UE conditions Flashcards
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?
shoulder impingement syndrome
Anterior shoulder pain that radiates distally over biceps mm. Pain aggravated by lifting, pulling. Positive Speeds test and Yergason’s test. dx?
biceps tendinopathy
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?
rotator cuff tear
Nocturnal pain, pain with overhead motion. Positive arch test and jobe’s test. dx?
rotator cuff tendinopathy
what is important to r/o in rotator cuff tendinopathy?
TOS and radiculopathy
what is arch test?
pain between 60-120 degrees of active ABduction. positive in rotator cuff tendinopathy
acute vs. chronic tears in rotator cuff tear
acute- athletes and trauma. chronic- elderly
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?
adhesive capsulitis (frozen shoulder)
3 phases of adhesive capsulitis
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)
not sure if patient has adhesive capsulitis or not. what is good therapeutic and diagnostic procedure?
lidocaine injection- pain will improve, but ROM will not (frozen shoulder)
be careful with glucocorticoid injections for biceps tendinopathy can cause..
tendon rupture
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..
proximal biceps tendon rupture
difference in management with proximal vs. distal tendon rupture
distal more likely to require surgical repair. proximal more common (proximal long head of biceps)
extensor tendon injury of the DIP joint
mallet finger
injury to the ulnar collateral ligament of the 1st MP joint
gamekeepers thumb
what conditions may cause medial elbow pain?
ulnar collaternal ligament tear and medial epicondylitis (is extra-articular), ulnar neuropathy
golfer’s (bowlers) vs. tennis elbow
golfer’s- medial epicondylitis. tennis- lateral epicondylitis
how is ROM affected in lateral/medial epicondylitis
it’s not, because extraarticular.
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?
Dequervain’s tenosynovitis
Dequervain’s tenosynovitis involves entrapment of what tendons?
abductor pollicus longus and extensor pollicus brevis tendon at styloid process of radius
non-infectious inflammation of the flexor tendon sheath of the finger or thumb
trigger finger
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?
ulnar collateral ligament tear
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?
medial epicondylitis
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?
lateral epicondylitis
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?
gamekeepers thumb