Shoulder and Upper and Lower Extremity Disorders Flashcards
Anterior and Posterior Joint Dislocation and Deformities
Anterior MC than posterior
Posterior associated with seizure/electrocution
Bankart lesions: tear in the labrum with dislocation - increases risk future dislocation (Bony Bankart is ant glenoid - surgical)
Hillsachs Deformity: lose chunk of humoral head from glenoid impact - humoral groove
AC Joint Separation Grading
Grade 1: only acromioclavicular ligament strained - highest arthritis risk
Grade 2: Disruption of AC and mild coracoclavicular ligament displacement
Grade 3: Tear all 3 ligaments - get >100% displacement distal clavicle end
Parsonage Turner Syndrome
Brachial plexus neuritis or neuralgic amyotrophy
- inflammation of suprascapular or entire brachioplexus
Often seen after vaccination or URI - white knuckle pain with nerve burnout and weakness and atrophy after
May eventually resolve
Tx: w/ oral corticosteroids, Neurontin, PT
Brachial Plexus Traction Injury
“stingers”
Stretching of brachial plexus - usually traumatic football injury
C5-C6 MC
Temporary arm numbness, will resolve over time
Calcific Tendonitis
Deposition of hydroxyapatite into rotator cuff tendon
Deposition phase: gooey toothpaste-like - more painful and inflammatory, white-knuckle pain with active movement
Reabsorption phase: chalk-like, more dormant w/o inflammation
Adhesive Capsulitis
Idiopathic frozen shoulder with tightening and shrinking of shoulder capsule
Female, DM, hypothyroidism
Freezing, frozen, thawing phases - no more pain @ rest after freezing, only w/ abduction over 90 degrees
Insidious onset with pain, night pain in elbow (referred)
Loss of passive and active ROM
Conditions that cause both passive and active ROM loss in shoulder
Adhesive capsulitis
Glenohumeral osteoarthritis
Proximal biceps tendon rupture
Long-head rupture - electric shock sensation with bruising and deformity
Elderly - association w/ rotator cuff injury due to age
SLAP
Superior labral, anterior-posterior labral injuries
Long head of biceps inserts on anterior superior glenoid - biceps anchor
MC complaint = pain throwing ball
+Obrien test, crank, clunk, and resisted supination and external rotation test
Distal Biceps Tendon Rupture
Pain, muscle cramp with “Popeye” deformity
Lose peak flexion, but still have supinator and brachioradialis (flexor)
Typically broken during eccentric motion - trying to catch something
Hooks test for tendon attachment
Enthesis
Enthesopathy
Enthesis: where tendon attaches to bone
Enthesopathy: disease of the area where tendon attaches to bone
Medial and Lateral Epicondylitis
Angiofibromatis metaplasia - histopathology
Tennis = lateral (MC) = extensor digitorum complex
Golfer = medial = flexor/pronator muscles
Radial and Ulnar Nerve Palsies
Radial innervates extensors - caused by sleeping on arm, get wrist drop and limp fingers and numbness in 1st dorsal web space
-MC @ cubital tunnel
Ulnar innervates flexors and ulnar deviator - WArtenberg’s and Froment’s sign
-MC @ carpal, then cubital tunnel
Dupuytren’s Contracture
Thickening of palmar fascia superficial to tendons - no tendon involvement
Myofibrous contraction where muscle fibers contract down and scar - get prominent cord in finger
Lederhosen on feet, Pyrones on penis
Open palmar fasciectomy is gold standard
Splinting doesn’t work = get palm skin necrosis
Ganglion Cysts
Filled with synovial fluid from weakening in joint capsule
Outpouch at the joint
