Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSK > UE Part 2 > Flashcards

UE Part 2 Flashcards

1
Q

Bones of the elbow

A
  • humerus
  • Radius
  • ulna
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Ligaments of the elbow

A
  • ulnar collateral ligament
  • radial collateral ligament
  • annular ligament
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

joints of the elbow and their function

A
  • ulnohumeral and radiocapitellar articulation: flexion/extension of the elbow and pronation/supination of the forearm
  • Proximal radioulnar articulation: pronation/supination of the forearm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what does the radius articulate with

A

capitulum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what does the ulna articulate with

A

trochlea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

nerves of the elbow

A
  • ulnar
  • median
  • radial
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

arteries of the elbow

A

brachial branches into
* radial
* ulnar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

where does the biceps brachii originate and insert

A

long head intertubercular groove
short head coracoid process
inserts on the radial tuberosity and biceps aponeurosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

where does the triceps brachii originate and insert?

A

long head originates on lateral aspect of scapular
lateral head on posterior humerus
attaches on olecranon via triceps tendon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

where are the flexor muscles located?

A

Anterior aspect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

where are the extensor muscles located

A

posterior aspect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what cushions the olecranon and should not be palpable in normal patients?

A

olecranon bursa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

imaging of elbow

A
  • Standard X-rays: AP and lateral
  • Oblique (radiocapitellar) 45 degree view –> improved radial head visualization
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How should the anterior humeral line and the radiocapitellar line align on lateral xray

A
  • Anterior humeral line should bisect the middle third of the capitellum
  • Radiocapitellar line (drawn through enter of radius) should pass through center of capitellum
  • Disruption of these relationships may indicate fracture

anterior humeral line = anterior humerus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the most common chief complaints of elbow

A
  • Pain
  • Stiffness
  • Swelling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What does pain on the posterior aspect of the elbow indicate?

A
  • Ulnar nerve compression
  • Olecranon bursitis
  • Fracture of olecranon
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What does pain of the medial elbow indicate?

A
  • Arthritis
  • Ulnar collateral ligament tear
  • Medial epicondylitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What does pain of the anterior elbow indicate

A

Arthritis
Rupture of the distal biceps tendon
Pronator syndrome
Lateral epicondylitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What does pain of the lateral elbow indicate

A
  • Fracture of the distal humerus
  • Fracture of the radial head
  • Posterior interosseous nerve syndrome
  • Olecranon bursitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Physical exam of elbow

A

Normal ROM
* 0-150 degree flexion
* 10-15 degree hyperextension
* 80 degree supination/pronation
* Inspect
* Palpate
* ROM
* Muscle strength

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What muscles/nerves can be tested in elbow?

A
  • Flexion and supination: bicep, C5-C6, musculocutaneous nerve
  • Extension: tricep, C7-C8
  • Pronation: pronator teres muscles, median nerve, C6-C7
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What does valgus stress test of the elbow test?

A
  • Stability of medial ligamentous structures, primarily ulnar collateral ligament
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How is valgus stress test of elbow performed?

A
  • Hold elbow in 20 degree flexion with forearm in supination
  • Apply pressure on Lateral side of elbow attempting to open the medial joint line
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What does varus stress test determine?

A
  • Stability of the lateral collateral ligament and lateral capsule
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How is the varus stress test performed?

A
  • Hold elbow in 20 degree flexion with forearm in supination and apply pressure on the medial side of the elbow, attempting to open the lateral joint line
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Disorders of the elbow

A
  • Fractures
  • Subluxation of radial head
  • Epicondylitis
  • Olecranon bursitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Etiology of distal humeral fractures

A
  • Direct trauma
  • Axial loading transmitted through the elbow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Types of distal humeral fractures

A
  • Supracondylar (MC in children): type A
  • Epicondylar (medial or lateral): type B
  • Intercondular: type C (MC) both epicondyles impacted
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Distal humeral fracture complications

A
  • Intra-articular or comminuted fractures
  • Nerve injury to ulnar or radial nerve
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How would ulnar nere injury present?

A
  • Sensory changes to medial 2 fingers
  • Flexion/adduction of wrist impacted
  • 4th and 5th DIP joint flexion impacted
  • Finger abduction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How does radial nerve injury present?

A
  • Sensory changes to dorsal thumb, pointer finger and middle of middle finger and wrist
  • Motor: wrist extension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Presentation of distal humeral fractures

A
  • Pain
  • Swelling
  • Tenderness
  • Ecchymosis
  • Crepitus
  • Elbow ROM limited
  • Shortening of arm with displaced shaft fracture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What should be assessed on exam of distal humeral fracture?

A
  • Skin
  • Joints/bones above and below
  • N/V status
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What can be impacted with a supracondylar fracture?

A
  • Radial artery
  • Median nerve
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What can be impacted in an epidconylar fracture?

A
  • Ulnar nerve (medial)
  • Radial nerve (lateral)
  • depennding on epicondyle impacted
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Imaging for distal humeral fracture

A
  • AP and lateral elbow x-ray
  • Look for fat pad “sail sign”
  • MC in kids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What does the fat pad sail sign indicate?

A

Intra-articular bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Management of supracondylar fracture?

A
  • Isolated without displacement or angulation: long arm cast/splint with elbow flexed at 90 degrees
  • Displaced, angulated, or NV compromise: ORIF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Management of epicondylar humeral fracture

A
  • Isolated, minimally displaced: long arm cast/splint with elbow at 90 degrees
  • Medial condyle fracture: forearm in pronation
  • Lateral condyle fracture: forearm in supination
  • Moderate displacement (2-4 mm): percutaneous pinning or ORIF
  • Severe displacement: ORIF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Long arm posterior casting indications

A

Supracondylar distal humerus, olecranon, proximal mid-shaft radius and ulnar fractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

MOI of olecranon fracture

A
  • Fall on a semi-flexed supinated forearm (avulsion) MC
  • 2nd MC: direct trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Presentation of olecranon fracture

A
  • Pain, tenderness, swelling, ecchymosis over olecranon process
  • Limited ROM of elbow
  • Deformity if associated elbow dislocation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Exam of olecranon fracture

A
  • Assess distal NV status and overlying skin
  • Ulnar nerve most often affected
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Olecranon fracture imaging

A
  • AP and lateral elbow
  • Radiocapitellar view if unclear or complicated presentation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Management of nondisplaced olecranon fracture (<1-2 mm displacement)

A
  • Posterior long arm splint with elbow in any degree of flexion, forearm in neutral position
  • Monitor for vascular compromise
  • Encourage hand/finger ROM/strength
  • Repeat x-ray in 7-10 days to ensure alignment intact
  • Cast/splint removed after 2-3 weeks
  • Start gentle ROM therapy
  • Consider PT referral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Management of displaced olecranon fracture

A
  • Closed: splint and refer for ORIF
  • Open: admit for IV abx and consult ortho
  • If contraindication for surgery, sling and start ROM as pain allows
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Complications of olecranon fracture

A
  • Elbow stiffness, loss of ROM
  • Arthritis
  • Non-union
  • Surgical implant failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

MOI of radial head/neck fracture

A

fall on outstretched hand resulting in compression of radial head into the capitellum
Most common fracture of the elbow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Classification of radial head/neck fracture

A
  • Mason classification
  • Type I: <2 mm displacement
  • Type II: displacement > 2 mm
  • Type III: comminuted
  • Type IV: radial head fracture with associated elbow dislocation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Presentation of radial head/neck fracture

A
  • Pain and tenderness along lateral aspect of elbow over radial head
  • Limited ROM related to pain or joint effusion
  • Painful pronation/supination
  • +/- local swelling/ecchymosis
  • Additional exam: assess bones and joints above and below, skin, NV status
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Imaging of radial head/neck fracture

A
  • AP and lateral elbow with fracture line, fat pad sign
  • Capitellar view if unable to appreciate fracture on standard views
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Management of type I radial head/neck fracture

A
  • Sling with or without a posterior splint –> splint should be removed after 1-2 days
  • AROM after 24-48 hours with full extension, flexion; pronation and supination with elbow flexed at 90 degrees
  • F/U with ortho in 1 week
  • Aspiration if hemarthrosis is present to allow early ROM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Management of type II-III radial head/neck fracture

A
  • Sling and splint with ortho evaluation in 2-3 days to discuss consideration of ORIF
  • Ortho can assess for mechanical block
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Management for type IV radial head/neck fracture

A

Immediate consult for reduction and ORIF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What is radial head subluxation?

A
  • AKA nursemaid’s elbow
  • Subluxation of the radial head through annular ligament due to laxity
  • MC in children under 5
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

MOI of radial head subluxation

A
  • Pulling on a pronated forearm while the elbow is extended
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Clinical presentation of radial head subluxation

A
  • Hx of mechanism followed by crying which subsides quickly
  • Arm held semi-flexed, adducted, and pronated
  • ROM is refused: resistance with attempted supination
  • Tender over radial head
  • No swelling or ecchymosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Imaging of radial head subluxation

A
  • Not necessary for diagnosis
  • X-ray only if suspicion of other injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Management of radial head subluxation

A
  • Reduction
  • If failed reduction, order radiographs, splint, and refer to ortho
  • If succesful reduction, tylenol/motrin prn +/- sling, parent education
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

How can radial head subluxation be reduced?

A
  • Premedicate with tylenol or motrin
  • 2 techniques: supination-flexion or hyperpronation
  • Immediate re-assessment of NV status
  • After 15-30 minutes reattempt if no improvement, 3-4 attempts acceptable
  • Reduction less likely to be successful if seen 1-2 days after injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Supination-flexion reduction technique

A
  1. Hold elbow with thumb over radial head
  2. Quickly supinate fully
  3. Folowed by complete flexion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Hyperpronation reduction technique

A
  • Hold elbow with your thumb overlying radial head
  • Hyperpronate forearm
  • Followed by complete extension then flexion
  • EBM states that this technique is often more effective than the first and may be less painful
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What is epicondylitis

A
  • Tendinosis of wrist extensors or wrist flexors at their origination site on their respective epicondyles
  • Lateral: wrist extensors (tennis elbow) MC
  • Medial: wrist flexors (golfers elbow)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

MOI of epicondylitis

A
  • Chronic repetitive overuse resulting in micro-trauma at tendon insertion
  • Acute strain due to excessive loading
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Epidemiology of epicondylitis

A
  • MC between 30-50 years of age
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Presentation of lateral epicondylitis (tennis elbow)

A
  • Pain with wrist extension and gripping- shaking hands, using computer mouse, use of screwdriver, back-handed tennis swing, opening jar
  • Paint tenderness 1 cm distal to epicondyle
  • Pain with wrist extension and supination against resistance (elbow extended)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Presentation of medial epicondylitis

A
  • Pain with arm pronation and wrist flexion, grip pain/weakness-golf swing, overhead throwing, bowling
  • Point tenderness 1 cm distal to epicondyle
  • Pain with wrist flexion and pronation against resistance (elbow extended)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Diagnostics for epicondylitis

A

Normal AP and lateral elbow (not needed for diagnosis)`

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Management of epicondylitis

A
  • Activity modification, NSAIDs, ice after use
  • Refer to PT if failure of conservative treatment
  • PT after initial pain subsides: gentle stretching and strengthening
  • Bracing: counterforce brace
  • Steroid injection x 3 max
  • Refer to ortho if symptoms persist for 6 months of conservative therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What is olecranon bursitis

A

Inflammation of the olecranon bursa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Mechanism of olecranon bursitis

A
  • Trauma: fall or direct blow to elbow
  • Inflammation: excessive leaning on elbow or secondary to systemic inflammatory conditions (RA, gout, etc)
  • Infection: septic bursitis, MC pathogens staph and strep
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Presentation of olecranon bursitis

A
  • Gradual or sudden swelling of the brusa up to 6 cm in daimeter
  • Small lumps of scar tissue remain as swelling subsides
  • +/- pain, tenderness, limited ROM: more so in trauma and infectious etiologies, chronic recurrent swelling is less tender
  • Redness and warmth in acute bursitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Diagnostics for olecranon bursitis

A
  • Aspiration for large, symptomatic bursa
  • AP and alteral elbow x-ray if hx of trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What analysis is performed on bursal fluid

A
  • CBC
  • Gram stain
  • C&S
  • Crystals
75
Q

Management of inflammatory or traumatic olecranon bursitis

A

Mild swelling
* Activity modification and NSAIDS
* Use of elbow pad, compression during acute phase

Significant swelling
* Aspirate, apply compression bandage, and f/u in 2-7 days
* If fluid returns and cultures are negative repeat aspiration and re-culture
* If cultures remain negative but swelling persists, aspiration and injection of 1 mL of corticosteroid into the bursal sac

76
Q

Management of mild, with no immunosuppression, septic bursitis

A
  • Bactrim or keflex
  • Abx tailored to culture and sensitivity once available
77
Q

Management of severe bursitis or immunosuppression

A
  • IV vancomycin
  • Add pseudomonal coverage if associated with trauma ie ciprofloxacin or zosyn
  • Abx tailored to culture and sensitivity once available
78
Q

What are indications of a severe presentation of septic bursitis

A
  • systemic toxicity (fever, hypotension, tachycardia)
  • rapid progression or progression 48 hours after abx
  • unable to tolerate oral therapy
  • close indwelling medical device ex prosthetic joint or vascular graft
79
Q

forearm anatomy

A
80
Q

forearm series imaging

A

AP and lateral

81
Q

Hand, wrist, and finger series imaging

A

PA
Oblique
Lateral

82
Q

MOI of forearm fractures

A
  • Direct blow
  • Fall on outstretched hand
83
Q

Complicated forearm fractures

A
  • Galeazzi: radial midshaft with instability of distal radioulnar joint
  • Monteggia: proximal third of ulnar shaft with dislocation of radial head due to instability of the proximal radioulnar joint

MUGR

84
Q

Diagnosis of forearm fracture

A
  • Forearm series: should provide you a view of the wrist and elbow
  • Add dedicated elbow or wrist if needed to further evaluate the joint
84
Q

Forearm fracture presentation

A
  • Deformity
  • Swelling
  • Ecchymosis
  • Point tenderness overlying fracture
  • Decreased ROM of joint above and below
  • Assess NV status
  • Assess compartments of forearm
85
Q

Indications for emergent (<1 hour) orthopedic referral for forearm fracture in adult

A
  • Arterial compromise
  • Open fracture
86
Q

Indications for urgent referral to ortho (<24 hours) for forearm fracture ina dult

A
  • Ulnar shaft fracture with <50% apposition or >10 degrees angulation
  • Forearm fracture with any DRUJ or PRUJ instability
  • Forearm fracture with peripheral nerve injury
  • Both bones fracture with displacement
87
Q

Indications for priority orthopedic referral for forearm fracture in adult

A
  • Isolated radial shaft fracture with any displacement
  • Both bones fracture even with minimal or no displacement
  • Isolated proximal third ulna fracture
88
Q

Management of simple, isolated fracture of the ulnar shaft

A
  • <50% displacement, <10% angulation before or after closed reduction and no joint involvement
  • Long-arm posterior splint: elbow at 90 degrees, forearm in neutral position, slight wrist extension
  • After 1-3 weeks remove splint and place in a functional forearm brace for 4-6 weeks to allow protected AROM of the elbow, forearm, and wrist
  • F/u to ensure alignment at 1 week and then q 4 wk until complete healing has occured, usually 8 weeks
89
Q

Management of isolated radial fractures, combined radius-ulna fracture, or galeazzi or monteggia fracture

A
  • Double sugar tong
  • Combined radius-ulna fracture and galeazzi or monteggia, refer to ortho
90
Q

Wrist bone anatomy review

A

scaphoid
lunate
triquetrum
pisiform
trapezium
trapezoid
capitate
hamate

lateral to medial proximal line then distal

some lovers try positions they can’t handle

91
Q

What are the 2 ligaments of the wrist?

A

Ulna collateral and radial collateral

92
Q

What is the ulnar nerve area of sensation?

A
  • Ring finger and pinky finger
93
Q

What is the median nerve area of sensation

A
  • Thumb and first 2 fingers
94
Q

What is radial nerve area of sensation

A

dorsal thumb and first 2 fingers

95
Q

What is the palmar blood flow

A
  • Ulnar and radial artery
  • Deep and superficial palmar arch
  • CCommon palmar digital arteries and proper palmar digital arteries, radial artery index finger
96
Q

What is the dorsal wrist blood flow?

A
  • Radial artery
  • Basal metacarpal arch
  • Dorsal metacarpal arteries
  • Digital arteries
97
Q

MOI of wrist fracture

A

Fall on outstretched hand

98
Q

Common types of wrist fractures

A
  • Colles fracture: distal radius fracture fragment tilted dorsally
  • Smith’s fracture: distal radial fragment tilted volarly
99
Q

What is a dinner fork derormity?

A

Colles fracture

100
Q

What is a garden spad deformity?

A

Smith’s fracture

101
Q

Presentation of wrist fracture

A
  • acute pain
  • tenderness
  • swelling
  • deformity of the wrist
102
Q

diagnostics of wrist fracture

A

wrist x-ray series

103
Q

wrist fracture management for nondisplaced or minimally displaced and non-articular fractures

A
  • sugar tong splint or short arm cast for 2 to 3 weeks
  • Casts should not be placed until 72 hours after injury
  • AP and lateral radiographs should be performed each week for 2 weeks to assure union and reduction
104
Q

management for displaced and open fractures

A

ORIF

105
Q

epidemiology of scaphoid fracture

A
  • MC carpal fracture
  • MC in young men
106
Q

MOI of scaphoid fracture

A
  • Hyperextension injury
  • fall on outstretched hand
107
Q

Anatomic considerations of scaphoid fracture

A

Blood supply enters at the distal 1/3 of the bone

108
Q

Complications of scaphoid fracture

A
  • High incidence of delayed diagnosis
  • Non-union
  • Avascular necrosis
109
Q

Presentation of scaphoid fracture

A
  • Wrist pain/swelling along radial aspect
  • Tenderness along anatomical snuff box
  • Grip and ROM may be painful/weak/limited
110
Q

Scaphoid fracture diagnostics

A
  • Wrist series plus
  • Scaphoid (navicular) view: PA view with the wrist in ulnar deviation
  • CT/MRI if x-rays remain negative and suspicion is high
111
Q

Management of nondisplaced or negative x-rays scaphoid fracture

A
  • Thumb spica splint/cast x 6 weeks
  • Refer to ortho
  • Repeat x-rays in 7-14 days if initially negative
  • If x-rays remain negative and tenderness persists –> CT/MRI
  • Monitor for complications and to ensure complete healing with serial x-rays/MRI
112
Q

Management of displaced scaphoid fracture

A
  • ORIF
  • Percutaneous pin placement
  • Monitor for complications and to ensure complete healing with serial x-rays/MRI
113
Q

Indications for thumb spica splint

A
  • Scaphoid
  • Lunate
  • Trapezium
  • 1st metacarpal
  • 1st phalynx bone fractures
  • 1st MCP dislocation
  • Ulnar collateral ligament tear
  • De Quervain’s tenosynovitis
114
Q

What is carpal tunnel syndrome?

A
  • Compression of the median nerve at the carpal tunnel
115
Q

Risk factors for carpal tunnel syndrome

A
  • Repetitive wrist movements
  • Wrist injury
  • Pregnancy
  • Sedentary lifestyle
  • Familial
  • Multiple systemic conditions
116
Q

Presentation of carpal tunnel syndrome

A
  • Burning, tingling pain over median nerve distribution of the hand
  • Exacerbated by activity and at night
  • Aching pain radiating to elbow and shoulder
117
Q

Physical exam of carpal tunnel syndrome

A
  • Tinel’s and Phalen’s signs
  • Carpal compression test
  • Hand elevation test
  • Grip weakness
  • Thenar atrophy (late)
118
Q

Diagnosis of carpal tunnel syndrome

A

EMG/NCS

119
Q

Management of carpal tunnel syndrome

A
  • Activity modification
  • Cock-up wrist splint
  • Corticosteroid injection
  • Refer for to ortho for carpal tunnel release
120
Q

Indications for referral to ortho for carpal tunnel release

A
  • Failure of >3 months of conservative therapy
  • Objective neurologic findings of thenar muscle atrophy
121
Q

Anatomy review of hand bones

A
122
Q

What is the epidemiology of metacarpal factures?

A

Most common in adults

123
Q

What is the most common fracture in the hand?

A

Boxer’s fracture: fracture of 4th or 5th metacarpal that results from a closed fist striking a object

124
Q

What is the epidemiology of phalangeal fractures?

A

MC in children, involving the physis of the 5th phalange
Distal phalynx most commonly injured in adults

125
Q

Presentation of metacarpal/phalangeal fractures

A
  • History of trauma
  • Local tenderness, swelling, deformity, and decreased ROM
  • Boxer’s fracture most likely to be malrotated
  • Assess distal NV status
126
Q

Management of displaced metacarpal neck fracture

A

> 30 degree angulation –> reduction followed by splint/casting
<30 degree angulation –> splint for 2-3 weeks. If 4th or 5th metacarpal, ulnar gutter splint; if 2nd and 3rd metacarpal –> radial gutter splint

127
Q

Management of non-displaced metacarpal/phalangeal fractures

A
  • Non-displaced fractures of the 2-5th metacarpal/phalangeal shaft: splint for 3-4 weeks
  • Gutter splint: metacarpal
  • Phalangeal fracture: buddy tape or aluminum splint
  • Non displaced fracture of 1st metacarpal/phalange: thumb-spica splint, wrist in 30 degrees of extension
  • Non-displaced/non-articular 1st metacarpal base: thumb spica splint/cast x 4 weeks
    *
128
Q

Management of displaced/angulated metacarpal/phalangeal shaft fracture or intra-articular fractures

A
  • Refer/consult ortho for further evaluation
  • Closed vs open reduction and fixation
129
Q

Pathology of Gamekeeper’s thumb aka skier’s thumb

A

Rupture of the ulnar collateral ligament of the 1st MCP joint

130
Q

MOI of Gamekeeper’s Thumb

A

Forced radial abduction

131
Q

Clinical presentation of gamekeeper’s thumb

A
  • Pain, swelling, tenderness along the medial 1st MCP joint
  • Weak pincer formation
  • Stress testing after local anesthesia
132
Q

Diagnostics of Gamekeeper’s thumb

A

1st phalange finger series

133
Q

Management of gamekeeper’s thumb

A

Thumb spica splint
Refer to ortho for surgical repair

134
Q

Pathology of Mallet finger

A
  • Rupture, laceration, or avulsion of the extensor tendon at the distal phalanx
135
Q

MOI of Mallet finger

A

Hyperflexion of DIP

136
Q

Clinical presentation of mallet finger

A
  • DIP is flexed at 40 degrees with the inability to actively extend
  • PROM is intact
  • Mild tenderness over dorsal DIP
  • May be associated with an avulsion fracture of distal phalanx
137
Q

Mallet finger diagnostics

A

Finger series rule out avulsion fracture

138
Q

Management of Mallet finger

A
  • Finger splint DIP in full extension x 4-8 weeks
  • Splint can not be removed
  • If not treated properly will result in swan neck deformity: hyperextension of PIP with flexion of DIP
139
Q

Pathology of Boutonniere deformity

A

Rupture of the central slip of the extensor tendon where it inserts on the middle phalanx

140
Q

MOI of boutonniere deformity

A

Forced flexion of the PIP

141
Q

Presentation of Boutonniere deformity

A
  • Finger is held partially flexed at the PIP and extended or hyperextended at the DIP
  • May not be as noticeable with swelling
  • Swelling, pain along dorsal PIP
  • Point tenderness along dorsal PIP
  • Limited ROM and inability to fully extend the PIP, remains flexed at 30 degrees
142
Q

Diagnostics of Boutonniere deformity

A
  • Finger series to r/o avulsion fracture
143
Q

Management of Boutonniere deformity

A

Finger series to r/o avulsion fracture

144
Q

Management of boutonniere deformity

A
  • Splint PIP in extension leaving DIP free x 4-8 weeks
  • Refer to ortho if indicated
145
Q

When would you refer to ortho for Boutonniere deformity?

A
  • If conservative therapy fails
  • Associated irreducible PIP dislocation
  • Associated open fx
146
Q

What is dequervain tenosynovitis

A
  • Inflammation of the tendon sheath covering the extensor/abductor tendons of the thumb
147
Q

Etiology of de quervain tenosynovitis

A

Overuse syndrome

148
Q

Presentation of de quervain tenosynovitis

A
  • Aching pain and point tenderness along the radial aspect of the wrist with use
  • Pain may radiate up arm
  • Thickened 1st dorsal compartment creating a prominence at the radial styloid
  • Finkelstein test is diagnostic
149
Q

What is a postiive Finkelstein test

A

Ulnar deviation of an adducted thumb reproduces pain

150
Q

Management of De Quervain tenosynovitis

A
  • Thumb spica splint
  • Activity modification
  • NSAID’s
  • Refer to ortho if conservative therapy fails for corticosteroid injections into tendon sheath and surgical release of the first dorsal compartment
151
Q

What is a ganglion cyst

A
  • Fluid-filled swelling overlying a joint or tendon sheath filled with clear, gelatinous, sticky, or mucoid fluid
152
Q

MC location of ganglion cyst

A

Dorsal aspect of the wrist

153
Q

Epidemiology of ganglion cyst

A

MC in females aged 10-40`

154
Q

Pathogenesis of ganglion cyst

A

Unknown, but thought to occur as result of mucoid degeneration of periarticular structures

155
Q

Clinical presentation of ganglion cyst

A
  • Localized intermittent pain/tenderness
  • Cyst is firm, smooth, rounded, rubbery
  • May fluctuate in size over time
  • Transillumination will help differentiate cyst from solid lesion
156
Q

Diagnostics for ganglion cyst

A
  • X-ray to rule out bony pathology
  • US or MRI if atypical presentation
157
Q

Management of ganglion cyst

A
  • Observation: most will spontaneously regress
  • Aspiration, with or without injection of a corticosteroid
  • Surgical removal
158
Q

What is trigger finger

A
  • Idiopathic dysfunction of flexor tendon of finger as it glides through the tendon sheath
  • Often due to a discrepancy in size of the tendon and its sheath
  • 3rd and 4th digits most commonly affected
159
Q

Presentation of trigger finger

A
  • Catching, snapping, or locking of the involved finger
  • Worse upon awakening
  • MOre than one finger may be affected
  • Associated with pain and dysfunction
  • Painful nodule on the palm
160
Q

Management of trigger finger

A
  • NSAIDs, +/- corticosteroid injection into the tendon sheath
  • If symptoms persist, a second injection may be considered in 3 to 4 weeks
  • Patients with RA are at risk for tendon rupture and should only have one injection
  • Failure of conservative therapy –> surgical release considered
161
Q

What is dupuytren contracture?

A

Progressive fibrosis of the palmar fascia

162
Q

Epidemiology of dupuytren contracture

A

Men >50 years old

163
Q

Risk factors for dupuytren contracture

A
  • Epilepsy
  • DM
  • Pulmonary disease
  • Alcoholism
  • Smoking
  • Repetitive vibrational trauma
164
Q

What is the most common phalange affected by dupytren contracture

A

4th phalange

165
Q

Presentation of dupuytren contracture

A
  • One or more painless nodules near the distal palmar crease
  • Nodules gradually thicken leading to a cord that contracts
  • Flexion normal, but extension limited
166
Q

Diagnostics for dupuytren contracture

A

Clinical diagnosis no other testing needed

167
Q

Management of dupuytren contracture

A
  • Night splinting may slow progression
  • Surgery release if 30 degree fixed flexion of MCP, involves excising thickened soft-tissue bands and release of joint contractures
168
Q

BRACHIAL PLEXUS

A

AHHHH

169
Q

What is brachial plexus syndrome

A

Damage to brachial plexus

170
Q

MOI of brachial plexus syndrome

A
  • Traction force: shoulder depressed and head/neck tilted to opposite side to damage C5, C6, and C7 roots
  • Direct blow to top of shoulder damages C5, C6, and C7
  • Stretching of the plexus when arm abducted forcefully ie grabbing something while falling damages C8 and T1
171
Q

Presentation of brachial plexus syndrome

A
  • Sharp, burning shoulder pain with radiculopathy in the affected nerve root distribution
  • Weakness is common
172
Q

Physical exam of brachial plexus syndrome

A
  • Evaluate sensation, motor function, DTR
  • Injuries to C8-T1 can be associated with Horner’s sundrome d/t preganglionic injury and sympathetic chain disruption
  • Assess lower extremities for spinal cord involvement: spasticity or weakness in ipsilateral leg suggests spinal cord injury
  • Look for associated injuries
173
Q

S/S of Horner’s syndrome

A
  • Ipsilateral ptosis
  • Myosis
  • Anhidrosis
  • Enophthalmos
174
Q

Diagnostics of brachial plexus syndrome

A
  • X-rays: c-spine and shoulder
  • CT c-spine: rule out c-spine fractures if x-ray abnormal
  • MRI: for visualizing spinal cord and nerve roots if x-rays are abnormal or symptoms persist
  • EMG/NCS: may help differentiate location of nerve dysfunction
175
Q

Management of brachial plexus syndrome

A
  • Typically conservation: stretch and strengthen, splint in neutral position of any joints affected by paralyzed muscles
  • Encourage PROM to reduce joint stiffness or tendon constrictures
  • Athletes must have complete resolution of symptoms and normal PE before allowed to return to activity
176
Q

What are the structures of the thoracic outlet?

A
  • First rib
  • Subclavian artery and vein
  • Brachial plexus
  • Clavicle
  • Lung apex
177
Q

What is thoracic outlet syndrome?

A
  • Compression of the brachial plexus and/or subclavian vessels as they exit the narrow space between the superior shoulder girdle and the 1st rib
  • Most commonly affects women 20-50 yo
178
Q

Clinical presentation of thoracic outlet sydnrome

A
  • Compression of the brachial plexus
  • Aching pain/paresthesia
  • Compression of the vascular structures: intermittent swelling and discoloration
  • Fatigue, weakness, and aching pain of extremity
  • Symptoms often exacerbated by lifting arm above the head
179
Q

Physical exam of thoracic outlet syndrome

A
  • Inspect for swelling/discoloration
  • Palpate the supraclavicular fossa to assess for a mass
  • Palpate for distal UE pulses
  • Check sensation and motor function cervical nerve roots
  • Elevated arm stress test
180
Q

What is the elevated arm stress test

A

Both shoulders abducted at least 90 degrees and supported posteriorly the patient opens and closes fists at a moderate speed for 3 minutes.
Positive if reproduced neuro and/or vascular s/s

181
Q

Diagnostics for thoracic outlet syndrome

A
  • AP and lateral c-spine to rule out congenital anomalies
  • PA/lateral CXR to help rule out apical lung tumors
  • MRI to rule out cervical disc rupture or cervical spondylosis
182
Q

Management of throacic outlet syndrome

A
  • Non-surgical (most patients): 3-6 months of home exercise programs emphasizing muscle strengthening and posture
  • Avoid strenuous activities, placing straps over shoulders, and any activity that exacerbates symptoms
  • NSAIDs, muscle relaxers, TENS unit

MSK (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions