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Musculoskeletal Pm&r Boards > Ue > Flashcards

Ue Flashcards

0
Q

Treatment options for acute AC joint injuries type I and II.

A
  • Rest ice nonsteroidal anti-inflammatory drugs
  • sling for comfort
  • avoid heavy lifting in contact sports
  • shoulder girdle complex strengthening -return to play with patients asymptomatic with full range of motion

-type one: two weeks
Type 2:6 weeks.

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1
Q

How many degrees glenohumeral motion for everyone degree of scapulothoracic motion in arm abduction?

A

2 GH:1 St motion

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2
Q

Treatment of AC joint injuries type III (controversial)

A
  • Conservative or surgical route depends on patients need (occupation or sports) for part particular shoulder stability.
  • Surgical for those indicated (heavy labor, athletes)
  • generally no functional advantage is seen between the two treatment regimens
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3
Q

Treatment for acute AC joint injury type 4-6

A

Recommend surgery: ORIF or distal clavicle resection with reconstruction of the cc ligament.

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4
Q

Describe a mallet finger

A

Mallet Finger occurs when a sudden unexpected passive flexion occurs at the DIP joint. This results in an avulsion fracture fragment of bone from the base of a distal phalanx into which the extensor tendon inserts.

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5
Q

How do you treat Malet Finger?

A

Treat by splinting to immobilize the distal phalanx in hyperextension

  • acute need splinting for six weeks
  • chronic splinting for 12 weeks

-surgical indications: poor Volar subluxation, avulsion greater than one third of the bone

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6
Q

Describe Boutonnière deformity

A

Hyperextension at the MCP joint, flexion at the PIP joint and extension at the DIP joint caused by weakness/tearing of the distal extensor hood, which allows the lateral band to slip down and flex the PIP joint.

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7
Q

Describe a swan neck deformity.

A

A swan neck deformity occurs as a result of contractures and shortening of the intrinsic muscles causing flexion at the MCP joint,
Hyperextension at the PIP joint,
and flexion at the DIP joint.

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8
Q

How does distance between the humeral head and achromion lend to the diagnosis of rotator cuff tear?

A

The thickness of supraspinatus is roughly 6 mm. If there is less than this difference, that indicates the tendon is not present between via chromium and the humeral head.

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9
Q

What does PIN innervate?

A
  • ECRB
  • supinator
  • EDC
  • EDM
  • ECU
  • APL
  • EPL
  • EPB
  • EIP
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10
Q

What exam finding would you have in PIN syndrome?

A

The pseudo-claw- hand deformity maybe demonstrated due to finger extensor weakness.

  • Radial deviation is noted with wrist extension (ECU weakness) and sensation is spared
  • Macebearer supinator

-always spares brachioradialis triceps DCR-L, DCR-B, and Anconeus

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11
Q

What are the medial rotators of the hip?

A

TAGGGSS

  • tensor fasciae of superior gluteal nerve
  • adductor Magnus, longus, and brevis
  • adductor Magnus is obturator and sciatica tibial division
  • adductor longus and brevis are obturator
  • gluteus medius superior gluteal Nerve
  • gluteus minimus superior gluteal nerve
  • Gracilis obturator
  • semi tendinosis sciatic nerve tibial division
  • semi-membranous sciatic nerve tibial division.
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12
Q

What tendons form the anatomical snuff box?

A

Medial= EPL
Lateral =EPB & APL
Floor is scaphoid and trapezium
Proximal= head of radius

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13
Q

But hand injury for cyclists frequently have?

A

Ulnar nerve injury at Guyon’s canal resulting in hand weakness decreased sensation of the hand volar surface of fourth and fifth digit

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14
Q

Name the hip flexors

A

Iliopsoas from the femoral nerve

  • Sartorius femoral Nerve
  • rectus femoris femoral Nerve
  • pectineus femoral Nerve L2-L4
  • Tfl superior gluteal L4, five S-1
  • adductor brevis , obturator
  • adductor longus obturator
  • . adductor Magnus obturator and sciatic nerves L2- S1
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15
Q

Hip adductors

A

Chrysalis obturator nerve

  • pectin this femoral nerve
  • adductor longest Obturator Nerve
  • adductor brevis Obturator
  • adductor. Magnus Bob Obturator and (tibial)sciatic nerves
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16
Q

Strongest shoulder muscles

A

Adductors, extensors, flexors, abductors, internal rotators, external rotators,

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17
Q

It’s tendons run through the carpal tunnel?

A

Fds, fdp, fpl with median nerve

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18
Q

Injury to the long thoracic and spinal accessory nerves causes what kind of injury?

A

Scapular winging with weakness of Serena’s interior and trapezius. Rehab starts with immobilization to prevent overstretching weakened muscles.

19
Q

What is game keepers thumb?

A

Forced abduction of the thumb is associated with injury to the ulnar collateral ligament of the first metacarpophalangeal joint (MCP). Skiers are at risk due to falling with ski poles.

20
Q

What is a boxers fracture?

A

Fracture of the fifth metacarpal and is the most common fracture occurring in the metacarpals. Usually occurs after closing an object with a closed fist.
Usually requires close reduction and casting

21
Q

What is with Little League elbow?

A

Inflammation of the growth plate on the medial epicondyle in throwing athletes between the age of 9 and 12 with medial elbow pain and recent history of throwing.
Pe may show tenderness over the medial condyle, pain with resisted flexion of the wrist, and Valdis stress testing the Can also be a slight elbow flexion contracture.

22
Q

What is kienbock’s disease?

A

Pain over the dorsal aspect of the wrist, directly over the lunate. Idiopathic blood loss to the lunate causing avascular necrosis. The diseas is correlated with repetitive stress or fracture. Risk factors include short ulnar variants and poor vascular supply.

23
Q

Describe the cause of lateral winging of the scapula

A

Lateral winging it was caused by a spinal accessory nerve or trapezius injury

24
Q

Describe the cause of medial winging of the scapula

A

Injury too long thoracic nerve or Serrito’s interior.

25
Q

What innervates teres minor?

A

Axilary nerve

26
Q

What is the dorso scapular nerve innervate?

A

Levator scapula and rhomboids

27
Q

What is the suprascapular nerve innervate?

A

Supraspinatus and infraspinatus

28
Q

Describe a Bankart lesion

A

With anterior instability of the shoulder the humoral head remains fully out of the socket. The anterior glenoid labrum may become torn or even avulsed off of the glenoid rim which is called a Bankart lesion.

29
Q

Describe a hill-Sachs lesion

A

Compression fracture of the posterior humeral head

30
Q

Describe the thoracic outlet syndrome

A

Compression of the brachial plexus and/or subclavian vessels as they exit between the superior shoulder girdle and first rib

31
Q

Describe a slap lesion

A

Injury to the superior glenoid labrum and biceps long head tendon.

32
Q

Describe the Stimson technique

A

Patient lies prone on table or bed with anterior shoulder dislocated arm hanging off the side. A 5 to 15 pound weight is attached to the distal arm. The physician places their thumb on the patients of cahromium and use his fingers of the same hand over the same over the humeral head. As the patients muscles gradually relax the provider gently pushes the humeral head caudally until it reduces

33
Q

Osteochondritis dissecans

A

Fragmentation of bone and cartilage overlying the capitellum in the elbow. This often occurs in teenage boys involved and throwing sports due to Valgus stress on the elbow.

It is often mistaken for Panners which has more to do with the circulatory problem affecting the bone in the elbow and occurs in children 5 to 12 years of age.

34
Q

Osteochondritis dissecans

A

Fragmentation of bone and cartilage overlying the capitellum in the elbow. This often occurs in teenage boys involved and throwing sports due to Valgus stress on the elbow.

It is often mistaken for Panners which has more to do with the circulatory problem affecting the bone in the elbow and occurs in children 5 to 12 years of age.

35
Q

Extensor compartments of the hand

A

I- extensor pollicis brevis, abductor pollicis longus
2- extensor carpi radialis brevis, extensor carpi radialis longus
3- extensor pollicis longus
4- extensor digitorum
5-extensor digiti minimi
6-extensor carpi ulnaris

36
Q

What are the typical radiographic features of osteoarthritis?

A

Joint space narrowing, osteophyte formation, subchondral cyst.

37
Q

What did the dorsal interosseous muscles of the hand do?

A

The D I O proximaly attach to the adjacent metacarpals and distally attached to the proximal phalanges. Their main function is digit abduction and MCP flexion.

38
Q

Describe Froment’s sign

A

Patient is asked to pinch a piece of paper between their index finger and thumb while the examiner tries to pull the paper away. If the patient flexes the first interphalangeal joint suggesting adductor pollicis weakness the test is considered positive that indicates possible ulnar nerve palsy

39
Q

What x-ray view is used to look for a hill Sachs deformity?

A

Anterior posterior views and stryker Notchview are used.-In the stryker Notchview the patient is supine with a cassette placed under the involved shoulder. The palm of the affected arm is placed on top of the head with fingers pointing posteriorly and elbow pointing upward towards the ceiling. X-ray beam is centered over the process with being directed 10° toward the head
( Michael Jackson Head on hat posture)

40
Q

What makes up the Quadrangular space?

A

Teres minor, teres major, long head of the triceps muscle, and medial border of the humerus.

It is an area potential compression of the posterior humoral circumflex artery or axillary nerve.

41
Q

What is the difference between suprascapular nerve compression at the suprascapular notch versus the spingoglenoid notch?

A

Compression at the suprascapular notch result in deep boring shoulder pain along superior scapula and weakness of the shoulder abduction and external rotation.
-If nerve entrapment occurs at the level of the spingo glenoid notch then only appreciable finding maybe isolated atrophy and weakness of the infraspinatus muscle. Pain is not so prominent at this level because the sensory fibers have already exited.

42
Q

Describe erbs palsy

A

Upper trunk (c5-6) palsy results in weakness of shoulder abduction, elbow flexion and supination. Most common in newborns

43
Q

What is the Smiths fracture?

A

Smith’s fracture is when the distal radius fracture fragment is displaced to the palm/volar aspect. is also called a reverse Colles’ fracture because the Colles’ fracture the radial this place is dorsally.

44
Q

It is FDS insert?

A

Middle phalanx of the index middle ring and small fingers.

45
Q

Described dupuytren’s contracture

A

That the physiology results of collagen type III proliferation on the Palmer fashion.
-Most commonly involves the ring finger
- appears in the fourth -sixth decade of life
-more severe in males and Northern European descent.
Treatment includes triamcinolone injections in early stages, collagenase injections and surgery.

46
Q

Describe the proximal tibiofibular joint

A

It is located between the lateral tibial condyle and the fibular head and has been construed as the fourth compartment of the knee joint. It is a synovial joint and communicates with the new joint in approximately 10% of adults. It is a source of lateral knee pain is often overlooked.

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