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MPT1 > UE - Elbow, Wrist, and Hand Pathology > Flashcards

UE - Elbow, Wrist, and Hand Pathology Flashcards

1
Q

systematic approach criteria

A
  • 2 important questions
  • ask chief complaint
  • agg/ease factors
  • radiating or radicular complaints
  • patient reported outcome measures
  • develop differential diagnoses
  • body chart
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2
Q

What is a patient reported outcome measure you can always use?

A

PSFS
patient specific functional scale

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3
Q

What questions are on the PSFS?

A

list activities the patient has difficulty doing and rate the difficulty on a scale of 1-10

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4
Q

systematic approach to objective exam

A
  • point to pain
  • clear joints above and below (& cervical)
  • observe area
  • bruising, effusion, swelling
  • quantity and quality of motion
  • strength assessment
  • special testing
  • palpation
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5
Q

biceps tendon is more involved with shoulder pathology or function?

A

pathology

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6
Q

What is a common source of anterior shoulder pain?

A

biceps tendon

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7
Q

t or f? proximal biceps rupture is an orthopedic urgency

A

false!
- proximal may be therapeutic
- distal is an ortho urgency

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8
Q

SLAP stands for

A

superior labrum anterior posterior (lesion)

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9
Q

how to tell normal vs symptomatic anatomy for SLAP lesion

A
  • difficult to see on imaging
  • discrepancy even at time of arthroscopy
    -sublabral recess is a normal finding
    0 tears noted in 72% asymptomatic subjects over 40
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10
Q

Common treatments for SLAP lesions

A
  • debride or repair (depends on tear type)
  • release the LH biceps
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11
Q

Slap management depends on age

A
  • over 40: tenodesis vs tenotomy
  • young overhead athlete: repair and protect
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12
Q

SLAP is rarely seen in isolation. What are other conditions that may be concurrent?

A
  • RC repair
  • chronic instability
  • internal impingement
  • chronic pain
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13
Q

tenodesis

A

Biceps tenodesis is done by detaching your biceps tendon from your labrum and moving the tendon to your upper arm bone (humerus).

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14
Q

tenotomy

A

Biceps tenotomy means cutting off one tendon and not reattaching it, allowing it to heal to the humerus over a few weeks.

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15
Q

SLAP lesion postop management

A
  • depends on surgery
  • period of immobilization (longer for repair, so rehab is slower)
  • want to maintain motion (prevent stiffness)
  • progress is based on impairments and healing
  • SMART goals
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16
Q

What increases chances for a distal biceps rupture?

A
  • 40-60 years old
  • usually active with high BMI
  • 7.5x more likely with smokers
  • 86% occur in dominant arm
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17
Q

What causes a distal biceps rupture?

A

unexpected eccentric load

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18
Q

How to diagnose distal biceps rupture?

A

-hook test
-visible deformity
-ecchymosis
-palpable gap
- mechanism of injury
-supination weakness
-tender to palpate radial tuberosity

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19
Q

how to manage a distal biceps tear

A
  • early surgical intervention is a must (otherwise >4 weeks the tendon will retract and may need a graft)
  • can loose supination strength and elbow flexion
  • non-op is only older patients with co-morbidities
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20
Q

common complications to distal biceps tear surgery

A

rupture
infection
fracture

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21
Q

postop management of distal biceps tear

A
  • period of immobilization
  • several weeks of controlled motion in a brace
  • full motion by 6-8 weeks
  • return to work/sport depends
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22
Q

Elbows are the ______ most commonly dislocated joint

A

2nd

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23
Q

What direction is the elbow most commonly dislocated in?

A

posterolateral (named for direction the ulna travels)

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24
Q

What are the 2 types of elbow dislocations?

A
  • simple: no fracture, reduction, brane, immediate rehab and motion
  • complex: fracture, often unstable and requires surgery
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25
Q

What is the terrible triad of the elbow?

A
  • elbow dislocation
    -radial head fracture
  • coronoid fracture
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26
Q

Which band of UCL is tight in flexion?

A

Posterior band

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27
Q

Which band of UCL is tight in extension?

A

Anterior band

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28
Q

What population is UCL injuries most common in?

A

Overhead throwers and athletes

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29
Q

What is the resconstruction surgery first described in 1974 for UCL injuries?

A

Tommy John surgery

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30
Q

What are some UCL injury risk factors?

A

high pitch counts
pitch on consecutive days
pitch for multiple teams
pitching velocity
pitching while fatigued
GIRD
decreased rotator cuff strength
core weakness

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31
Q

T or F. non-operative treatment for UCL injuries should be attempted for all athletes

A

true! but most team physicians tend to be ortho surgeons. must be willing to stop throwing. structural diag must be made via MRI

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32
Q

What tendon do they use for surgical UCL reconstruction?

A

palmaris longus or hamstring autograft

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33
Q

UCLR postop care?

A
  • period of immobilization
  • bracing and return of motion by 6-8 weeks
  • return to throwing 10-18 months
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34
Q

Is RTS the same as return to PLOF?

A

No! especially for high level athletes, may see some deficits

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35
Q

Where does ulnar nerve entrapments occur?

A

cubital tunnel
guyon’s canal

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36
Q

Where do median nerve entrapments occur?

A

pronator teres
carpal tunnel

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37
Q

Where do radial nerve entrapments occur?

A

Pin within radial tunnel (motor only)
radial tunnel syndrome (pain only, no motor)

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38
Q

What are some ways to treat cubital tunnel syndrome without surgery

A
  • education
  • ergonomic changes
    -night splinting/wrap with towel
  • activity modification
  • monitor for increased muscle involvement
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39
Q

Where is guyons canal?

A

between hook of hamate and pisiform

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40
Q

What are two potential causes for guyons canal syndrome?

A

handlebar palsy and computer mouse

41
Q

Describe the 3 zones of injury for guyons canal

A

1 - motor and sensory
2 - motor only
3 - sensory only

42
Q

What is the floor of guyons canal?

A

Pisohamate ligament

43
Q

What are some ways to test for ulnar neuropathy diagnosis?

A
  • froments sign
  • wartenbergs sign
  • tinels sign
    pressure provocation test
    elbow flexion test
44
Q

What are some pathologies that effect the radial nerve?

A

humeral shaft fracture
proximal humeral fracture
saturday night palsy
radial tunnel syndrome
PIN entrapment

45
Q

Where do you palpate the radial tunnel?

A

3 cm distal to LE

46
Q

T or F? Radial tunnel syndrome is painless and only has motor loss

A

F, radial tunnel syndrome is very painful with no motor or sensory loss
- no lateral epicondyle tenderness

47
Q

T or F? PIN syndrome is only characterized by motor loss

A

True! PIN is only a motor nerve

48
Q

What nerve are we concerned with being damaged after a distal biceps tear repair?

A

Radial

49
Q

Where is arcade of frohse and why do we care about it?

A

Where radial nerve pierces supinator. common site of compression

50
Q

pronator syndrome affects which nerve?

A

median nerve compression at two heads of pronator teres

51
Q

What are some symptoms of pronator syndrome?

A

volvar forearm pain
numbness of first 3 digits
pain worse with physical activity

52
Q

How do you differentiate pronator syndrome from carpal tunnel compression?

A
  • sparing of palmar cutaneous branch
  • forearm pain
53
Q

AIN - test how?

A

Okay sign - can’t flex thumb IP joint is abnoramal
pronator quadratus weakness

54
Q

What are some risk factors for developing carpal tunnel syndrome?

A

repetitive wrist motions
pregnancy
diabetes
rheumatoid arthritis

55
Q

What exams do you complete for carpal tunnel syndrome?

A

phalens
reverse phalens
tinels
APB strength!

56
Q

What are some treatments for carpal tunnel syndrome

A

activity mod and education
splinting and night splinting
impairment based rehab
aggressive observation (don’t want to progress to muscle wasting)
surgical release

57
Q

tennis elbow

A

lateral epicondylitis
(pain with resisted wrist and finger extension)

58
Q

golfers elbow

A

medial epicondylitis (pain with resisted weist flexion and pronation)

59
Q

What muscle is the most likely issue with lateral epicondylitis

A

ECRB

60
Q

What are some special tests for tennis elbow?

A

mills, maudsleys, cozens
tenderness at lat. epicond.

61
Q

What muscles are issues with medial epicondylitis

A

pronator teres and flexor carpi radialis

62
Q

What tests should you use for golfers elbow?

A

resisted pronation and flexion
tenderness at medial epicondyle

63
Q

How to treat olecranon bursitis?

A

supportive care
1-2 months minimum recovery
compressive wrapping
elevation
NSAIDs
education

64
Q

What are some concerns for septic bursitis?

A
  • ed and primary care
  • need antibiotics and surgical debridement
  • education (many patients want it drained)
  • INCREASED RISK FOR TRICEPS RUPTURE
65
Q

Why is the elbow predisposed to be stiff?

A
  • congruity of ulnohumeral articulation
  • three articulations in one capsule
  • blending of ligaments with the capsule
66
Q

According to the capsular pattern, which ROM is lost first with stiff elbow

A

flexion

67
Q

How much elbow flexion can you lose before it impacts ADLs?

A

30 degrees

68
Q

Which carpal bone is most likely to fracture?

A

Scaphoid

69
Q

Scaphoid has a ______________ blood supply

A

retrograde

70
Q

must place a _____________ on hand to treat a scaphoid fracture

A

thumb spica

71
Q

T or F. A scaphoid fracture is always plain and visible on xrays

A

false!!!!

72
Q

Scapholunate injuries are due to?

A

hyperextension injuries

73
Q

What special test do we use for sacpholunate injuries

A

watson scaphoid test

74
Q

How do we treat scapholunate injuries?

A

normal films = treat like sprain
short period of splint mobilization, control inflammation
progression based on exam and interventions based on impairements

75
Q

What are 3 possible radial sided tendonopathies?

A
  • De Quervain’s tenosynovitis
  • intersection syndrome
  • flexor carpi radialis tendonitis
76
Q

What is De Quervains

A
  • inflammation of the 1st extensor compartment (EPB and AbPL)
  • caused by repetitive thumb extension and abduction
77
Q

What special test can be used to ID De Quervains

A

positive finkelsteins test

78
Q

Intersection syndome

A

where 1st and 2nd extensor compartment muscle bellies meet in the extensor compartment
ECRL ECRB - 2nd compartment

79
Q

flexor carpi radialis tendonitis

A

radial sided tendinopathie

80
Q

What are possible ulnar sided wrist pathologies?

A

-Triangular fibrocartilage complex (TFCC)
- hyperextension injuries
- repetitive stress injuries

81
Q

TFCC management

A

period of mobilization
NSAIDs
cortisone injection
impairment based rehab
surgery

82
Q

what are 3 possible surgical procedures to handle TFCC

A
  • debridement
  • repair with sutures
  • correction of ulnar variance (by shortening bone)
83
Q

Gamekeepers thumb

A

UCL injury of thumb
ABD stress of 1st MCP joint
chronic insufficiency
thumb spica

84
Q

Skier’s thumb

A

UCL injury of thumb
ABD stress of 1st MCP joint
acute injury

85
Q

stener lesion

A

adductor aponeurosis between torn UCL and PP
surgery necessary for healing

86
Q

how to treat gamekeepers thumb?

A

thumb spica for 2-6 weeks!
understand injury and healing
avoid stress to ucl region
impairment based rehab progression
splinting or taping to support RTP
amount of laxity and functional impact
presence of bone involvement

87
Q

What is a central slip rupture characterized by?

A

forced PIP flexion
lateral bands migrate volarly

88
Q

What can happen if a central slip rupture isn’t addressed promptly?

A

boutonniere deformity is development.
PIP flexion with DIP hyperextension

89
Q

What should you look for on a physical exam when you suspect a central slip rupture?

A
  • ask about history of PIP injury (jamming or dislocation)
  • tenderness to central slip insertion
  • DIP stiffness with PIP in extension
90
Q

How do you treat a central slip rupture?

A

must recognize early
splint so PIP is in full extension and DIP is free to move

91
Q

What characterizes a jersey finger?

A
  • forced hyperextension of the DIP joint
  • avulsion of the FDP
  • typically on ring finger
92
Q

how do you manage a jersey finger?

A

early management is important
surgery!! to stop tendon from traveling up hand

93
Q

What does the deformity for jersey finger look like?

A

when they try to make a fist one of their fingers cannot flex the DIP joint and it is straight

94
Q

What is a mallet finger characterized by?

A
  • forceful flexion of the extended DIP joint
  • disruption of the terminal extensor tendon
  • unable to extended DIP
  • dorsal swelling and pain
95
Q

How do you treat mallet finger?

A
  • early management critical
  • DIP splinted in full extension for 6-8 weeks with PIP joint free to move
96
Q

What deformity can form when mallet finger goes untreated?

A

swam neck deformity

97
Q

What is swan neck deformity characterized by?

A
  • flexed DIP, hyperextended PIP
98
Q

What can cause swan neck?

A

untreated mallet finger
FDS rupture = unopposed PIP extension
Rheumatoid arthritis

99
Q

how do you treat swan neck?

A

double ring splint

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