UE part 2 trigger Flashcards
what humeral fx is MC in children
type A supracondylar
what Xray view is used for radial head visualization
oblique (radcap view, 45degre)
What humeral fracture is MC overall
type C intercondylar
weakness with flexion and adduction of the wrist suggests disruption of what nerve
ulnar
radial = extension
what nerves/arteries do supracondylar humeral fractures typically affect
radial artery/median nerve
epicondylar fx = ulnar and radial nerve
when do you see fat pad sail signs? what do they indicate
distal humeral fractures.
indicates intra articular bleeding or occult fx.
what type of distal humeral fracture must have NO angulation or displacement in order to avoid doing ORIF.
Type A supracondylar.
Type B can have displacement of <2mm and still use conservative tx
what is the difference in splinting for Type A and B distal humeral fractures
A - long arm cast at 90d (at neutral position i assume)
B - long arm cast at 90d either pronated (medial condylar fx) or supinated (lateral condylar fx)
what is the MC nerve affected in olecranon fxs?
ulnar
look it just runs right over it!:)
tx is long arm posterior splint with neutral forearm and to squeeze a rubber ball 5 mins/day.
olecranon fx with <2mm displacement
if >2mm then ORIF
if open then IV abx and consult ortho
pain/tenderness along lateral aspect of elbow. Limited ROM especially w pronation/supination.
radial head/neck fx
Sling with AROM after 24-48 hrs flexion, ext, pronation and supination. FU w ortho in 1 week
mason T1 radial head/neck fx
Sling and splint with ortho follow up in 2-3 days to discuss ORIF is tx for what type of radial head/neck fx
mason type 2-3 radial head/neck fx
what type of radial head/neck fx requires immediate ortho consultation
type IV (fx+ dislocation)
arm held semi-flexed adducted and pronated with refusal of ROM and tenderness over radial head
nursemaids elbow (radial subluxation0
elbow pain with wrist extension and supination is suggestive of what
lateral epicondylitis
point tenderness 1 cm distal to the epicondyle
medial or lateral epicondylitis
pain in the elbow with wrist flexion and pronation is suggestive of what
medial epicondylitis
when can you use a counterforce brace as treatment
epicondylitis
when do you get imaging for olecranon bursitis
only when there has been trauma involved
if we aspirate a large and non septic olecranon bursitis and cultures come back negative what is the next step
reaspirate and reculture.
if negative again and persistent swelling then aspirate again and give 1 mL corticosteroid injection
when do we use bactrim (alt keflex) as a treatment for UE problems
mild septic olecranon bursitis in an immunocompetent patient
what would suggest that septic bursitis is severe
Systemic toxicity
Rapid progression in 48hrs
Unable to tolerate PO
Close indwelling medical device
Immunosuppressed
im gonna forget that bolded one i just know it
if they have any of these then we tx w vanc and add cipro or piptaz if trauma occurred
if a patient has traumatic septic olecranon bursitis and a prosthetic humeral head what is the treatment
vanc + (piptaz or cipro)
because close indwelling med device = severe
midshaft radial fx with unstable distal radioulnar joint is known as what
dorsal galeazzi fracture
dislocation of radial head with associated proximal ulnar fx and unstable proximal radioulnar joint is known as what
monteggia fx
take a sec and just memorize this.
its forearm fractures and what makes them:
1. emergent (<1hr)
2. urgent (<24hrs)
3. priority (24-72 hrs)
okie dokie
Long-arm posterior splint with neutral forearm + slight wrist extension + 90d elbow for 1-3 weeks then a functional forearm brace for 4-6 weeks.
simple isolated non proximal ulnar shaft fx
Isolated radial fx, Combined radial + ulnar fx, and Galeazzi or Monteggia fx all require what kind of splinting
sugar tong splint
what supplies this area
ulnar nerve
wrist pain and swelling along the radial aspect with tenderness to the anatomical snuff box and a weakened/painful grip
scaphoid fx.
tx for scaphoid fx
thumb spica splint/cast w imaging and ortho referral
the physis is the more common area of 5th phalange injury in what demographic
children
in adults its the distal phalanx
malrotation of the 5th digit (or of any digits i suppose) suggests what
boxers fx
what is the treatment for a fracture of the 3rd metacarpal neck with a 25 degree angulation
radial gutter splint for 2-3 weeks
- if >30d then reduce it prior to splinting
- use radial gutter for 2nd and 3rd
- use unar gutter for 4th and 5th
- use buddy tape/aluminum splint for phalangeal
when would you use a thumb spica with 30 degrees of wrist extension
non displaced fx of 1st metacarpal or phalange
hyperflexion of the DIP leads to what diagnosis
mallet finger
pt presents with pain in the distal 2nd digit. PE shows a flexed DIP with inability to actively extend. PROM is intact. what is likely diagnosis and what is tx
mallet finger (DIP hyperflexion injury)
splint of DIP in full extension for 4-8 weeks. DO NOT REMOVE SPLINT
what causes swan neck deformity and what is it
PIP stuck in hyperextension with DIP stuck in flexion.
caused by inadequately treated mallet finger
forced flexion of PIP resulting in rupture of central extensor tendon is known as what?
boutonniere deformity.
forced radial abduction of the 1st MCP resulting in rupture of the UCL is known as what
gamekeepers thumb
when would you splint PIP in extension but leave DIP free for 4-8 weeks?
boutonniere deformity
Inflammation of tendon sheath covering extensors and ABductors of the thumb
de quervains tenosynovitis
pt presents with aching pain and point tenderness along radial wrist radiating up the arm. on PE you see a thickened 1st dorsal compartment. what is the likely diagnosis and how do you treat it
de quervains tenosynovitis
thumb spica splint, activity mod, NSAIDS. if doesnt work then cortsteroid injections or surgery
note: would also see + finkelsteins on this!
+ finkelstein test
De Quervain’s Tenosynovitis
pt presents with complaints of a painful nodule on her palmar aspect of the hand. She reports its worse at night and often causes catching/locking of her third and fourth digit. what is the likely diagnosis and what is the tx?
trigger finger
1. NSAIDS
2. corticosteroid injection
3. surgery if all else fails
pt presents with a hx of DM, epilepsy and COPD. reports hes a construction worker who uses a jackhammer daily. hes a chainsmoker and loves an alcoholic beverage. He complains of inability to fully extend his 4th digit. on exam you see a nodule on the palm but the pt denies it being painful. his 4th digit is stuck in a 35 degree flexion.
dx and tx?
dupuytrens
surgery for this pt! indicated if fixed flexion is >30
if its <30 then do night splinting to slow progression
brachial plexus injuries involving C8-T1 can cause what presentation
PAM horners syndrome
(ptosis, anhidrosis, miosis)
a pt reports to your office after falling from a tree and catching herself w her left hand on a tree branch. she then gently lowered herself to the ground. she is now experiencing sharp burning pain win her LUE as well as ptosis. what is the dx and tx? what additional PE exam would increase worry?
dx: brachial plexus syndrome of C8-T1.
tx: conservative (strengthening, stretching, PROM to reduce stiffness.)
PE: worrisome to see ipsilateral leg spasticity or weakness because it suggests spinal cord injury
making an “ok” symbol w your hand uses what nerve root
C6
what nerve root controls wrist flexion and finger extension
C7
finger flexion is C8
pt presents with aching pain along her entire LUE with associated paresthesias. She reports increasing fatigue and weakness of the arm as well as exacerbation of symptoms when she lifts her arm above her head. What is likely the Dx and what is the pathology behind it? How else could this present
dx: thoracic outlet syndrome
patho: compression of brachial plexus/subclavian vessels as they exit the space between superior shoulder girdle and 1st rib
If vascular structures were compressed it would present with intermittent swelling and discoloration of the extremity!
pt presents with pain and swelling along the medial 1st MCP joint. on PE you see weak pincer function.
what exam would you do to diagnose this? what is the dx?
dx: gamekeepers thumb
diagnostic: stress test of MCP joint after anesthesia. 1st phalange finger series.
