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Ortho > shoulder/elbow > Flashcards

shoulder/elbow Flashcards

1
Q

Common shoulder problems for young people:

A

instability, trauma

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2
Q

common shoulder problems for middle age

A

rotator cuff, frozen shoulder

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3
Q

common shoulder problems for elderly

A

arthritis, fx

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4
Q

What’s the first classification you want to make when working with a shoulder dislocation?

A

Trauma or not? Unidirectional vs multi-directional

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5
Q

Patient c/o lateral pain from deltoid down to elbow. Where is this typically coming from?

A

Cuff

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6
Q

Patient c/o shoulder pain that radiates to hand, where is this typically coming from?

A

cervical spine

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7
Q

What shoulder problems cause loss of ROM?

A

1) Adhesive capsulitis
2) OA
3) cuff tear

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8
Q

What comorbidities are particularly relevant to MS issues?

A

DM, thyroid, smoking and any serious med problem that would r/o candidacy for sx

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9
Q

pop-eye deformity

A

Stephanie: biceps tear

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10
Q

What problem most commonly causes muscle wasting?

A

compression neuropathy

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11
Q

If you can get more ROM from the shoulder passively than actively, what are you thinking first?

A

cuff tear

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12
Q

If you have lost passive ROM in the shoulder, what are you thinking first?

A

OA, adhesive capsulitis

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13
Q

SITS muscles

A

supraspinatous, infraspinatous, teres minor, subscapularis

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14
Q

SITS muscle fxn

A

1) supraspinatous–abduction
2) infraspinatous–external rotation
3) teres minor–multidirection accessory
4) subscapularis–internal rotation

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15
Q

What special test is checking internal rotation?

A

Gerber lift-off

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16
Q

Gerber lift off is checking what muscle strength?

A

subscapularis

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17
Q

What is the belly press test checking?

A

subscapularis

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18
Q

Which PE tests are looking for impingement of the rotator cuff?

A

Neer (arm raise) and Hawkin’s

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19
Q

If you passively moved the arm in adduction across the body, what would you be checking for?

A

pain reproduced at AC joint

also can reproduce impingement pain

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20
Q

The _________ sign shows a tear in the _________ and is concerning b/c it limits the ability for patients to perform ADL’s like brushing teeth/hair, feeding

A

Hornblower’s sign, teres minor

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21
Q

Infraspinatous is responsible for ______ rotation. If a patient’s arms are passively placed in jazz hand position, but they cannot maintain it, this is a positive ____________

A

external rotation, Lag test

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22
Q

What are the signs of shoulder instability?

A

A) Apprehension, humerus feels like it will pop out anteriorly
B) Jobe relocation, feels better if you push posteriorly on proximal humerus
C) Augmentation–feels worse if you pull anteriorly
D) Release–Release of JOBE feels bad

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23
Q

What are the grades of the load and shift test for shoulder stability?

A

0–no movement
1–humeral head to the glenoid labrum
2–humeral head over glenoid rim
3–dislocation

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24
Q

A sulcus sign is suggestive of __________________

A

ligament laxity = multidirectional instability

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25
Q

How could you test posterior instability of shoulder?

A

Jerk test: arms out like linebacker, push posteriorly and listen/feel for jerk/clunk

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26
Q

SLAP

A

superior labrum, anterior/posterior

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27
Q

What is a common cause for young people to get a SLAP tear?

A

throwing

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28
Q

What test can you do to check a SLAP tear?

A

O-brien’s test/empty can test. Arm is horizontal, 10 degrees adducted. Pain worse with thumb down

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29
Q

2 tests for biceps?

A

speed test (wolverine) and yergason test (elbow flexion).

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30
Q

Long thoracic nerve palsy is a/w ___________

A

medial winging of serratus anterior

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31
Q

Lateral winging is caused by __________ nerve palsy, and is a/w what muscle?

A

CN XI, trapezius

32
Q

How can you tell the difference b/t medial and lateral winging?

A

Medial–wall push up produces vertical wing.

Lateral–external rotation produces oblique wing

33
Q

What type of imaging is best for the rotator cuff/SLAP region?

A

MRI with contrast

34
Q

What type of shoulder problems are mostly bony and should be evaluated with a CT?

A

Hill-Sach’s, Bankart, Glenoid morphology

35
Q

90% of all shoulder dislocations are _______

A

anterior

36
Q

90% of first time anterior shoulder dislocations are _______________

A

Bankart Lesions

37
Q

What is actually the damaged structure in a bankart lesion?

A

anterior inferior glenoid labrum

38
Q

What complication is often a/w a bankart lesion?

A

Hill Sach’s lesion/fx of the humeral head

39
Q

What will a patient’s arm look like if there is an anterior shoulder dislocation?

A

prominent humeral head with external rotation

40
Q

What must you check in the event of an anterior shoulder dislocation?

A

axillary nerve

41
Q

How do you tx anterior shoulder dislocation?

A

conscious sedation, reduction, sling, sx for repeaters

42
Q

What can cause a posterior dislocation aside from posterior directed force?

A

violent muscle contractions in sz or electrocution

43
Q

What will the arm look like in a pt with a posterior shoulder dislocation?

A

internally rotated, unable to abduct

44
Q

What are you looking for on xray for posterior dislocation?

A

light bulb sign, empty glenoid

45
Q

how do you tx a posterior shoulder dislocation?

A

sedation, reduction by external rotation and push humeral head anteriorly, then immobilize x 6 weeks

46
Q

How can you tx recurrent instability of shoulder?

A

PT, sx to repair labral tear, reconstruction of bone loss

47
Q

A fall onto the shoulder or catching a backwards fall with your elbows is likely to cause __________

A

AC joint separation

48
Q

This is an idiopathic condition characterized by pain and stiffness of the shoulder at rest. Pain increases at extremes of ROM. Ability to perform AROM is equal to PROM

A

adhesive capsulitis

49
Q

adhesive capsulitis is thought to be related to what systemic conditions?

A

endocrine (DM, thyroid)

50
Q

how do you tx this frozen shoulder?

A

PT, NSAIDS, CS inj, arthroscopy

51
Q

What’s the difference b/t a subacromial impingement and a rotator cuff tear?

A

spectrum of severity.

52
Q

What imaging is used for rotator cuff tear eval?

A

MRI for uncertain dx or pre-sx

53
Q

Most common mgmt for cuff tear?

A

PT

54
Q

Term for when the rotator cuff cant contain the humeral head withing the glenoid

A

rotator cuff arthropathy

55
Q

What can be done for rotator cuff arthropathy?

A

Reverse TSA (total shoulder arthroplasty) for pts with no rotator cuff fxn (fossa becomes ball, humerus becomes socket)

56
Q

What does high-dose steroids increase the risk of?

A

AVN

57
Q

Tx of OA in shoulder

A

NSAIDS, Cox2, PT, CS inj

58
Q

how are non-displaced proximal humerus fx’s treated?

A

ORIF with sling/immobilization

long recovery, residual stiffness!!

59
Q

where is the most common location for a clavicular fx?

A

middle 3rd

60
Q

when do you repair a clavicle fx?

A

if > 2cm of shortening

61
Q

the trochlea articulates with the ________

A

coronoid process of the ulna

62
Q

The capitellum articulates with the __________

A

radial head fossa

63
Q

what are you thinking if there is ttp over the medial epicondyle of the elbow?

A

1) medial epicondylitis
2) MCL injury
3) medial epicondyle avulsion

64
Q

A positive Tinel’s sign in ulnar nerve distribution indicates _________

A

cubital tunnel

65
Q

Where is the tenderness in tennis elbow?

A

lateral epicondyle/radial head/capitellum

66
Q

What is the milk test?

A

like your doing a delt stretch and you milk the thumb, which creates valgus stress and reproduces pain in problem with the ulnar collateral ligament

67
Q

MOI for UCL injury

A

land on palm, valgus stress from supination

68
Q

what is the most common problem of the elbow?

A

lateral epicondylitis

69
Q

What does lateral epicondylitis look like on PE?

A

tenderness is anterior and distal to lateral epicondyle, wrist extension exacerbates

70
Q

How do you tx epiconylitis?

A

NSAIDS, CS inj, orthotics, PT, LASERS, sx

71
Q

Lateral epicondylitis is an inflammatory disorder, what about medial epi?

A

more of an overuse injury (especially pronation)

72
Q

Which nerve is a/w neuropathy in 50% of medial epicondylitis cases?

A

ulnar

73
Q

Medial epicondylitis is a/w with increased pain during what movements?

A

pronation and wrist flexion

74
Q

What are the 3 tx’s for radial head fx?

A

1) Conservative–non-displaced
2) ORIF for young or displaced >2mm
3) replacement–older, severely comminuted

75
Q

The _______ is a fracture of the distal radius with dislocation of the distal radioulnar joint

A

galeazzi fx (distal, radial fx)

76
Q

The ___________is a fracture of the proximal third of the ulna with dislocation of the head of the radius

A

monteggia fx (proximal, ulna fx)

Ortho (10 decks)

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