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Musculoskeletal 2 > Sports Med - UE > Flashcards

Sports Med - UE Flashcards

1
Q

Define concussion

A

Current definition: a complex pathophysiological process affecting the brain induced by biochemical forces.

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2
Q

Is concussion a structural injury?

A

NO!

it may result in neuropathological changes, but the acute clinical symptoms largely reflect a functional disturbance NOT a structural injury.

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3
Q

Concussion typically results in…

A

the rapid onset of short-lived impairment of neurologic function that resolves spontaneously

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4
Q

Concussion epidemiology

A

-8.9% of all reported high school athletic injuries
-F > M in similar sports
? F weaker neck muscles and smaller head mass?
? M more reluctant to report injury?

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5
Q

Common sports for concussion

A

Football, F Soccer, M Lacrosse, M Soccer, F Basketball, Wrestling, F Lacrosse, Softball, M Basketball, M & F Volleyball, Baseball

**cycling is #1 for traumatic brain injuries

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6
Q

Concussion symptoms

A
  • HA
  • dizziness
  • double vision
  • nausea
  • light/sound sensitivity
  • feeling foggy
  • LOC
  • amnesia
  • behavioral changes
  • cognitive impairment
  • sleep disturbance
  • depression
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7
Q

Classification of concussions

A
  • grading system was abandoned
  • the majority resolve in short (7-10 day period)
  • children take longer than adolescents to recover
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8
Q

On-field evaluation

-initial action: primary survey/LOC

A
  1. determine level of consciousness:
    - “Can you hear me?”
    - Response to painful stimulus
  2. Determine ABCs:
    - Clear the airway and assess breathing
    - Remove mouthpiece
    - Check Circulation
  3. Inspect ears and nose:
    - do you see CSF?
  4. Secondary Survey:
    - Signs of trauma (fracture, dislocations, bleeding)
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9
Q

On-field evaluation

-Management of Unconscious Athlete

A

Airway:

  • Permanent brain damage – within 4 minutes after oxygen deprivation
  • Assess airway:
  • -Look, listen, feel for breathing
  • Emergency Roll:
  • -No pulse / not breathing and not in supine position (maintain in-line stabilization)
  • -Expose chest
  • -Remove facemask
  • -Jaw thrust to open airway (2 quick breaths)

Circulation:

  • Carotid pulse
  • Not breathing with pulse – Rescue breathing
  • No pulse – CPR
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10
Q

On-field evaluation

-Facemask removal

A

Most helmets have four fasteners
-Can cut all four or cut the bottom two and retract the mask

Common tools for helmet removal:

  • Hand held screwdriver
  • Anvil Pruner
  • Trainer’s Angels
  • FM Extractor
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11
Q

On-field evaluation

-Modified jaw thrust

A

-Grasp each side of the mandible at the angle and pull upwards
-Must be careful not to disturb the c-spine
-May not always open the airway
Should be done by a professional rescuer or athletic trainer
-Essentially dislocating the jaw

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12
Q

On-field evaluation

-Management of unconscious but breathing athlete

A

Cervical spine evaluation:
-Palpate for gross bony deformity

Blood pressure:

  • Palpation of pulse and minimum Systolic BP:
  • -Carotid artery – 60 mmHg
  • -Femoral artery – 70 mmHg
  • -Radial artery – 90 mmHg

Pupil responsiveness:

  • Open athlete’s eyelids:
  • Open eyelids – pupil constriction (absence – brain not receiving oxygen / brain damage)

**Continue monitoring every 5 minutes

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13
Q

On-field evaluation

-Management of conscious athlete (history)

A

Loss of consciousness:
-Does athlete describe “blacking out” or “seeing stars”

Mechanism of injury

Symptoms:

  • Pain in cervical spine
  • Numbness, tingling, burning pain radiating through upper or lower extremities
  • Sensation of weakness in cervical spine, upper and/or lower extremities
  • Burning or aching in the chest secondary to cardiac inhibition
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14
Q

On-field evaluation

-Management of conscious athlete (inspection/palpation)

A

Inspection:

  • Cervical vertebrae:
  • Alignment
  • Cervical musculature:
  • Presence of spasm

Palpation:

  • Cervical spine:
  • -Spinous and transverse processes:
  • -Alignment, crepitus, tenderness
  • -Cervical musculature:
  • -Spasm in upper trapezius, levator scapulae, SCM
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15
Q

On-field evaluation

-Management of conscious athlete (neuro evaluation)

A

Neurological Testing:

  • Sensory testing
  • Motor Testing
  • Active motion:
  • -Wiggle toes and fingers
  • -Movement of ankles, wrists, knees, elbows, hips, and shoulders
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16
Q

Removing the athlete from the field

A

Walking athlete off the field:
Lying → standing: ↓ BP (risk of fainting / unsteadiness)
Allow athlete to adjust to position changes

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17
Q

Removing the athlete from the field

-Using a spine board (supine athlete)

A
  • Place the extremities in axial alignment (arm on side toward which athlete rolled abducted to 90 degrees - if not wearing shoulder pads)
  • Place the spine board close to the side of the patient
  • Other responders position along the side of the athlete, according to the captain’s (person at the head) directions
  • Ideal to have 4 or 5 additional helpers, depending on the size of the patient
  • Each person is responsible for one body segment: trunk, hips, thighs, lower legs
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18
Q

Removing the athlete from the field

-Using a spine board (prone athlete)

A
  • one person takes charge and immobilizes the head
  • hands should be placed so that the head and neck can maintain their position as the body moves
  • assistants kneel and reach across patient’s body
  • each person is in charge of a different part, such as the trunk, hips, and legs
  • their arms should cross each other for stability and synchronization
  • limbs are placed at athlete’s sides
  • on the captain’s call, the body is turned in unison onto the board
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19
Q

Concussion management

A
  • physical and cognitive REST until symptom resolution
  • do NOT need to awaken throughout the night, observe for normal breathing pattern
  • “Cocoon Therapy” AKA a whole list of what you CANNOT do vs. do what you can tolerate/does not worsen symptoms
  • encourage pt to eat/drink normally
  • wear sunglasses if photophobia
  • sleep in a dark room as much as possible 2 – 3 days, then try to resume normal sleep/wake hours and nap 15 – 20 minutes
  • limit exposure to telephone, texting, music, TV
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20
Q

New concussion recommendations regarding exercise

A
  • new recommendations include starting very light, easy, early exercise after 48 hours
  • activity should be below symptom-exacerbation thresholds
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21
Q

Management via medications

A
  • avoid and let symptoms be your guide
  • extreme headache , ok to take Tylenol but NO NSAIDs…
  • -avoid over use
  • -masking symptoms
  • -rebound headaches
  • melatonin for sleep & headaches
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22
Q

School considerations

A
  • Attendance
  • Visual Stimulus
  • Workload
  • Physical Exertion
  • Breaks
  • Audible Stimuli
  • Testing
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23
Q

Return to play (RTP)

A
  • symptom free & off medication (exception: antidepressants
  • neurocognitive Testing
  • -objectively evaluate condition, track recovery
  • -measures symptoms, verbal & visual memory, processing speed, reaction time
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24
Q

What is gradual RTP protocol?

A
  • proceed 1 level at a time if asymptomatic at current level
  • 24 hrs per level = 1 week to proceed through full rehabilitation protocol
  • any symptoms = drop down to asymptomatic level x 24hrs before proceeding
  • may stretch out RTP if < 13 years old
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25
Q

Rehab stage 1

  • functional exercise
  • objectives
A
  1. no activity
    - complete physical and cognitive rest (no school, if indicated)
    - recovery of cognitive function
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26
Q

Rehab stage 2

  • functional exercise
  • objectives
A
  1. light aerobic exercise
    - walking, swimming, or stationary bike; no resistance training
    - increase heart rate
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27
Q

Rehab stage 3

  • functional exercise
  • objectives
A
  1. sports-specific exercise
    - running drills; no head impact activity
    - add movement
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28
Q

Rehab stage 4

  • functional exercise
  • objectives
A
  1. non-contact training drills
    - progression to more complex training drills; start progressive resistance training
    - exercise, coordination, cognitive load
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29
Q

Rehab stage 5

  • functional exercise
  • objectives
A
  1. full contact practice
    - after medical clearance only; normal activity
    - restores confidence and assess functional skills
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30
Q

Rehab stage 6

  • functional exercise
  • objectives
A
  1. return to play
    - normal game/ competition
    - prevent next injury
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31
Q

Do helmets prevent concussions?

A

NO!

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32
Q

Helmets/headgear info

A
  • get a new bike helmet following impact
  • football helmets reduce impact force to head, but not concussion incidence
  • soccer head gear unclear utility, heading can be performed safe? and avoidance does not prevent concussion
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33
Q

Define second-impact syndrome

A

Sustain an initial head injury then second injury before symptom free from first head injury

Cerebral vascular congestion → diffuse cerebral swelling → death

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34
Q

Who is at higher risk for second-impact syndrome?

A
  • peds and adolescents at higher risk
  • all reported cases are of athletes < 20 y.o.
  • catastrophic football head injuries 3x more likely in high school than in college athletes
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35
Q

Long term effects

-CTE

A

Chronic Traumatic Encephalopathy

  • seen in 18-year old multisport athlete with a history of concussions from football upon autopsy
  • new football, soccer
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36
Q

Long term effects

-3 or more concussions

A

increased LOC, post-amnesia, confusion

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37
Q

Athletes with 2 or more concussions…

A
  • athletes with 2 or more concussions who are concussion free x 6 months performed similarly on NP testing as athletes with 1st concussion in last week
  • 2 or more concussions lower GPA
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38
Q

List common shoulder injuries

A
  • Clavicle fracture
  • AC sprain
  • SC sprain
  • Shoulder Dislocation
  • Little Leaguer Shoulder
  • Shoulder Impingement
  • Rotator Cuff Sprain/Tear
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39
Q

Treatment of clavicle fractures

A
  • MC is sling or figure 8

- figure 8 is to try to move the bone back in place so it doesn’t require surgery

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40
Q

SC sprain

A
  • between sternum and clavicle

- rare injury

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41
Q

SC sprain mechanism of injury

A
  • indirect force transmitted through the humerus, the shoulder joint and the clavicle
  • direct impact to clavicle
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42
Q

S/sx of SC sprain

A

-may have deformity at sternal end
Swelling
-pain
-inability to abduct shoulder through full ROM

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43
Q

What are the degrees of separation for SC sprain?

A

1st degree: no deformity, pain w/ palpation & motion, mild stretching of SC ligament

2nd degree: subluxation of the proximal end of clavicle

3rd degree: complete rupture of SC and CC ligaments, with dislocation of the proximal end of clavicle

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44
Q

Tx for SC sprain

A
  • RICE
  • immobilization
  • NSAIDS

Grade 1 seperation – RTP in 1-2 weeks
Grade 2 seperation – RTP in 3-4 weeks
Grade 3 seperation – Surgery

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45
Q

What is an emergency in SC sprain??

A

Any posterior subluxation or dislocation is an emergency d/t potential cardiovascular compromise

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46
Q

Define little leaguer’s shoulder

A
  • proximal humerus (Salter Harris Type I fracture)

- secondary to overuse

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47
Q

What do you see on xray for little leaguer’s shoulder?

A

widening of proximal humeral physis

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48
Q

Tx of little leaguer’s shoulder

A

rest and activity modification

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49
Q

List the elbow injuries

A
  • Radial Head Fracture
  • Supracondylar Fracture
  • Little Leaguer’s Elbow
  • UCL injury
  • Medial Epicondylitis
  • Lateral Epicondylitis
  • Elbow Dislocation
  • Olecranon Bursitis
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50
Q

Radial head fx etiology

A
  • MC adult elbow fracture

- mechanism - FOOSH

51
Q

PE of radial head fx

A
  • Pain/Effusion Elbow
  • Commonly associated with wrist pain
  • Pain with forearm rotation
  • Check for mechanical click
52
Q

Xray findings of radial head fx

A
  • fat pad or boat sail sign

- can be subtle

53
Q

Mason classification of radial head fx

A

I - nondisplaced

II - < 30% head and > 2mm displacement

III - comminuted

54
Q

Nonoperative tx of radial head fx (grade I)

A
  • Sling/posterior splint for comfort
  • ROM 7 days
  • Possible Aspiration Hematoma
  • Repeat XR 2-3 wks
  • Complication
  • Extension/Supination Loss
55
Q

Tx of grade II

A
  • debatable
  • Ortho Referral
  • No Mechanical Sx
  • -Conservative
  • -Early ROM
  • -Close XR F/U
  • Mechanical Sx
  • -Possible SURGERY
  • -ORIF
56
Q

Tx of grade III

A

Ortho Referral

Surgery

  • ORIF
  • radial head replacement
57
Q

What is the MC fracture of the elbow in children?

A

Supracondylar humerus fx

58
Q

Supracondylar humerus fx

-etiology

A
  • 95% are extension type injuries
  • Produces posterior angulation/displacement of the distal fragment
  • Occurs from a fall on an outstretched hand
  • Ligamentous laxity and hyperextension of the elbow are important mechanical factors
  • May be associated with a distal radius or forearm fractures
59
Q

Supracondylar humerus fx

-types

A

Type 1: Non-displaced

Type 2: Angulated/displaced fracture with intact posterior cortex

Type 3: Complete displacement, with no contact between fragments

60
Q

Supracondylar humerus fx type I tx

A
  • in most cases, these can be treated with immobilization for approximately 3 weeks, at 90 degrees of flexion
  • if there is significant swelling, do not flex to 90 degrees until the swelling subsides
61
Q

Supracondylar humerus fx type II tx

A
  • if minimally displaced (anterior humeral line hits part of capitulum)
  • immobilization for 3 weeks.
  • close follow-up is necessary to monitor for loss of reduction

Displaced (anterior humeral line misses capitulum):

  • reduction
  • the degree of posterior angulation that requires reduction is controversial
  • probable surgical fixation
  • if varus/valgus malalignment exists, reduction and surgical fixation
62
Q

Supracondylar humerus fx type III tx

A

Surgery!

63
Q

Define little leaguer’s elbow

A
  • with repetitive throwing, ligaments and tendons put tension on the end of the bone → causes inflammation of growth plate and ultimately stress fracture
  • activity-related pain, tenderness to palpation, decreased pitching effectiveness
64
Q

Tx of little leaguer’s elbow

A

Rest for several weeks until sx resolve

65
Q

Ulnar collateral ligament injuries

A
  • chronic valgus stress places ligament at risk for laxity or tearing
  • pitchers at highest risk
66
Q

UCL injuries

-evaluation

A
  • medial pain during late cocking, acceleration or deceleration is hallmark
  • pain with valgus testing more reliable than laxity
  • laxity on valgus testing at 30° minimal unless tear is complete
67
Q

What do you see on MRI for UCL injury?

A

fluid leakage outside of joint represents complete tear

68
Q

UCL injury tx

A
  • rest
  • physical therapy
  • NSAIDs
  • return to throwing when pain-free
  • surgery → autologous tendon secured in tunnels in humerus and ulna in figure-of-eight fashion, ulnar nerve transposed
69
Q

Lateral epicondylitis

A

“tennis elbow”

  • result of poor mechanics and continual use over a long period of time
  • wrist extensor tendons at lateral epicondyle of the humerus become chronically inflamed
70
Q

Lateral epicondylitis

  • PE
  • tx
A
  • pain over lateral epicondyle and minimal swelling
  • TX: RICE, Counterforce brace, wrist brace, limiting activity, mild stretching and strengthening, NSAIDS, Tenex, PRP, Surgery is rare
71
Q

Medial epicondylitis

A

“golfer’s elbow”

  • inflammation of wrist flexor tendons
  • result of repetitive throwing
72
Q

Medial epicondylitis

  • PE
  • tx
A
  • pain over medial epicondyle
  • TX: Same as lateral epicondylitis and decrease throwing

*monitor ulnar nerve- watch for numbness, tingling, or excessive pain

73
Q

Elbow dislocation mechanism of injury

A
  • third most frequent joint dislocation
  • fall on extended elbow with outstretched hand
  • majority posterior/posterolateral (90-95%)
74
Q

S/sx of elbow dislocation

A
  • Ulna and/or radius displaced posteriorly, w/ olecranon process sitting posteriorly
  • Severe swelling/bleeding
  • Extreme pain
75
Q

Classification of elbow dislocation

A

Simple: no fracturepurely ligamentous

Complex: associated with fracture
-Radial head is MC fx

76
Q

Tx of elbow dislocation

A
  • Immobilize in position you find it
  • Send to ER
  • Radiographs
77
Q

Tx of simple elbow dislocation

A
  • closed reduction
  • long arm splint/cast x 2 weeks
  • progressive ROM
  • protect terminal extension x 6wks

*Major Complication = Extension Loss

78
Q

Tx of complex elbow dislocation

A
  • Splint in situ - no reduction
  • Exception: NV compromise

*Ortho referral for surgery

79
Q

Olecranon bursitis

-etiology

A
  • aseptic
  • direct blow or fall - hemarthrosis
  • gout
  • septic
  • insect bite
  • cut/abrasion
  • hematogenous
80
Q

S/sx of olecranon bursitis

A
  • pain
  • swelling
  • erythema/febrile = septic
81
Q

Tx of olecranon bursitis

A
  • Ice
  • Compression
  • Aspirate
  • If serous/bloody: inject 40mg steroid +compressive dressing+elbow extension x 3 days
  • If puss, requires I+D (Ortho Consult)

-Recurrent aseptic bursitis = surgery

82
Q

Scaphoid fx

A
  • MC fractured bone in the wrist
  • Peanut shaped bone that spans both row of carpal bones
  • Does not require excessive force and often not extremely painful so can be delayed presentation
83
Q

Scaphoid fx pathoanatomy

A
  • Blood supplied from distal pole
  • In children, 87% involve distal pole
  • In adults, 80% involve waist
  • Treatment depends on location of fracture
84
Q

Imaging for scaphoid fx

A
  • AP, lateral, oblique, and scaphoid view
  • Radiographs can be delayed for up to 4 weeks
  • ?MRI, bone scan, or treat and repeat film
85
Q

Scaphoid fx tx

A
  • cast 6-12 weeks
  • short arm vs. long arm
  • follow patient every 2 weeks with x-ray
  • CT and clinical evaluation to determine healing
  • consider screwing early
86
Q

Scaphoid fx non-operative tx disadvantages

A
  • nonunion rate 5-55%
  • delayed union
  • malunion
  • “cast disease”- joint stiffness
  • prolonged immobilization- sometimes >12 weeks
  • loss of time from employment and avocations
87
Q

Scaphoid fx referral

A
  • Angulated or displaced (1mm)
  • Non-union or AVN
  • Proximal fractures
  • Late presentation
  • Early return to play desired
88
Q

Triangular Fibrocartilage Complex (TFCC) Tear etiology

A
  • “wrist sprain”
  • Fall on dorsiflexed and ulnar deviated wrist
  • Axial load with forearm in hyperpronation
  • Positive ulnar variance predisposes to injury
89
Q

TFCC Tear Diagnosis

A

Exam:

  • Ulnar sided wrist pain
  • Often experience a click

Imaging:

  • Radiographs
  • MR arthrogram
90
Q

TFCC Tear Treatment

A
  • Splinting
  • Time
  • Injection

Surgical treatment:

  • Debridement
  • Repair
  • Open vs. arthroscopic
  • Ulnar shortening osteotomy
91
Q

DeQuervain’s Tenosynovitis Etiology

A
  • pain d/t inflammation of the short extensor and abductor tendons of the thumb
  • repetitive or unaccustomed griping and grasping causes friction over the distal radial styloid
92
Q

DeQuervain’s Tenosynovitis: Diagnosis

A
  • swelling and pain over 1st dorsal compartment

- (+) Finkelstein’s test

93
Q

DeQuervain’s Tenosynovitis: Treatment

A
  • Splint
  • Injection- 1st line
  • -up to 90% are pain free if injected within 6 months
  • Ice
  • NSAIDS
  • Rehab exercises
94
Q

DeQuervain’s tenosynovitis recurrence

A

Recurrence despite repeated injections

95
Q

Mallet finger etiology

A
  • Injury to the extensor tendon at the DIP joint

- MC closed tendon injury of the finger

96
Q

Mallet finger mechanism

A
  • Mechanism: object striking finger, creating forced flexion

- Tendon may be stretched, partially torn, or completely separated by a distal phalanx avulsion fracture

97
Q

Mallet Finger Presentation

A
  • Pain at dorsal DIP joint
  • Inability to actively extend the joint
  • Characteristic flexion deformity
  • On exam, very important to isolate the DIP joint to ensure extension from DIP and not the central slip
  • If can’t passively extend consider bony entrapment

**all of these need x-rays

98
Q

Mallet Finger Treatment

A
  • Splint DIP in neutral or slight hyperextension for 6 weeks
  • Cochrane review- all splints same results
  • Surgical wiring does not improve outcome
  • Office visit every 2 weeks
  • If not extension lag at 6 weeks, splint at night and for activity for 6 weeks.
  • Conservative treatment effective up to 3 months delayed presentation
99
Q

Mallet Finger Referral

A
  • Bony avulsion >30% of joint space
  • Inability to achieve passive extension
  • Despite proper treatment permanent flexion of the fingertip is possible
  • No fracture reduction in the splint
100
Q

Flexor Digitorum Profundus Tendon Injury (jersey finger)

-etiology

A
  • Athlete’s finger catches another player’s clothing
  • Forced extension of the DIP joint during active flexion
  • 75% occur in the ring finger
  • Force can be concentrated at the middle or distal phalanx
101
Q

Jersey Finger Presentation

A
  • Pain and swelling at the volar aspect of DIP joint
  • Can often feel fullness proximally if tendon retracted
  • Need to isolate the DIP to properly test
102
Q

Jersey Finger Treatment/ Referral

A

***All need to be referred for surgery immediately

103
Q

Collateral Ligament Injuries

-etiology

A
  • Forced ulnar or radial deviation
  • Can cause partial or complete tear
  • PIP is usually involved
  • Present with pain at the affected ligament
  • Evaluate with involved joint at 30 degrees of flexion and MCP at 90 degrees of flexion
104
Q

Collateral Ligament Injuries

-treatment

A

-If joint stable and no large fracture- can buddy tape
-Never leave the pinky alone
?Physical Therapy- if joint stiff

105
Q

Metacarpal Fractures

-etiology

A
  • MC hand fracture
  • Usually involves the neck
  • Fight or fall common mechanism
  • 4th and 5th fingers are most common fractures
106
Q

Metacarpal Fractures Diagnosis

A
  • Present with edema over the dorsum of the hand
  • Point tender
  • Ecchymosis
  • The distal fragment usually displaces volarly due to the interosseous muscles
  • Radiographs: AP, lateral, oblique
107
Q

Metacarpal Fracture Treatment

A
  • Angulation up to 40+ degrees can be tolerated
  • Attempt reduction?
  • Different cast types
108
Q

Metacarpal Fracture

-complications

A
  • Malrotation
  • Common with spiral or oblique fractures
  • Greater than 10% malrotation leads to scissoring effect of the fingers
  • Metacarpal head
  • Loss of knuckle
109
Q

Metacarpal Fracture Referral

A
  • Rotation
  • Angulation > 70 degrees
  • Preference
110
Q

Proximal PIP dorsal dislocation (Coach’s Finger)

A
  • MC dislocated joint in the body

- can injure the volar plate or cause an avulsion fracture of the middle phalanx

111
Q

Proximal PIP dorsal dislocation

-relocation

A
  • reduce via gentle longitudinal traction
  • If initially unsuccessful should hyperextend the distal portion to unlock
  • If not done <1 hour consider a digital block
112
Q

Post Reduction Care of proximal PIP dorsal dislocation

A
  • Radiographs should be obtained to ensure joint congruity
  • Examine collaterals
  • PIP should be splinted in less than 30 degrees
113
Q

Proximal PIP Dorsal Dislocation

-referral

A
  • Avulsion fracture > 1/3 of joint space
  • Irreducible fracture
  • Instability post-reduction
114
Q

Volar Plate Injury

-etiology

A
  • Hyperextension, such as dorsal dislocation
  • PIP is usually affected
  • Collateral damage is often present
  • The loss of joint stability can cause hyperextension deformity
115
Q

Volar Plate Injury

-diagnosis

A
  • Maximal tenderness at volar aspect of affected joint
  • Bruising, swelling
  • Full extension and flexion possible if joint stable
  • Collaterals should be tested
  • Radiographs may show an avulsion fracture at the base of involved phalanx
116
Q

Volar Plate Injury

-treatment

A
  • Progressive splinting starting at 30 degrees flexion
  • Followed by buddy taping
  • If less severe, can buddy tape immediately
  • Can play sports if splinted
117
Q

Ulnar Collateral Ligament Injury of the Thumb (GameKeeper’s/Skier’s Thumb)
-etiology

A
  • Caused by forced abduction of the 1st MCP joint

- Left untreated the joint will be unstable with weak grip strength

118
Q

Skier’s Thumb

-diagnosis

A
  • Difficulty opposing pinky to thumb
  • Swelling and black and blue over thenar eminence
  • Can’t hold an OK sign
  • Consider digital block and to facilitate ligament testing
119
Q

Skier’s Thumb Grading/Treatment

-grade 1

A
  • Pain without instability with stress

- Splinting 1-2 weeks

120
Q

Skier’s Thumb Grading/Treatment

-grade 2

A
  • Pain with mild instability: gapping <20 degrees

- Casting 3-6 weeks

121
Q

Skier’s Thumb Grading/Treatment

-grade 3

A
  • Stenner’s Lesion
  • Instability: gapping > 20 degrees or > 35 degrees compared to unaffect thumb
  • Early surgical intervention within 2-3 weeks
122
Q

Skier’s Thumb Referral

A
  • Fracture
  • Unstable joint
  • Stener lesion
123
Q

Stener lesion

A

fibers of the adductor pollicis tendon (intrinsic hand muscle) with fibers of the extensor aponeurosis
-aponeurosis has flipped up and gotten in the way of the UCL

Musculoskeletal 2 (14 decks)

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