Shoulder, Elbow, Wrist and Hand Flashcards
Joint that stabilizes the shoulder in the AP plane
Acromioclavicular
Joint that helps prevent vertical dislocation of humerus
Corcao-acromial
Function of the supraspinatus muscle
Initiation of arm abduction/elevation
Depression and centering of the humeral head on the glenoid
Function of the Infraspinatus and teres minor muscles
External rotation of the humerus
Function of the subscapularis muscle
Internal rotation of the humerus
Pathology that results from a loss of innervation/function of the periscapular muscles of the shoulder (scapulothoracic joint)
Loss of 2:1 motion of scapula to humerus
Potential for subacromial impingement
Potential for winged scapula
Periscapular muscles
Trapezius Rhomboid Levator scapulae Serratus Latissimus
Function of the coraco-acromial arch
Prevents vertical displacement of the humerus
Role of the coracoacromial ligament/arch in shoulder impingement
Previous injury to the CoAc joint can cause calcinosis of the ligament, increasing the risk for subacromial impingement
Ligaments most commonly involved in subacromial impingement
Supraspinatus and long head of the biceps
Spectrum of disease seen in rotator cuff tears (based on age)
YOUNG: Most commonly overruse pain with activity only
MIDDLE: Most commonly impingement or overruse, pain occurs with activity and can awaken at night
OLD: Most commonly a true rotator cuff tear or bony impingement. Pain is chronic even at rest.
PE tests that can be performed to detect impingement
Neer, Hawkins
Mechanism by which supraspinatus weakness can cause impingement
Supraspinatus typically depresses humeral head
With weakness, humerus can rise and pinch the supraspinatus tendon beneath the acromion
Shoulder position in an anterior dislocation
ABducted
EXternally rotated
Shoulder position in a posterior dislocation
ADDucted
INternally rotated
Burkhart’s lesions
Tear of the anterior-inferior labrum in an anterior shoulder dislocation
Hill-Sach’s Lesions
Denting of the humerus in shoulder dislocation
Common causes of posterior humeral dislocation (uncommon)
Trauma
Electrocution
seizures
Multidirectional Humeral Instability
Can develop as a result of multiple dislocations or laxity of the rotator cuff
Patients often experience multiple subluxation events and show hesitance on exam
A frank dislocation event is rare
Treatment options in shoulder dislocations
Patients should get XR to evaluate for fracture and then reduced
XR should be repeated in 3-10 days to ensure no fracture
Indications for a surgical reduction of a shoulder dislocation
If repeated instability and subluxation is not corrected in PT
Patient has anatomical snuffbox pain
Immobilize ALWAYS, may be an occult scaphoid fracture
Bennett’s Fracture
Fracture of the 1st metacarpal due to an axial force against a flexed thumb (bad punching form)
Fracture is very unstable as AbPL pulls fracture proximally and AdPL adducts fracture
Boxer’s fracture
Angular fracture of the 5th metacarpal
Heals well
Distal radial fracture
Common fracture in adults FOOSH (may also occur with an ulnar styloid fracture)
Heals well
Phalangeal fracture (Skiier’s Thumb)
Avulsion fracture of the ulnar collateral ligament of the 1st digit DIP joint.
Mallet Finger (fracture)
Similar to Skiier’s thumb, but an avulsion fracture of the DIP of fingers due to the lateral extensor tendons of the DIP joint
Soft tissue mallet is the same without fracture
Muscle implicated in tennis elbow
Extensor carpi radialis brevis
Defromity in mallet finger
PIP Extension is lost, PIP joint remains flexed on extension
Boutinnier Deformity
Rupture of the central extensor slip (DIP)
Leads to inability to extend DIP joint, but PIP joint remains intact
Symptoms of an RA extensor tendon ruputre
inability to extend thumb due to rupture of the EPL
Ulnar deviation of the fingers
Tendon most often involved in RA mediated tendon rupture
EPL
Amount of force needed in repaired tendons to function
40N
Muscles supplied by the median nerve
All Flexors except FDP and FCU
Thenar muscles
Radial nerve innervation
Forearm and wrist extensors
Sensation to dorsal thumb and pointer finger
Primary abnormality seen in radial nerve damage
wrist drop
Deficits seen in Carpal tunnel syndrome
Loss of sensation to the thumb, pointer and middle finger finger
Atrophy of thenar muscles
Loss of grip strength
Weakness in ab/adduction of thumb and pointer
Deficits seen in cubital tunnel syndrome
Loss of sensation to ring and pinky fingers
Loss of ab/adduction of fingers
Weakness in wrist flexion (opposite wrist drop seen in carpal tunnel)
Claw hand on extension of fingers
