UE conditions Flashcards

1
Q

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?

A

shoulder impingement syndrome

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2
Q

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

A

biceps tendinopathy

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3
Q

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?

A

rotator cuff tear

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4
Q

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

A

rotator cuff tendinopathy

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5
Q

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

A

TOS and radiculopathy

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6
Q

what is arch test?

A

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

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7
Q

acute vs. chronic tears in rotator cuff tear

A

acute- athletes and trauma. chronic- elderly

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8
Q

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?

A

adhesive capsulitis (frozen shoulder)

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9
Q

3 phases of adhesive capsulitis

A

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)

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10
Q

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

A

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

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11
Q

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

A

tendon rupture

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12
Q

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..

A

proximal biceps tendon rupture

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13
Q

difference in management with proximal vs. distal tendon rupture

A

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

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14
Q

extensor tendon injury of the DIP joint

A

mallet finger

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15
Q

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

A

gamekeepers thumb

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16
Q

what conditions may cause medial elbow pain?

A

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

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17
Q

golfer’s (bowlers) vs. tennis elbow

A

golfer’s- medial epicondylitis. tennis- lateral epicondylitis

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18
Q

how is ROM affected in lateral/medial epicondylitis

A

it’s not, because extraarticular.

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19
Q

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?

A

Dequervain’s tenosynovitis

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20
Q

Dequervain’s tenosynovitis involves entrapment of what tendons?

A

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

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21
Q

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

A

trigger finger

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22
Q

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?

A

ulnar collateral ligament tear

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23
Q

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?

A

medial epicondylitis

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24
Q

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?

A

lateral epicondylitis

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25
Q

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?

A

gamekeepers thumb

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26
Q

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?

A

trigger finger.

27
Q

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?

A

mallet finger

28
Q

most common closed tendon injury of finger=

A

mallet finger

29
Q

tx of mallet finger

A

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

30
Q

Is epicondylitis d/t inflammation?

A

no, d/t chronic tendinosis

31
Q

tx of humerus fractures

A

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

32
Q

how does distal humerus fracture or olecranon fracture tx change

A

more serious tx needed if displaced.

33
Q

Xray finding to look out for in distal humerus fracture

A

fat pad sign- indicates if bleeding into the joint

34
Q

Olecranon fracture tx

A

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

35
Q

what neuro symptoms might result from olecranon fracture?

A

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

36
Q

common arm injuries d/t FOOSH

A

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

37
Q

causes of lateral elbow pain

A

lateral epicondylitis, radial head fracture

38
Q

tx for monteggia and galeazzi fracture

A

refer to ortho surgeon for surgical intervention

39
Q

fracture of the most proximal part of radius

A

radial head fracture

40
Q

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

A

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)

41
Q

difference between fall in colles vs. smiths

A

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

42
Q

Fracture in which distal radius fx fragment tilts downward

A

smith’s fracture

43
Q

fracture in which distal radius fx fragment tilts upward

A

colle’s fracture

44
Q

what fracture may coexist with colle’s?

A

ulnar styloid process often fractured as well

45
Q

fractures that cause pain in wrist

A

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

46
Q

osteonecrosis of the LUNATE bone causing slow, progressive collapse

A

kienbock disease

47
Q

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

A

dupuytren’s contracture

48
Q

cystic swelling overlying a joint or tendon sheath

A

ganglion cyst

49
Q

general tx rule for fractuers

A

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

50
Q

most common carpal fracture occuring usually d/t FOOSh

A

scaphoid fracture

51
Q

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

A

scaphoid fracture

52
Q

what phalynx is most commonly injured

A

distal phalynx

53
Q

boxer’s fracture. what is it? and tx?

A

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

54
Q

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?

A

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

55
Q

etiology of kienbock disease

A

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

56
Q

Most frequent focal mononeuropathy

A

carpal tunnel syndrome

57
Q

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?

A

carpal tunnel syndrome - median n. affected

58
Q

risk factors for carpal tunnel

A

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

59
Q

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?

A

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

60
Q

ulnar n., medial n. derived from…

A

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

61
Q

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?

A

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

62
Q

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?

A

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

63
Q

how to tell difference between ganglion cyst and tumor

A

ganglia will transilluminate.