A

Tennis elbow - epicondylitis

119
Q

What is the intervention for tennis elbow and golfers elbow?

A

Manual therapy, braces, resistance exercises, and surgery if absolutely needed after 6 months

120
Q

What condition is characterized by involving the origin of the flexor carpi radialis and pronator teres?

Begins as micro tearing and there is repeated stress involving flexor-pronator tissues. People like pitchers can get this.

A

Golfer’s elbow

121
Q

What is a medial (ulnar) collateral ligament sprain caused by?

A

Chronic valgus and external rotation forces or a FOOSH

122
Q

What condition is characterized by being from chronic valgus and ER forces (pitching), a FOOSH, from a surgery for cubital tunnel syndrome, can irritate the ulnar nerve, and causes medial elbow pain?

A

Medial (ulnar) collateral ligament sprain

123
Q

What is the intervention for a medial (ulnar) collateral ligament sprain?

A

Rest, strengthening, supervised throwing, and maybe surgery via Tommy John surgery (reconstruction of ligament by resorting of anterior oblique band of UCL)

124
Q

What is the term for a pathologic bone formation that is formation of mature lamellar bone in nonosseous tissues?

A

Heterotopic ossification

125
Q

What is the term for heterotypic ossification that forms in inflammatory muscle?

A

Myositis ossificans

126
Q

What can ossification result from?

A

Direct elbow trauma and aggressive PROM after the trauma

127
Q

What condition is characterized by:
- Swelling over olecranon process
- Pain and swelling that is acute or gradual
- Bruising over olecranon from trauma or irritation by repetitive weight bearing

A

Olecranon bursitis (students elbow)

128
Q

What fracture of the arm is caused by direct trauma to the arm or shoulder or by axial loading through the elbow and is above the condyles of the humerus?

A

Supracondylar fracture

129
Q

What fx of the arm is of the distal end of the humerus and is difficult to manage, from a high-energy injury?

A

Intracondylar fractures

130
Q

With elbow dislocation, is posterior less common than anterior?

A

No, posterior is more common than anterior. The ulna is placed posteriorly in relation to the distal humerus

131
Q

T or F?
Elbow dislocation can lead to compartment syndrome, myositis ossificans, and UCL involvement

132
Q

What are the three main joints of the distal forearm and hand?

A

Distal radioulnar joint
Radiocarpal joint
Mid-carpal joint

133
Q

What general condition is characterized by:
- being common in hand and wrist and presents w no major motor or sensory issues
- can be accompanied by a hx of pain or vague sensory disturbances
- needs surgery or just PT depending on severity

A

Peripheral nerve entrapment

134
Q

Compression of what nerve in the forearm causes chronic wrist pain and functional impairment of the hand? It is the moat common compression neuropathy and between 40-60 yo

A

Median nerve entrapment - subset of peripheral nerve entrapment. Also called carpal tunnel syndrome.

135
Q

What are some things that can cause carpal tunnel syndrome of the median nerve?

A

Pregnancy b/c fluid retention, RA, OA, trauma, collagen disorders, etc

136
Q

What is the treatment for carpal tunnel syndrome?

A

Splints, joint immobilization, modify activities, exercise, and possibly surgery to release entrapment of nerve

137
Q

What condition is characterized by:
- can occur at Guyon’s canal
- clinically presents as claw hand b/y unopposed action of extensor digitorum in 4th and 5th fingers
- can’t extend 2nd and distal phalanges of any fingers
- cannot adduct or abduct or oppose fingers
- cannot adduct thumb
- loss of sensation on ulnar side of hand, ring finger, and over entire little finger
- all of this can also happen at the elbow

A

Ulnas nerve entrapment

138
Q

What is the term for inflammation of the tendon or tendon-muscle attachment?

A

Tendinitis

139
Q

What is the term for inflammation of the tendon sheath?

A

Tenosynovitis

140
Q

What tendinopathy condition is characterized by:

  • Progressive tenosynovitis affecting tendon sheaths of Dorsal side of wrist resulting in thickening of extensor retinaculum, and compression of tendons esp during radial deviation
  • Characterized by degeneration and thickening of tendon sheath
A

De Quervain’s Disease

141
Q

What are some predisposing factors to De Quervain’s disease?

A

Overuse, repetitive tasks involving overexertion of thumb or radial/ulnar deviation of wrist, and arthritis

142
Q

What test is used to determine De Quervain’s disease?

A

Finkelstein test - grab thumb in fist and ulnar deviate

143
Q

What condition is characterized by:
- active cellular process in fascia of hand, characterized by development of nodules in palmar and digital fascia

  • contractures at MCP, PiP, and sometimes DiP joint
  • has a higher incidence in alcoholics, diabetic, and epileptics
A

Palmar Fasciitis or Dupuytren Contracture

144
Q

T or F?
Conservative treatment for Palmar fasciitis is clinically useful

A

False - it is not useful

145
Q

What can happen if an extensor tendon ruptures?

A

Mallet finger forms at DiP joint

146
Q

What tendon rupture is rupture of the flexor pollicis profundus at its insertion and is caused by a forceful passive extension while FDP is contracting?
(like when a finger is caught in a jersey while tackling in football)

A

Rupture of the terminal phalangeal flexor (Jersey Finger)

147
Q

What fracture of the distal radius is a complete fracture with posterior displacement of the distal fragment?

A

Colle’s Fracture

148
Q

What fracture of the distal radius is a complete fracture with palmar displacement of the distal fragment?

A

Smith’s fracture

149
Q

What fx of the distal radius is a posterior or molar articular fracture resulting in wrist subluxation?

A

Barton’s fracture

150
Q

What fracture of the distal radius is incomplete and undisplaced and commonly seen in children?

A

Buckle fracture

151
Q

Fx of what bone in the hand is commonly missed but is caused be a FOOSH, has poor blood supply leading to delayed healing or nonunion, and there is pain over the anatomic snuffbox?

A

Scaphoid in hand

152
Q

An ulnar collateral ligament sprain (aka gamekeeper’s thumb, skier’s thumb, breakdancer’s thumb) of the thumb is an injury to the UCL of the MCP joint of thumb and is commonly caused by what?

A

A hard abducting force on the thumb

153
Q

What condition, formerly known as reflex sympathetic dystrophy, refers to a disorder that can occur even after minor injury to a limb?

A

Complex regional pain syndrome

154
Q

What are symptoms of CRPS (complex regional pain syndrome)?

A

Pain and increased pain sensitivity, change in skin color or texture, swelling, change in skin temp, decreased function, and rapid or no hair/nail growth

155
Q

What are things that may worsen complex regional pain syndrome?

A

Immobilization and over protecting the limb

PTA (21 decks)

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