UE conditions

Question 1

Patient presents with nocturnal shoulder pain. Positive Neers test, positive hawkins-kennedy test. Posterior impingement test positive. PE shows tenderness in subacromial space, limited glenohumeral ROM. Dx?

Answer 1

shoulder impingement syndrome

Question 2

Anterior shoulder pain that radiates distally over biceps mm. Pain aggravated by lifting, pulling. Positive Speeds test and Yergason’s test. dx?

Answer 2

biceps tendinopathy

Question 3

Chronic nocturnal shoulder pain, “catching or grating” of the shoulder when raising hand overhead. PE- passive ROM normal, but active rom is often LIMITED. Tenderness over greater tuberosity. dx?

Answer 3

rotator cuff tear

Question 4

Nocturnal pain, pain with overhead motion. Positive arch test and jobe’s test. dx?

Answer 4

rotator cuff tendinopathy

Question 5

what is important to r/o in rotator cuff tendinopathy?

Answer 5

TOS and radiculopathy

Question 6

what is arch test?

Answer 6

pain between 60-120 degrees of active ABduction. positive in rotator cuff tendinopathy

Question 7

acute vs. chronic tears in rotator cuff tear

Answer 7

acute- athletes and trauma. chronic- elderly

Question 8

60 year old patient presents with severe unilateral shoulder pain. Has been going on for the last couple years, comes and goes. Upon PE, has decreased active AND passive ROM, difficulty raising both hands up in air, reaching across chest to touch opposite shoulder, can’t reach back to scratch their back. dx?

Answer 8

adhesive capsulitis (frozen shoulder)

Question 9

3 phases of adhesive capsulitis

Answer 9

initial painful phase (worse at night, stiffness), intermediate frozen phase (1 year or less), and recovery (thawing)- gradual return of ROM (less than 2 years)

Question 10

not sure if patient has adhesive capsulitis or not. what is good therapeutic and diagnostic procedure?

Answer 10

lidocaine injection- pain will improve, but ROM will not (frozen shoulder)

Question 11

be careful with glucocorticoid injections for biceps tendinopathy can cause..

Answer 11

tendon rupture

Question 12

55 year old patient with long hx of shoulder pain from rotator cuff disease. Was working out and felt sudden pain/pop. Pain was acute and severe for a few hours and is nos a chronic dull ache. Upon PE, you see “popeye deformity” near elbow. suspect..

Answer 12

proximal biceps tendon rupture

Question 13

difference in management with proximal vs. distal tendon rupture

Answer 13

distal more likely to require surgical repair. proximal more common (proximal long head of biceps)

Question 14

extensor tendon injury of the DIP joint

Answer 14

mallet finger

Question 15

injury to the ulnar collateral ligament of the 1st MP joint

Answer 15

gamekeepers thumb

Question 16

what conditions may cause medial elbow pain?

Answer 16

ulnar collaternal ligament tear and medial epicondylitis (is extra-articular), ulnar neuropathy

Question 17

golfer’s (bowlers) vs. tennis elbow

Answer 17

golfer’s- medial epicondylitis. tennis- lateral epicondylitis

Question 18

how is ROM affected in lateral/medial epicondylitis

Answer 18

it’s not, because extraarticular.

Question 19

40 yo female presents with pain at the radial side of the wrist during pinching/grasping using thumb and with wrist movement. Tenderness and swelling over radial styloid. Have increased pain with resisted thumb extension. Positive finkelstein’s test. dx?

Answer 19

Dequervain’s tenosynovitis

Question 20

Dequervain’s tenosynovitis involves entrapment of what tendons?

Answer 20

abductor pollicus longus and extensor pollicus brevis tendon at styloid process of radius

Question 21

non-infectious inflammation of the flexor tendon sheath of the finger or thumb

Answer 21

trigger finger

Question 22

Athlete with history of overhead throwing (football athlete) presents with medial elbow pain. No swelling or ecchymosis over area. Valgus stress test aggravates pain. dx?

Answer 22

ulnar collateral ligament tear

Question 23

Patient presents with elbow pain, gradual in onset. Upon PE, there is pain with resisted wrist flexion and passive wrist extension with elbow in full extension. ROM normal. dx?

Answer 23

medial epicondylitis

Question 24

Patient presents with elbow , gradual in onset. Upon PE, there is pain with resisted wrist extension and passive wrist flexion with the elbow in full extension. ROM normal. dx?

Answer 24

lateral epicondylitis

Question 25

Patient presents with thumb pain. Pain is worse during extension of ABduction of thumb. upon PE, you notice swelling and tenderness of the MP joint on the ulnar side. Laxity with valgus stress testing. dx?

Answer 25

gamekeepers thumb

Question 26

Patient presents with "finger problems." complains that there is a "snapping" sensation when the finger is flexed. it "locks" in the palm overnight and gradually "unlocks" during the day. Patient cannot open/close their hand smoothly. Swelling and tenderness over the flexor tendons over MP joint. dx?

Answer 26

trigger finger.

Question 27

30 year old man with pain on DIP on middle finger. There is swelling and ecchymosis. Cannot extend DIP joint fully and so it is flexed at rest. dx?

Answer 27

mallet finger

Question 28

most common closed tendon injury of finger=

Answer 28

mallet finger

Question 29

tx of mallet finger

Answer 29

immobiliztation with DIP joint extension splinting x 6-8 weeks CONTINUOUS

Question 30

Is epicondylitis d/t inflammation?

Answer 30

no, d/t chronic tendinosis

Question 31

tx of humerus fractures

Answer 31

if proximal humerus fracture of humeral shaft fracture, tx is immobilization, ROM/strengthening exercises. if Distal fracture depends if displaced or not. If non displaced, splinted x 10D then ROM. If displaced, need surgican intervention- ORIF

Question 32

how does distal humerus fracture or olecranon fracture tx change

Answer 32

more serious tx needed if displaced.

Question 33

Xray finding to look out for in distal humerus fracture

Answer 33

fat pad sign- indicates if bleeding into the joint

Question 34

Olecranon fracture tx

Answer 34

if non-displaced, posterior splint and f/u xrays in 7-10 days to ensure alignment. ROM for 2-3 weeks. If displaced, surgical intervention

Question 35

what neuro symptoms might result from olecranon fracture?

Answer 35

numbness in 4th/5th finger commonly d/t ulnar n. trauma

Question 36

common arm injuries d/t FOOSH

Answer 36

ROM-GCS radial head fracture, olecranon fracture, monteggia's fracutre, galeazzi's fracture, and colles fracture, scaphoid fracture

Question 37

causes of lateral elbow pain

Answer 37

lateral epicondylitis, radial head fracture

Question 38

tx for monteggia and galeazzi fracture

Answer 38

refer to ortho surgeon for surgical intervention

Question 39

fracture of the most proximal part of radius

Answer 39

radial head fracture

Question 40

differentiate the 2 types of fractures that can occur from FOOSH with arm in pronation vs. forearm in hyperpronation

Answer 40

FOOSH with arm in pronation- Monteggia's fracture (fracture of the proximal 1/3 of ulna + dislocation of the head of the radius). FOOSH with forearm in hyperpronation- Galeazzi's fracture (fracture of the radius + dislocation of the distal radioulnar joint)

Question 41

difference between fall in colles vs. smiths

Answer 41

colles- FOOSH, common in ppl with osteoporosis. smiths- falling on flexed wrists

Question 42

Fracture in which distal radius fx fragment tilts downward

Answer 42

smith's fracture

Question 43

fracture in which distal radius fx fragment tilts upward

Answer 43

colle's fracture

Question 44

what fracture may coexist with colle's?

Answer 44

ulnar styloid process often fractured as well

Question 45

fractures that cause pain in wrist

Answer 45

colles, smiths, and galeazzi fracture. any of the hand fractures may also cause wrist pain

Question 46

osteonecrosis of the LUNATE bone causing slow, progressive collapse

Answer 46

kienbock disease

Question 47

slow, progressive, nodular thickening and contracture of the palmar fascia

Answer 47

dupuytren's contracture

Question 48

cystic swelling overlying a joint or tendon sheath

Answer 48

ganglion cyst

Question 49

general tx rule for fractuers

Answer 49

if non-displaced or minimally displaced, immobilize. F/U with xray to ensure alignment. ROM/strengthening exercises after. If displaced/malaligned, refer for surgical intervention. If open fracture or NV compromise- emergent referral

Question 50

most common carpal fracture occuring usually d/t FOOSh

Answer 50

scaphoid fracture

Question 51

Patient presents with tenderness over anatomical snuffbox. Pain at radial aspect of the wrist, just proximal to thumb metacarpal. dx?

Answer 51

scaphoid fracture

Question 52

what phalynx is most commonly injured

Answer 52

distal phalynx

Question 53

boxer's fracture. what is it? and tx?

Answer 53

5th metacarpal neck fracture - ulnar gutter splint x 2-3 weeks

Question 54

30 yo man presents with dorsal wrist pain, mild swelling of wrist, crepitus, stiffness, decreased gfip strength, limited wrist ROM. Xray is normal- no fractures (r/o scaphoid fracture). But there is increased bone density (followed by bony collapse). dx and tx?

Answer 54

kienbock disease (osteonecrosis of lunate bone). No cure. NSAIDS for pain/swelling. immobilization to relieve pressure on lunate. REFERRAL ASAP. - revascularization

Question 55

etiology of kienbock disease

Answer 55

lunate fracture, trauma, abnormal loading on radiocarpal joint- causing disrupted blood supply

Question 56

Most frequent focal mononeuropathy

Answer 56

carpal tunnel syndrome

Question 57

Patient presents with pain during wrist flexion and extension. Pain/paresthesia along 1st 3 digits and radial 1/2 of 4th digits on palmar side. Positive phalen, tinnel, manual carpal compression, and hand elevating test. dx?

Answer 57

carpal tunnel syndrome - median n. affected

Question 58

risk factors for carpal tunnel

Answer 58

obese, female, preggo, DM, RA, hypothyroid, genetic, workplace

Question 59

Patient presents with numbness/tingling in 4th and 5th digits, medial elbow pain. Positive tinels, elbow flexion, compression pressure, combined elbox flexion with pressure. dx and tx?

Answer 59

ulnar neuropathy- often clinical diagnosis. NCM/EMG useful to confirm diagnosis. Mild- conservative tx. Sx persis over 6 months or severe- refer

Question 60

ulnar n., medial n. derived from...

Answer 60

ulnar n- C8-T1. median n.- C6-T1

Question 61

Patient presents with acute onset of elbow pain. Upon PE, there is a mass over the elbow 6 cm big, warm to touch and erythematous. dx and tx?

Answer 61

olecranon bursitis. if small and minimal sx- NSAIDS and activity modification. if larger, do bursa aspiration and r/o infection via cultures. if negative infection, inject steroids in 2-7 days. if concern for septic bursitis, initiate abx and consider I and D

Question 62

50 yo male patient presents with sx in ulnar aspect of hand (4th and 5th) digits), thickening of skin. Stiffness in hand/fingers. PAINLESS. Decreased ROM, "puckering" of dermal tissue. dx?

Answer 62

dupuytren's contracture (nodular thickening and contracture of palmar fascia)

Question 63

how to tell difference between ganglion cyst and tumor

Answer 63

ganglia will transilluminate.