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Orthopedic I > UE Clinical Syndromes > Flashcards

UE Clinical Syndromes Flashcards

1
Q

Impingement Syndrome

- Defn, Symptoms & MOI

A

mechanical impingement of subacromial structures

  • pain ant/sup part of shoulder
  • weakness
  • stiffness

MOI - age, repetitive overhead, muscle or postural imbalances, structural asymmetery, impaired kinematics

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2
Q

Impingement Syndrome

-classifications

A

Classified as outlet vs. nonoutlet & intrinsic vs. extrinisic

  • outlet = supraspinatus outlet encroached
  • nonoutlet = secondary to thickening of bursa or RC tendons
  • Intrinsic = RC weakness, overuse, or degenerative tendinopathy
  • Extrinsic = shape of acromion, INSTABILITY, degeneration
    »primary (involved structures in subacromial space) vs. secondary (DO NOT involve subacromial structures)
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3
Q

Stages of Impingement Syndrome

A

I - edema & hemorrhage of bursa cuff (<25 years old)
II - irreversible changes - fibrosis & tendonitis (25-40)
III - more chronic changes; partial or complete tears (40+)

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4
Q

Shoulder Instability

  • defn & classifications
  • treatment
A

instability/laxity of the shoulder joint

Classifications
- traumatic: usually due to bankart lesion (labral tear)
SYMP: recurrent dislocations
*positive Apprehension test

  • atraumatic: overstretch
    SYMP: tendonitis, sensation of instability & laxity
    *negative Apprehension test

Treatment - scapular stabilization & RC strengthening
NO Manual therapy if hypermobile

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5
Q

Adhesive Capsulitis

- defn & classification

A

aka frozen shoulder
inflamed & fibrotic condition of capsuloligamentous tissue

Classification -
Primary (idiopathic)
Secondary (due to known disorders) - systemic, intrinsic or extrinsic factors
(see algorithm)

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6
Q

Adhesive Capsulitis

- Stages

A

Stage 1 = 0-3months
- pain w/ AROM & PROM

Stage 2 = 3-9months

  • freezing stage
  • chronic pain w/ AROM & PROM w/ limitations

Stage 3 = 9-15 months

  • frozen stage
  • minimal pain except at end of ROM
  • significant limitations w/ hard end feels

Stage4 = 15-24 months

  • thawing phase
  • minimal pain & progressive ROM improvements
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7
Q

SLAP lesion

-defn, symptoms & MOI

A

“superior labral tear from anterior to posterior)

injury of labrum at attachment where tendon of the long head of the biceps attaches

Symptoms - pain & instability/lack of control w/ overhead activities; pos. O’brien’s test

MOI - repetitive overhead activities, sudden eccentric biceps contraction

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8
Q

SLAP lesion

-classification

A

There are 6 classifications
Type 2 is most common

  • biceps anchor peels off from supraglenoid tubercle w/ detachment of labrum (ant to post)
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9
Q

Rupture of Biceps Brachii Long Head

-defn, symptoms & MOI

A

complete tear of tendon of biceps brachii (most commonly at supraglenoid tubercle - insertion point)

Symptoms - popping w/ pain that will ease –> tenderness over anterior shoulder
-popeye sign & positive speed’s test

MOI - lifting something heavy

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10
Q

Snapping Scapula

- defn, symptoms & MOI

A

abnormal articulation of scapulothracic joint that causes grinding sensation of scap

Symptoms - crepitis of scapula, pain w/ overhead activities, worse w/ abduction & eased w/ horz. adduction

MOI - repetitive overhead use, bony abnormalities, muscle imbalance (serratus ant & subscap)

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11
Q

Snapping Scapula

- differential diagnosis

A

scapular bursitis - pain & fullness over bursa (superior angle deep to levator scap)

Trapezoid bursitis - pain at bursa @ junction of scapular spine & medial border

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12
Q

Scapulocostal syndrome

-defn, symptoms & MOI

A

formation of adhesions due to irritated bursa btwn scapula & thorax

Symptoms -
pain (medial border of scap & underlying rib cage), dyskinesia & tenderness w/ restriction & loss of motion

MOI - trauma, poor posture, prolonged immobilization

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13
Q

AC Separation

- defn, symptoms & MOI

A

disruption of ligaments involved in the AC joint that causes separation of AC

Symptoms -
- tenderness & pain, piano key sign, increased joint space, positive HAC or O’briens test

MOI - falling onto shoulder w/ arm adducted by side

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14
Q

AC Separation

-classifications

A

I - sprain of AC ligament
II - torn AC & sprained CC ligaments
III - torn AC & CC ligaments w/ dislocation
IV - AC & CC ligaments torn w/ clavicle displaced posteriorly
V - AC & CC ligaments torn w/ gross disparity btwn clavicle & scapula
VI - Ac & CC ligaments torn w/ clavicle displaced inferiorly to coracoid process

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15
Q

Humeral Head Fractures

- defn, symptoms, & MOI

A

one to four-part fractures (see article) - based on Neer’s classifications

Symptoms - patient guarding & avoidance of using arm, pain & swelling, possible hematoma

MOI - younger population usually high energy trauma (MVA & sports) & older population usually low trauma energy (FOOSH)

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16
Q

Lateral epicondylitis

-stages

A

Stage I - inflammation w/o alterations to the tendons
Stage II - tendinosis or angiofibrolastic degeneration
Stage III - pathological changes in the tendon
Stage IV - 2+3 & degenerative changes in the bone

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17
Q

Lateral epicondylitis

-defn, symptoms, MOI

A

DEFN - inflammation of the insertion of the extensor tendons
Symptoms - lateral elbow pain, weakened grip strength, “special tests” - chair, Cozen,s Mills

MOI - overuse (repetitive grasping w/ wrist in extension) or trauma

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18
Q

Treatment for lateral (and medial) epicondylitis

A

Injection + PT

  1. Education - avoid MOI, specific instructions to athletes
  2. Modalities - iontoforesis proven very beneficial
  3. Ther ex - stretching, strengthening, eccentric wrist extension
  4. Manual therapy - transverse tissue massage, Mill’s manipulation, radial head & cervical mobilizations
  5. Assistive device- brace to remove pressure
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19
Q

Medial Epicondylitis

-defn, symptoms, MOI

A

DEFN - inflammation of the insertion of FCR tendon & pronator teres

Symptoms - pain at medial elbow, pain w/ flexion & pronation
-“special tests” - resisted muscle test & passive stretch test

MOI - overuse; repetitive wrist flexion

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20
Q

Little Leaguer’s Elbow

-defn

A

a variety of injuries of the elbow; usually at medial epicondyle & seen in young baseball players

General Rule:

  1. Will have problem w/ the bone IF medial growth plate is open
    - i.e. osteochondritis dissecans, growth plate fractures, apophysitis or fracture
  2. Will have problem w/ ligament IF growth plate is closed
    - i.e. MCL tear (tommy john), anterior capsule injury

Or can have olecranon trauma

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21
Q

Little Leaguer’s Elbow

-symptoms & MOI

A

Symptoms - pain in medial elbow, possible edema

MOI - excessive valgus stress, hyperextension & overuse
-high pitch volume, early use of breaking balls, inadequate biomechanics & lack of appropriate conditioning

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22
Q

Treatment for Little Leaguer’s Elbow

A
  1. Education is HUGE!
    Must teach correct biomechanis & know the guidelines/recommendations
    -throwing not allowed for 4-6 weeks & then start gradual
  2. Ther ex - core and upper limb strengthening
  3. Assistive Device - possible cast if excessive bone separation
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23
Q

Triceps tendinosis

-defn, symptoms, MOI

A

DEFN - inflammation & degeneration of the triceps tendon (usually at insertion point on olecranon)

Symptoms - pain & tenderness at post. elbow; pain w/ resisted elbow extension

MOI - overuse, repetitive sudden elbow extension
(pitching, shot put, javelin, bowling, heavy weight lifting)

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24
Q

Treatment for Triceps tendinosis

A
  1. Ther ex - French stretch & triceps towel stretch, triceps strengthening (eccentric, French press, etc)
  2. Assistive device: brace or strap
  3. Manual therapy - transverse massage
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25
Q

Radial Head Fracture

-types

A

Type I - small crack in radial head; bones still fit together
Type II - larger piece of bone is involved w/ slight displacement
Type III - comminuted & displaced
Type IV - dislocated & fractured

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26
Q

Radial Head Fracture

-defn, symptoms, MOI

A

DEFN - fracture of radial head (4 types)
-more frequent in women 30-40yrs old

Symptoms - pain & tenderness at lateral aspect of elbow w/ edema; limited forearm ROM esp. pronation/supination

MOI - FOOSH, elbow dislocation

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27
Q

Treatment for Radial Head Fracture

A
  1. Assistive device - cast or sling
  2. Education - immobilization during acute stages & while in cast (still move surrounding joints)
  3. Ther ex - PROM > AAROM > AROM > resistance training
    - focus on pronation/supination & flexion
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28
Q

Pulled Elbow

-defn, symptoms, MOI

A

DEFN - subluxation of the radial head from capitellum

Symptoms - arm is held in extension & pronation by the childs side; pain w/ movement OR avoids movement completely

MOI - sudden jerk on the extended pronated arm
-i.e. pulling an uncooperative child or swinging them by the arms

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29
Q

Treatment for Pulled Elbow

A
  1. Education - explain MOI to parent & how to prevent
  2. Manual therapy - reduction maneuver (if it is not the first time) - effective immediately
  3. Assistive device - may require a sling if the child doesnt use the arm right away
  4. HEP - observe the child
30
Q

Osteochondritis Dissecans

-defn, symptoms, MOI

A

DEFN - joint condition where the cartilage & a piece of bone come loose from the end of a bone

Symptoms - pain & swelling laterally & anteriorly, limited ROM, & clicking/locking

MOI - repetitive trauma or radialhumeral lateral compression forces
-compression causes the blood vessels to constrict which leads to bone necrosis

-common in baseball players - occurs during the cocking phase

31
Q

Treatment for Osteochondritis Dissecans

A

Surgery is required if there is locking or clicking

  1. Education - biomechanics of pitchers
  2. Modalities - ice & E-stim (no ultrasound over childs growth plate)
  3. Ther ex - passive & active ROM & strengthening, function & sport related exercises
  4. Ass device - sling in acute stage
32
Q

Olecranon Bursitis

-defn, symptoms & MOI

A

DEFN - inflammation of the bursa on posterior elbow

symptoms - edema, tenderness, pain, restricted ROM

MOI - traumatic, pressure (“students elbow”), infection, RA or gout

33
Q

Treatment for Olecranon Bursitis

A

Usually not recommended for PT

  • may requires oral anti-inflammatories or a steroid injection
  • aspiration or if more severe a bursectomy
  • PT’s role is education
34
Q

Elbow Instability

-defn, symptoms

A

DEFN - general laxity w/n the elbow joint capsule

  • can be conginetal or traumatic
  • increases susceptibility to subluxation or dislocation
  • humeroulnar joint is most commonly predisposed to recurrent instability

Symptoms of instability - pain, unusual noises, locking of the elbow towards extension, increased laxity in ligaments

35
Q

MOI for dislocation of the Elbow

-terrible triad

A

dislocation is due to elbow instability.. can occur due to..

  1. Valgus force - FOOSH - lead to terrible triad (elbow dislocation, radial head & coronoid fx)
  2. Varus (rare)
  3. Anterior dislocation - blow to flexed elbow
  4. Posterior - due to excessive stretching
  5. Posterior lateral (most common) - 3 stages (subluxed, dislocated incompletely & full dislocation)
36
Q

Treatment for Elbow Instability –> Dislocation

A
  1. Education - if they have instability it is chronic so must education about continued strengthening, ROM & avoidance of MOI
  2. NO manual therapy b/c already hypermobile
  3. Assistive device - if dislocated use a hinge splint
  4. Ther Ex - immobilization w/ periphery joint movement (acute), AROM & gentle stretching (subacute), strengthening & functional (chronic)
37
Q

Colles’ Fracture

-defn, moi & symptoms

A

DEFN - fracture of the distal radius w/ dorsal displacement
MOI - FOOSH; extension + compression
SYMPTOMS - dinner fork deformity, swelling, decreased ROM, decreased grip strength

38
Q

Treatment for Colles’ & Smith’s Fracture

A

Modalities - ice for edema
Manual therapy - massage scar tissue, joint glides
Ther. Ex - active exercises to promote circulation & movements of nerves
–> important to have high reps so they can return to function!

39
Q

Smith’s Fracture

-defn, MOI, symptoms

A

DEFN - fracture of the distal radius w/ volar displacement
MOI - FOOSH; flexion + compression
SYMPTOMS - edema, decreased & painful ROM, decreased grip strength

40
Q

Scaphoid Fracture

-defn, MOI, symptoms

A

DEFN - fracture of scaphoid carpal
MOI - FOOSH; extension + compression + radial deviation
SYMPTOMS - painful palpation in anatomical snuff box, painful/limited ROM, painful compression/axial loading

41
Q

Treatment for Scaphoid Fracture

A

Can be conservative or surgical
- usually conservative FIRST; surgical if not healed after 6 months (or in special cases)

Immobilization for 2-6 months in spica brace

Modalities - heat to increase circulation

42
Q

Boxer’s Fracture

-defn, MOI, symptoms

A

DEFN - fracture of the distal portion-neck- of metacarpal (typically 4th or 5th)
MOI - boxing or punching
SYMPTOMS - swelling at MC, pain w/ MMT

43
Q

Mallet Finger

-defn, MOI, symptoms

A

DEFN - avulsion of the extensor tendon from the DIP
MOI - forced flexion from direct force on DIP
–> common in basketball players
SYMPTOMS - cannot extend DIP, deformity of DIP

44
Q

Treatment of Mallet Finger

A

Volar splint (if partial tear)

If complete tear it is usually left alone or can be surgically repaired

Few exercises to strengthen extensor tendon once healed

45
Q

Scaphoid-Lunate Disassociation

-defn, MOI, symptoms, treatments

A

DEFN - injury to the ligament connecting the scaphoid and lunate
MOI - FOOSH & other trauma
SYMPTOMS - localized pain, swelling, clicking, pain w/ extension, increased mobility (glides), pain w/ weight bearing
–> special test = Positive Watson’s Test: locate and stabilize scaphoid; passively move patient from UD to RD; positive if scaphoid moves dorsally

TREATMENTS - immobilization, modalities & surgery

46
Q

Lunate Dislocation

-defn, MOI, symptoms, & treatment

A

DEFN - volar dislocation of the lunate
MOI - FOOSH
SYMPTOMS - pain w/ palpation, limited/painful ROM, N/T in median nerve distribution (due to compression)

TREATMENTS:

  • surgical reduction or immobilization (3-4 weeks)
  • limit wrist extension ~ 2 months
47
Q

Keinbock’s Disease

-defn, history, symptoms

A

DEFN - osteonecrosis/AVN of a bone following a fracture
HISTORY/MOI - FOOSH or compression fracture
SYMPTOMS - local tenderness, swelling, limited motion, pain w/ gripping & increased healing time

48
Q

Treatment for Keinbock’s Disease

A

GOAL = restore blood supply

How do we prevent it?

  1. Initial immobilization following fracture
  2. Thermal modalities (paraffin, heat, etc)
  3. ROM/Glides, Ther.ex to increase circulation

If all those fail, surgery for bone graft or prosthetic carpal

49
Q

Bennett’s Fracture

-defn, MOI, symptoms

A

DEFN - oblique, intra-articular fracture of first metacarpal
- volar segment held in place (bigger piece) & remaining segment is pulled radially & dorsally by APL
MOI - FOOSH (forced abd) OR axial blow directed against partially flexed metacarpal (fist fight)
SYMPTOMS - pain, swelling, defect in thumb (radial notch), unable to grab or pinch, N/T in thumb & wrist

50
Q

Treatment for Bennett’s Fracture

A

Modalities: ice initially, heat later
Ther Ex: gentle ROM at 6 weeks, functional activities at 8 weeks, & normal activity at 12 weeks
Manual therapy: chronic stage only
HEP: AROM & PROM every hour!
Assistive device: thumb spica
Education: protection and focus on non-affected joints during immobilization

51
Q

TFCC

-defn, MOI, symptoms

A

Triangular Fibrocartilage Complex Disc Injury

DEFN - disruption of TFCC disc;
- grade I = traumatic & grade II = degenerative conditions

MOI - FOOSH; repetitive UD
SYMPTOMS - pain on ulnar aspect of wrist, increased w/ UD & extension & forearm rotation; swelling, crepitus, weakness, instability
–> special tests: hypersupination; Fovea Sign (apply pressure in groove that separates ulnar styloid process & ulna head), loading wrist into UD and extension

52
Q

Treatment for TFCC Injury

A

Can be conservative (splint, steroid shot, PT) or surgical

Conservative:
Education: use of splint, description of injury
Modalities: ultrasound, E-stim, ice
Assistive Device: splint for 4-6 weeks
Manual Therapy: radial glide (for UD), prox/distal radioulnar medial & lateral glides for supination/pronation
Ther Ex: stretching & strengthening; esp pron/sup, flex/ext & UD/RD

53
Q

Carpal Tunnel Syndrome

-defn, MOI, symptoms

A

DEFN - inflammation of the flexor tendons that compresses the median nerve in the carpal tunnel
MOI - repetitive use of flexors w/ wrist extension, prolonged rest on palm, or traumatic
SYMPTOMS - N/T in median nerve distribution, painful ROM, nocturnal pain, thenar atrophy
–> special tests: Phalens/Reverse Phalens test, Tinel’s Test

54
Q

Treatment for Carpal Tunnel

A

Education: Must treat the source of the problem (ergonomics, activity modification)
Assistive Device: splint to limit excessive flexor use when wrist is extended; also noctural splint
Exercises: nerve & tendon glides
Manual therapy: carpal bone mobilization

Medical manageent: NSAIDS, carpal tunnel release
- evidence supports surgical treatment as more effective

55
Q

De Quervain’s Syndrome

-defn, MOI, symptoms

A

DEFN - tendonitis of the abductor pollicis longus & extensor pollicis brevis; tenosynovitis of the first dorsal compartment of the hand
— aka trigger thumb, texting thumb, gaming thumb

MOI - overuse; repetitive activity or forceful gripping w/ UD

SYMPTOMS - radial wrist pain w/ thumb movements, tenderness over first dorsal compartment, crepitus in tendon region

56
Q

Treatment of De Quervain’s Syndrome

A

Conservative or surgical release

Assistive device: thumb spica brace (3 weeks)
Modalities: ultrasound, iontophoresis
Manual therapy: transverse friction massage, radial glide, soft tissue & myofascial release therapy
Education: ergonomics, avoid exacerbation & activities
Ther Ex (HEP): stretching, ROM & strengthening

57
Q

Raynaud’s Phenomenon

  • defn, MOI, symptoms
  • primary vs. secondary
A

DEFN - disorder marked by brief episodes of vasospasm (narrowing in BV’s) specifically in hands and toes

  • primary = idiopathic
  • secondary = due to comorbid/underlying condition

MOI - direct cause unknown, idiopathic
–> triggered by cold temps & emotional stress

SYMPTOMS - decreased circulation, diffuse pain, pale fingers

  • digital pallor –> cyanosis –> rubor
  • Throbbing & tingling w/ return of blood
  • special test: Allen’s test
58
Q

Treatment for Raynaud’s Phenomenon

-pharmacological & non-pharm

A

Mainly will be pharmacological & lifestyle changes (if secondary)

  • Ca channel blockers, angiotensin converting enzyme inhibitors & ang. II receptor antagonists
  • exercise diet, clothing & smoking cessation

Non-pharmacological treatments:
Modalities: biofeedback, thermal
Manual therapy: massage to increase blood flow
Ther Ex: stress ball squeezes, AROM
Education: reduce stress, increase activity, stop smoking, wear enough layers of clothes

59
Q

Dupuytren’s Contracture

-defn, MOI, symptoms

A

DEFN - palmar fascia constriction; forces fingers to stay in flexed position (most commonly 4/5th digits & in men)

MOI - idiopathic; could be due to genetics, autoimmune rsn, or overproduction of collagen

SYMPTOMS - progressively thickening of palm of hand

  1. Nodule
  2. Cord
  3. Inability to straighten finger
60
Q

Treatment for Dupuytren’s Contracture (4 approaches)

A
  1. Surgical release w/ 2-3 months of therapy
  2. Needle aponeurotomy (needle divides the cords)
  3. Collagenase injection (enzyme that breakes up collagen)
  4. Corticosteroid injection (pain relief)

Education: importance to catch early so it doesn’t progress to surgery; avoid tight grips
Modalities: massage, heat
Ther Ex: intensive stretching program & strengthening
Manual Therapy: deep tissue or cross-frictional massage
Assistive device: post surgery custom splint/brace

61
Q

Risk Factors for Dupuytren’s Contracture

A

> 50, men, northern european descent, family history, tobacco & alcohol use, diabetes

62
Q

Risk Factors for Raynaud’s Phenomenon

A

Cold, gender, family history, tobacco, CT, occupation, previous injury

63
Q

Differential Diagnosis for the elbow

-anterior vs. medial vs posterior vs. lateral

A

Anterior = pronator syndrome, ant. capsular strain, biceps rupture OR elbow dislocation

Medial = MCL injury, medial epicondylitis, ulnar neuritis, OR fracture

Posterior = olecranon fracture or bursitis, stress fracture, OR triceps tendonitis

Lateral = LCL injury, lateral epicondylitis, osteocondral degeneration, osteocondritis dissecans, radial head fracture OR capitelum fracture

64
Q

Typical Treatment Progression (specifically for shoulder, but can be applied to all joints)

A
  1. Postural correction & proprioception
  2. ROM & flexibility
  3. Strengthening
  4. Functional exercises & endurance
65
Q

Treatment for Impingement Syndrome

A

First must address the underlying problem!
—> education about biomechanics

Ther Ex - postural corrections, ROM, stretching (pecs) & strengthening (scapular & RC muscles)
Manual therapy - inferior & posterior glides to open subacromial space
Assistive device - sling (acute), kinesio tape
HEP - pendulum & other ther. ex

66
Q

Treatment for Adhesive Capsulitis

A
  1. Education - explain nature of disease & prepare for extended recovery
  2. Modalities - hot packs & TENS
  3. Ther Ex - stretching; hold-relax stretch & low load prolonged stress
  4. Manual therapy - ER w/ inferior glide (RCI) & glides for general mobility
    - Grade III distraction, Grade III-IV mobilizations, NO MANIPULATIONS
  5. Assistive device - low load prolonged stress equipment
  6. HEP - pendulum & AAROM 3x/day
67
Q

Treatment for SLAP Lesions

A
  1. Ther Ex - scapular stabilization & posterior capsule stretching (sleeper, cross body)
  2. Manual therapy - depending on exam findings
  3. Assistive device - sling when acute
68
Q

Treatment for Rupture of Biceps Brachii Long Head

A
  1. Education - avoid heavy lifting 3-4 weeks
  2. Ther Ex - post op immobilization –> PROM/AROM –> RC and periscapular resistance training –> throwing program –> return to activity
  3. Manual therapy - as needed for ROM
  4. Ass. device - sling 2-4 weeks after surgery, hinged brace or cast
  5. HEP - AROM in all planes of movement to end range; 3x20, 3x per day
69
Q

Treatment for Snapping Scapula

A

If its due to overuse you can treat it conservatively, if its a lesion or body abnormality then requires surgery

  1. Ther Ex - improve muscular endurance of upper thoracic musculature & posture training, stretch upper pecs & trap
  2. HEP - posture training
  3. Manual Therapy - PAM’s of scapula, distraction grade III & medial glide
70
Q

Treatment for Scapulocostal Syndrome

A
  1. Ther Ex - serratus anterior punches, subscapular adduction & prone retraction (I,T,Y)
  2. HEP - floor/wall angels
  3. Manual therapy - scapular mobilization & trigger point release
  4. Education - postural re-education
71
Q

Treatment for AC Separation

A

Depends on type and if surgically fixed or conservatively

  1. Ther Ex - shoulder ROM > isometrics > isotonic & stretching
  2. Education - sling/brace
  3. Manual therapy - to regain shoulder motion
72
Q

Treatment for Humeral Head Fractures

A

usually treated conservatively; can be treated surgically if younger and requires higher level of function

  1. Modalities - ultrasound in subacute stage to increase blood flow
  2. Ther Ex - start ASAP - PROM > AAROM > AROM, pendulums, grip strengthening, postural corrections, isometrics & isotonics
  3. Manual Therapy - only in subacute/chronic phase

Orthopedic I (10 decks)

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