Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Medicine II: Orthopedics > Shoulder and Elbow > Flashcards

Shoulder and Elbow Flashcards

1
Q

Identify the anatomical structures of the shoulder and elbow

A

ok

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Rotator Cuff Tendonitis

A

Supraspinatus tendon is most often initially involved. Impingement syndrome, characterized by overhead activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Physical Exam for Rotator Cuff Tendonitis

A

Pt may occasionally be awakened by pain at night. Active ROM is limited by pain; no atrophy present; passive ROM shows mild weakness. Neer impingement sign positive and improves with lidocaine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Rotator Cuff Tears

A

Most common at the humeral insertion site of the supraspinatus tendon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Cause of Rotator Cuff Tears

A

Degenerative changes, microtrauma, intrinsic or extrinsic compression; acute trauma. Partial tears or full thickness tears.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Patient Presentation with a Rotator Cuff Tear

A

Pain and weakness (overhead), deltoid insertion (referred). Insidious, more common in older population. Consistent Night pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Physical Exam for Rotator Cuff Tears

A

Rotator cuff weakness with external rotation, abduction and internal rotation. Tender to palpation on the rotator cuff. Positive impingement signs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

X-rays for Rotator Cuff Tears

A

Acromial hook, Acromioclavicular joint, DJD. Superior migration of humeral head (massive tear).

Can also get: US/Arthrogram or MRI +/- contrast- very sensitive (too sensitive?)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Treatment for Rotator Cuff Tears

A

PT, NSAIDs, Injection, Surgery (open vs. arthroscopic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Treatment for Bursitis

A

Activity modificiation, PT, oral antiinflammatory meds; surgery after failure of tx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Bursitis

A

Inflammation of the subacromial bursa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Bursitis

A

Neer impingement sign positive (impingement of the supraspinatus tendon) and improves with lidocaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

SLAP Lesion

A

5-7% of first time dislocators, O’Brien test: + test if pain is worse when thumb is down. Superior labrum anterior posterior lesions = origin of long head of biceps brachii and superior capsulolabral structures. Type II most common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Diagnosis and Treatment for a SLAP Lesion

A

Diagnostic arthroscopy remains the best means to dx SLAP definitively. Active compression test may be the most useful maneuver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Shoulder Impingement Syndrome

A

Abnormal calcification of the CA ligament, Abnormal acromial morphology. Dynamic factors- rotator cuff dysfunction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Patient Presentation with Shoulder Impingement Syndrome

A

Insidious onset, pain (anterolateral shoulder, overhead, reaching behind, night, insidious)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Physical Exam for Shoulder Impingement Syndrome

A

Tenderness over rotator cuff/greater tuberosity. Sometimes limited motion 2 degree pain. Positive for impingement signs. Strength sometimes dimished due to 2 degree pain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

X-rays for Shoulder Impingement Syndrome

A

Acromial hook

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Treatment for Shoulder Impingement Syndrome

A

Physical therapy: rotator cuff strengthening, NSAIDs, Injection (diag + ther); Surgery- arthroscopic subacromial decompression.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Shoulder Instability (uni- and multi directional)

A

Test anterior, posterior and inferior instability. Multidirectional = positive sulcus sign. Classification based on direction of instability that elicits symptoms and presence or absence of hyperlaxity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Tests for Shoulder Instability (uni- and multi directional)

A 
Anterior = apprehension test or relocation test. 
Posterior = circumduction test or Jahnke test. 
Inferior = sulcus sign
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

TUBS: Shoulder Instability (uni- and multi directional)

A

caused by Traumatic event, Unidirectional, Bankart lesion associated; often requires Surgical treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

AMBRI: Shoulder Instability (uni- and multi directional)

A

Atraumatic, Multidirectional instability that may be Bilateral and best treated by Rehabilitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Adhesive Capsulitis aka:

A

Frozen Shoulder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Cause of Adhesive Capsulitis

A

Idiopathic: endocrine (DM, hypothyroidism)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Who is more prone to Adhesive Capsulitis

A

Diabetics and Females >40yo.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Presentation and Exam of a patient with Adhesive Capsulitis

A

Global, mostly anterior pain. Pain with any motion, especially sudden movements.

Active = passive ROM. Shoulder stiffness, painful, significant restriction in both active and passive ROM
Articular surfaces are normal and joint is stable, yet there is restricted ROM. Painful External Rotation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Imaging for Adhesive Capsulitis

A

Not typically helpful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Treatment for Adhesive Capsulitis

A

THERAPY!!!! (Do specific exercises), athroscopic release, closed manipulation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Lateral Epicondylitis

A

Most common problem of the elbow, 80% will have symptom improvement at 1 year; “tennis elbow”. 4th and 5th decade,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Etiology of Lateral Epicondylitis

A

chronic degenerative problem of the ECRB tendon. Common tendon to extensor muscles of hand and wrist.

32
Q

Most common site of Lateral Epicondylitis

A

Extensor carpi radialis brevis is most common site

33
Q

Patient Presentation with Lateral Epicondylitis

A

Chronic, bothersome pain, tenderness at lateral humeral epicondyle, pain with extension of wrist against resistance. Tender slightly anterior and distal to the lateral epicondyle, pain with resisted wrist extension; resisted 3rd MCP extension = pain

34
Q

Treatment of Lateral Epicondylitis

A

Non-op TX: NSAIDs, cortisone injections, orthotics, shockwave/laser/sclerotherapy, PRP, trephinatino, PT

Sx: failure of conservative tx, > 90% good to excellent result
TX: tennis elbow band, exercises, injection of local anesthetic and cortisone.

35
Q

Medial Epicondylitis

A

3rd to 5th decade, less common than lateral epicondylitis; “golfer’s elbow”. Ulnar neuropathy present in 50%

36
Q

Etiology of Medial Epicondylitis

A

Not entirely an inflammatory disorder, more an overuse injury

37
Q

Patient Presentation with Medial Epicondylitis

A

Common flexor origin, possibly with ulnar nerve compression. Medial elbow pain with activity, esp pronation. Tenderness over anterior aspect of the medial epicondyle or just distal in the flexor pronator mass, resisted pronation tenderness, resisted wrist volar flexion, ROM normal.

38
Q

Medial Epicondylitis

A

Non-op TX: NSAIDs, cortisone injection, wrist splint, PT after rest and discomfor decreases

SX: failed conservative tx, medial epicondylar debridement, ulnar nerve decompression/transposition, usually good to excellent results

39
Q

Olecranon Bursitis

A

Swelling and inflammation of olecranon bursa may result from trauma or may be associated with RA or gouty arthritis. Majority of cases are aseptic (three groups: idiopathic, traumatic and crystal induced). Patients are likely to be in fourth to sixth decades of life. Patients may have jobs involving repetitive elbow motion (mining, gardening and mechanical work). Swelling is superficial to olecranon process.

40
Q

Diagnosis of Olecranon Bursitis

A

**Most important test is analysis of bursal fluid (22 gauge needle, take 10ml)

41
Q

Presentation and Physical Exam for Olecranon Bursitis

A

Patient usually report direct blow to area or a hx of repetitive trauma. Localized bursal swelling and fluctuance over dorsal aspect of elbow. Fluid levels vary from a few mL to 40mL. Pts usually have painless ROM. Need to r/o fracture, infection and gout. Aspiration is indicated in pts on initial presentation

42
Q

Treatment of Olecranon Bursitis

A

Aseptic: Aspirate and inject cortisone if fluid is clear
Septic: Antibiotics (dicloxacillin or ciprofloxacin), may repeat aspiration if needed

43
Q

Mechanism of Anterior Glenohumeral Joint Dislocation

A

> 90% of all shoulder dislocations. Determine traumatic vs atraumatic. Mechanism: abduction, forced external rotation à humeral head levers against anterior capsule

44
Q

Patient Presentation with Anterior Glenohumeral Joint Dislocation

A

Arm held at side and external rotation, humeral head prominent, check axiallary nerve, before and after CR

45
Q

Imaging for Anterior Glenohumeral Joint Dislocation

A

Xray: axiallary lateral most importatnt, esp post reduction. May need MRI to evaluate labrum and cuff after reduction. CT sensitive for glenoid and humeral bone loss

46
Q

Treatment for Anterior Glenohumeral Joint Dislocation

A

TX in a sling, return to activity in 10 days. Surgery for first time dislocators in < 20, active. > 90% chance of recurrence.

Reduction maneuvers: conscious sedation, intra-articular lidocaine.

47
Q

Posterior Glenohumeral Joint Dislocation

A

2-4% of dislocation, missed 60-80% of the time

48
Q

Mechanism of Posterior Glenohumeral Joint Dislocation

A

Posterior direted force in adducted, IR humerus. Also common from violent muscle contractions: seizures, electrocution injuries.

49
Q

Patient Presentation with Posterior Glenohumeral Joint Dislocation

A

Shoulder internally rotated, unable to abduct or ER

50
Q

Imaging for Posterior Glenohumeral Joint Dislocation

A

Xrays: light bulb sign (IR), empty glenoid, RIM sign (distance bt glenoid and articular surface of humerus > 6 mm), reverse Hill-Sachs

51
Q

Treatment for Posterior Glenohumeral Joint Dislocation

A

Reduction maneuer- immobilization for 4-6 weeks in extensionand external rotation

52
Q

What is the most common type of Clavicular Fracture?

A

85% midclavicular fx, distal fx (15%), proximal fx (5%).

53
Q

Cause of Clavicular Fractures

A

Falls, MVA

54
Q

Treatment for Clavicular Fractures

A

Sling vs Figure 8 brace. Neuro exam is extremely important: pulses, strength, and sensation too.

55
Q

Operative Indications for Clavicular Fractures

A

Open, skin tenting with severe displacement, certain medial and lateral fracture patterns

56
Q

Surgical Treatment for Clavicular Fractures

A

Union: 2-4 mo. (longer for smokers); X-ray every 4 weeks.

57
Q

Prevalence of Humeral Fractures

A

Proximal are 4-5% of all fractures

58
Q

Cause of Humeral Fractures

A

Bimodal distribution- high energy in younger pts; low energy falls in osteoporotic bone. Outcomes based on fracture patterns/severity: AVN, nonunion/malunions

59
Q

Most common nerve injured with Humeral Fractures

A

Axillary nerve is most common injured nerve; test light touch and pinprick

60
Q

Imaging for Humeral Fractures

A

Need AP and lateral views as well as axillary view

61
Q

Treatment of Humeral Fractures

A

Most treated non-op: sling, PT after short immobilization, will often have residual stiffness, pain until callus formation. ORIF in younger pts; ORIF vs hemiarthroplasty in older pts with comminuted fx.

Long recovery: 6 mo-1 year, all will have residual stiffness. Loss of normal contour of shoulder, tenderness, ecchymosis and crepitus on ROM

62
Q

Treatment of Radial Head and Neck Fractures

A

Non-op: minimally displaced fractures, early ROM w/in 1 week. ORIF; younger, intra-articlar step-ff > 2 mm, block to motion. Radial head replacement: older, severe comminution.

63
Q

Etiology of Radial Head and Neck Fractures

A

Fx most commonly involves distal metaphysis of radius (14% of all fractures). Usually from FOOSH or dislocation of elbow

64
Q

Imaging for Radial Head and Neck Fractures

A

CT for pre-op planning/MRI to r/o injuries to ligaments/cartilage

65
Q

Treatment for Radial Head and Neck Fractures

A

Influenced by pattern and bone quality. Consider age/functionality. Surgery vs cast application

66
Q

Radial Shaft Fractures

A

Nondisplaced or minimally displaced fx of the ulnar shaft are common, usually from a direct blow (nightstick fracture)

67
Q

Galeazzi Fracture

A

Distal 1/3 radius fracture PLUS distal radial joint (DRUJ) injury/dislocation

68
Q

Treatment for a Galeazzi Fracture

A

Open reduction and internal fixation of radius +/- DRUJ stabilization

69
Q

Monteggia Fracture

A

Proximal ulnar fracture with radial head dislocation/fracture

70
Q

Treatment for Monteggia Fracture

A

ORIF ulna plus closed reduction radial head or ORIF

71
Q

Cause of Radial Head Subluxation (Nursemaid’s Elbow)

A

Forceful pull on childs extended/pronated arm. Annular ligament tears.

72
Q

Presentation of a patient with Radial Head Subluxation (Nursemaid’s Elbow)

A

Initial pain, then resumes play but does not use affected arm. Holds at side in flexor and pronation.

73
Q

Physical Exam for Radial Head Subluxation (Nursemaid’s Elbow)

A

Radial Head tenderness

74
Q

X-Rays for Radial Head Subluxation (Nursemaid’s Elbow)

A

Needed but not helpful

75
Q

Treatment for Radial Head Subluxation (Nursemaid’s Elbow)

A

Closed manipulation= constant slow supination, then elbow flexion. You will hear a “pop”. Initial pain and then use of arm. No immobilization. Parent education.

Medicine II: Orthopedics (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions