Random Shit To Know Flashcards
Kienbock’s Disease
AVN of lunate
Hypothenar hammer syndrome
Post-traumatic (micro or macro) digital ischemia of ulnar artery at Guyon’s canal. Pain over hypothenar eminence and ring finger (maybe small, middle, or index). Paresthesias.
Ulnocarpal impaction syndrome
Has positive ulnar variance (ulna longer than radius) with ulnar wrist pain due to impaction of ulna with carpals.
Elson Test
Special test for boutonnière deformity. Elson test: bend PIP 90 degrees over edge of table and try to extend the MIDDLE phalanx. If weak and the DIP gets rigid this is a positive test (DIP should stay limp)
Preiser’s Disease
AVN of scaphoid
Bennett’s Fracture
Fracture plus dislocation of metacarpal bone at base of thumb. Even though it is a fracture, there should still be a small fragment of the 1st metacarpal that continues to articulate with trapezium.
Pinch Grip Test
Looking to see if you can pinch the tips of thumb and index. Looks at anterior interosseous branch of median nerve. Can get compressed between heads of pronator teres. Innervates FPL, index and long fingers of FDP, pronator quadratus.
Wartenberg’s Sign
Position of abduction in the pinky. The ulnar nerve controls abduction and adduction of the pinky but with abduction the extensor digiti minimi and branch to pinky from EDC also play a part and are controlled by radial nerve. To do this test you have palm on a table and have them extend the fingers then abduct and adduct (they won’t be able to adduct).
Wartenberg Syndrome
Entrapment of superficial branch of radial nerve at posterior border of brachioradialis. Provides sensory input to dorsum of thumb, index, and middle fingers proximal to PIP’s.
Elbow flexion test
Test for ulnar neuropathy. Elbows maximally flexed, forearms maximally supinate, wrist placed in extension. Hold up to 3 minutes.
Froment’s Sign
Test for ulnar nerve palsy. Test for adductor pollicis (innervated by ulnar nerve). If positive the FPL (innervated by median nerve) will substitute and hyper flex IP joint. The patient will make strong pinch between thumb and index finger of flat object, then try to pull it out.
Bunnell-Littler Test
Evaluates source of PIP flexion motion limitation.
Normal = full PIP flexion with MCP extension
Capsular Retriction = no increase in PIP flexion with MCP flexion
Lumbrical Restriction = increased PIP flexion with MCP flexion
Scaphoid Shift Test
Looks at scapholunate instability. Also called Watson’s shift test. Patient rests elbow on table. Place thumb on palmar scaphoid and other fingers around forearm. Other hand puts their hand in ulnar deviation and extension. Move hand passively into radial deviation and flexion while keeping pressure on scaphoid. If you let go of the force abruptly there will be a painful thunk.
Murphy’s Sign
Sign for lunate dislocation. If you have patient make a fist the 3rd metacarpal should be higher than 2nd/4th. If sunken in there may be lunate dislocation.
Arcade of Struthers
Thin aponeurotic band from medial head of triceps to medial intermuscular septum about 6-10 cm proximal to medial epicondyle where ulnar nerve travels.
Time For Fracture to Heal
Minimum of 6 weeks
Speeds and Dynamic Speed’s Test
- Speed’s
- Resisted flexion from 90 flex/ER/supination/elbow extension position - Dynamic Speed’s
- Elbow flexed (90), shoulder flexed (45). Pull arm up towards ceiling against resistance
Yergason’s Test
Arm down by side with elbow at 90 and arm pronated. Supinate the arm against resistance and check for recreation of anterior shoulder pain at long head of biceps.
Bony Bankart
Avulsion fracture of anteroinferior glenoid associated with anterior shoulder dislocation.
Hill-Sachs Deformity
Impaction of posterior/superior/lateral humerus following anterior dislocation (Bankart).
Bristow-Laterjet Procedure
Procedure for anterior shoulder dislocations where they saw off coracoid and screw it to the front of the glenoid as a bumper plate.
Load and Shift Grades and What is Normal
25% anteriorly and 50% posteriorly is normal.
Grade 0 = Normal
Grade 1 = Excessive mobility up to glenoid rim but no subluxation
Grade 2 = Subluxation but spontaneous reduction
Grade 3 = Frank dislocation with locking
Anterior Interosseous Nerve vs Median Nerve
Median nerve travels between the 2 heads of the pronator teres and then gives rise to AIN (the median nerve continues down as well). The median dives between the FDS and FDP.
AIN: FPL, Radial 2 FDP, Pronator quadratus.
Median: Rest of the wrist/finger flexors (except FCU and ulnar FDP); 1st 2 lumbricals; thenar muscles; sensation to median nerve distribution.
Median nerve comes off lateral and medial cords.
Ulnar Nerve Course and Innervation?
Arises from medial cord of brachial plexus. Travels under Arcade of Struthers and then Osborne band.
Innervates: FCU, medial 1/2 FDP, 2 ulnar lumbricals, all 4 hypothenar muscles, all interossei, adductor pollicis. Ulnar nerve sensation.
Radial Nerve Origination and Innervation?
Arises from posterior cord. Divides into superficial and deep branch, deep branch turns into posterior interosseous nerve. Innervates BEAST brachioradialis/Brachialis, extensors, Anconeus, supinator, triceps.
How long to results of corticosteroid injections last?
2-6 weeks.
Cozen’s Test
Resisted wrist extension in 90 flexion, pronation, radial deviation. Sensitive test.
Mill’s Test
Pronate, flex wrist, extend elbow. Don’t flex the fingers though.
Maudsley’s Test
Resist 3rd digit extension in elbow extension position (very sensitive).
When does peel back mechanism occur?
Cocking phase of throwing
Putti-Platt Procedure
Tightening the anterior capsule and subscapularis with subsequent accepted loss of ER to increase stability of shoulder. Not used for baseball players because of the loss of ER.
Fat-Pad Sign
Also called “sail sign”. Describes the elevation of the anterior fat pad. It’s usually concealed in the coronoid fossa. Happens with increased swelling or a fracture (usually condylar in children and radial head in adults).
Capsular Shift
Capsule and ligaments tightened to increase shoulder stability. This has fallen into favor for MDI and will maximize stability but allow full return of ROM.
Volkmann’s Contracture
Acute ischemia to the muscle fibers of the forearm flexors»_space; extensors.They become fibrotic and shortened and leads to contracture. This is caused by obstruction of the brachial artery near the elbow due to improper/poor fitting of cast; supracondylar fractures; crush injuries; and compartment syndromes.
Position on arm: Wrist flexion/pronation, thumb adduction, MCP extension, IP flexion
Runner’s Hematuria Prevention
- Keep a small amount of urine in the bladder before run
- Avoid high doses of NSAID’s (they have blood-thinning effects and can exacerbate problem)
Runner’s Hematuria Management
Usually clears up within hours/days. Regardless, recommend sending to PCP to investigate possibility of serious pathology (kidney stones, cancer, etc.)
Diuresis
Water loss at the kidneys
Wound healing intention?
Primary Intention = when wound edges are approximated (sutures, staples, glute)
Secondary Intention = wound edges cannot be approximated and wound needs to heel from the bottom
Tertiary Intention = combination of both, wound cannot be stitched up immediately but can after awhile
Time delay allowed to close wound to have minimal risk for infection?
4-6 hours so wound edges aren’t too inflamed, colonized, or necrotic.
Management of hypoglycemia?
Mild: management can be treated with absorbed glucose, hard candy, sugared beverage, fruit juice.
Severe: Usually has mental status changes, autonomic changes, and/or collapse. Needs to be treated with subcutaneous/intramuscular injection of glucagon (kits for home administration are available and should be available at athletic events for athletes with DM1).
Athlete Collapses With No Prodromal Symptoms?
Cardiac collapse tends to be instantaneous with no symptoms prior to the collapse. If they have ventricular fibrillation they will hit the ground and no longer talk.
Sickling Collapse vs Heat Collapse
Sickling collapse usually occurs within first 1/2 hour on field and core temperature not greatly elevated.
Salter-Harris Fracture
A growth plate fracture of a long bone.
Type 1: Fracture line runs straight across growth plate
Type 2: Fracture breaks at an angle going through most of the growth plate and the metaphysis
Type 3: Rare. Usually in distal tibia bone. Cuts vertically through epiphysis and then through part of physis (almost like a 90 angle)
Type 4: Vertical/oblique line that goes through metaphysis, physis, and epiphysis.
Type 5: Growth plate damage but no fracture.
1 = Straight
2 = M
3 = E
4 = ME
5 = Crush
