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MSK 1 > UE pathologies > Flashcards

UE pathologies Flashcards

1
Q

shoulder tendinopathy SOC

A

acute/reactive (signs of inflammation) tendinitis

chronic/degenerative (no inflammation) tendinosis

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2
Q

treating shoulder tendinopathy (PT and physician)

A

PT management:
manage inflammation
treat underlying biomechanical cause
activity modification: change load

Physician management:
acute-oral medication, steroid shot
chronic- excise abnormal tissue, injections: prolotherapy/ sclerosing, extracorporeal shock wave therapy

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3
Q

PT management of shoulder tendinopathy

A

acute/reactive:
protect/reduce aggressive loading (frequency/ duration)
encourage healing (STM, modalities)

degenerative/chronic:
normalize load
CFM
heavy loading (if patient can't tolerate eccentric, start with max isometric, then concentric, then eccentric. if still too aggressive, heavy load, slow speed, low reps)
modalities
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4
Q

shoulder tendinopathy clinical presentation

A

signs of inflammation (acute)
pain with contraction/ activity
pain with passive stretch depending on TR
tenderness over tendon

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5
Q

calcific tendinopathy clinical presentation

A

calcium deposit in tendon- local hypoxia/ necrosis
degenerated tendon
acute or chronic
may have tendon tears, subacromial bursitis
IMAGING IS REQUIRED

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6
Q

adhesive capsulitis (frozen shoulder) stages

A

stage 1: (prefreezing)
painful, inflammation, minimal ROM limitation

stage 2: freezing
maximally painful, some ROM limitation

stage 3: frozen
ROM most limited, less pain

stage 4: thawing
ROM returning scarred down, decreased pain

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7
Q

adhesive capsulitis clinical presentation

A

decreased classical AROM/ PROM: ER>ABD>IR
ER first to be affected, last to be gained back

decreased PROM A: ANT>INF>POST

PROM quality: tight capsule/ adhesion

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8
Q

adhesive capsulitis interventions

A

depends on stage and degree of inflammation and irritability

conservative: pain control, ROM restoration, strengthening
pendulum exercises

stage 2: (freezing) gentle oscillatory glides (grade I, II, III) for ROM would be appropriate

stage 3 and 4 (frozen and thawing) more aggressive glides like grade III and IV could benefit patient

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9
Q

Codman’s exercise

A

significant amounts of shoulder flexion can be achieved using gravity in stopping posture with less symptoms

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10
Q

humeral neck fractures MOI

A

FOOSH, trauma
INTRACAPSULAR
demographics: older women with osteoporosis or young athletes

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11
Q

what nerves and arteries could be injured with a humeral neck fracture?

A

humeral circumflex artery
axillary nerve

long head of biceps can be trapped at fracture site

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12
Q

humeral neck fractures examination and treatment

A

minimal to no fracture findings because it is intracapsular
local tenderness in axilla
could have normal PROM C because it could all be in the capsule

non-displaced treatment-
sling for 4 weeks, passive or active assist ROM at 2 weeks

displaced treatment
older patients (poor prognosis)
total shoulder arthroplasty

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13
Q

proximal humeral fracture MOI

A

extracapsular; proximal 1/3rd, could be displaced or nondisplaced

FOOSH, trauma

PROM A findings can be unremarkable because it is extracapsular

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14
Q

what nerves and arteries could be injured with proximal humeral fracture?

A

radial nerve

brachial artery

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15
Q

clavicle fracture MOI

A

FOOSH, trauma
more common in children
complications could include brachial plexus injury or pneumothorax

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16
Q

clavicle fracture treatment

A

bracing
figure 8 brace if non-displaced

ORIF if displaced

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17
Q

Sprengel’s deformity

A

congenital
undescended/ underdeveloped scapula
elevation and internal rotation of scapula

treatment: normalize function

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18
Q

AC joint sprain etiology

A

acute-traumatic sprain
chronic- OA/ arthritis
graded I-VI

grade 3 and higher will have piano key sign

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19
Q

AC joint sprain interventions

A

management is based on injury severity

Grade I-III
immobilization and PT management

Grade IV-VI
surgical intervention + PT

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20
Q

SC joint sprain etiology

A

mostly anterior POSTERIOR IS LIFE THREATENING
Acute-trauma
inflammation

chronic- graded I-IV

SC joint has a disc, click/pop/lock symptoms

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21
Q

peripheral nerve pathology etiology

A

laceration/trauma
compression
traction

painful changes at location or radiating through area of innervation
sensory fibers: paresthesia, sensory alteration
motor fibers: weakness and reflex will be affected

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22
Q

commonly injured peripheral nerves at shoulder

A 
primary
spinal accessory
suprascapular
musculocutaneous
axillary
long thoracic
dorsal scapular

secondary
median
radial
ulnar

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23
Q

peripheral nerve treatments

A 
PT management
relieve compression
protect nerve
strengthening
desensitization
modalities (e-stim)

physician management
surgical debridement
transposition
injection

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24
Q

subacromial/ subdeltoid bursitis etiology

A

acute
traumatic/ mechanical

chronic
primary/ secondary

acute=bursitis
chronic=bursoses

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25
Q

subacromial/ subdeltoid bursitis clinical presentation

A

acutely very painful and inflamed
active/ end range PROM painful in same directions
symptoms with stretch/ contraction of overlaying musculature
palpable tenderness

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26
Q

subacromial/ subdeltoid bursitis treatment

A

PT management
modalities to control pain and inflammation
immobilize to decompress
patient education
STM mobilize fluid in latter stages of care

Physician management
anti-inflammatory/ anesthetic- oral or injection
excision

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27
Q

rotator cuff pathology

A

compression
tensile overload
macrotrauma

PAIN AT NIGHT=HALLMARK
worse with movement/ contraction
weakness and loss of ROM

PT
1 pain/inflammation reduction
2 ROM restoration
3 strengthening
4 return to normal activity

Physician
surgical repair for massive tears
immobilization + PROM/AAROM/AROM/strengthening

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28
Q

shoulder impingement syndrome (SIS) types

A

external/primary
compression in subacromial space
CLASSIC PAINFUL ARC 60-120*
stage I-III

internal/secondary
compression between humeral head and glenoid fossa
COMMON IN OVERHEAD ATHLETES
greatest risk >90* ABD and ER

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29
Q

SIS etiology/predisposing factors

A 
age
arm positioning (pitcher)
structure-acromion and scapula (hook, straight, curve acromion)

muscle imbalance
capsule tightness
postural imbalance
impaired scapular kinetics

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30
Q

SIS muscle imbalance

A 
weakness
rotator cuff external rotators
scapular pivoters
humeral head "seaters" not depressors
scapulothoracic musculature
lower and mid trap, SA

tightness
pec minor/major
shoulder internal rotators

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31
Q

SIS posture

A

increased thoracic kyphosis
forward head
rounded shoulders

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32
Q

GH instability

A

slipping, popping out during overhead activities
laxity vs instability

could lead to internal impingement

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33
Q

GH instability most common direction

A

anterior instability is most common
posterior capsular tightness, loss of IR

could lead to anterior dislocation
DO NOT REDUCE ON FIELD
you may cause other trauma due to guarding
needs to be reduced by physician under anesthesia

34
Q

Bankart
Hill-sachs
SLAP

A

Bankart
anterior inferior labral avulsion

hill-sachs
compression fracture of posterior humeral head

SLAP
superior labral lesions in anterior/posterior direction

35
Q

TUBS

AMBRI

A

TUBS
traumatic unilateral bankart lesion requiring surgery

AMBRI
atraumatic multidirectional bilateral instability’ R stands for rehab or requiring surgery with inferior interval shift

36
Q

bankart MOI

A

trauma/ acute or repetitive subluxation

clicky, popping, special test

37
Q

hill sachs MOI

A

trauma
compressive force w/ dislocation

“soft” humeral head hits “hard” glenoid rim

38
Q

SLAP MOI

A

trauma
compressive force w/ sublux
repetitive microtrauma: eccentric biceps load, “peel back” full external rotation in overhead athletes

39
Q

GH labral pathology management

A 
immobilization
pain and inflammation control
activity mod
dynamic stabilization
closed-chain ex.

post surgery:
overall stability
protect repair
restore ROM

40
Q

scapular dyskinesis types

A

I
SICK scapula
malposition of Scapula, Inferior/medial border prominence, Coracoid pain/malposition, Kinesis abnormality of scapula

II
protruded medial border

III
superior translation

41
Q

scapular dyskinesis dynamic pattern

A

loss of upward rotation
excessive scapula IR
excessive scapula anterior tilt/ tipping

42
Q

scapular dyskinesis muscular force couple

A

rotator cuff and deltoid
subscap, infraspinatus, teres minor, prevents superior migration of humeral head
rotator cuff is for shoulder stability

43
Q

scapular stability/ dyskinesis tests

A 
repeated motions
lateral slide test (magee)
scap assistance
scap retraction
scapular reposition
44
Q

repeated motions

A

elevation (flexion/abduction)
5-10 reps
watch for consistent winging/ dysrhythmia

45
Q

elbow capsular pattern

A

classical- flexion>extension
accessory- radial head P/A>A/P
end feel: tight capsule

46
Q

MCL sprain MOI

A

acute
chronic valgus/ ER stress
iatrogenic

clinical presentation
history
special test- valgus
PFT

47
Q

MCL sprain intervention

A 
PT
activity mod
pt. education
manual therapy
modalities

surgery: tommy john

48
Q

median nerve entrapment sites

A 
scalene
ligament of struthers (pronator teres ligament)
biceps aponeurosis
FDS
pronator teres
carpal tunnel
49
Q

pronator syndrome

A

median nerve entrapment at elbow

50
Q

anterior interosseous syndrome entrapments ite

A

FPL
FCR
PT
FDS

51
Q

radial nerve entrapment sites

A

high radial nerve compression- mid arm
posterior interosseous nerve syndrome (PINS)
radial tunnel syndrome (RTS)
superficial radial nerve entrapment- sensory

52
Q

high radial nerve entrapment MOI

A

strenuous activity
mid-shaft humerus fracture

motor and sensory loss

53
Q

posterior interosseous nerve syndrome (PINS) site

A

b/w brachialis and brachioradialis
radial neck
ECRB
supinator (arcade of frohse)

motor loss only

54
Q

radial tunnel syndrome

A

deep branch of radial nerve
minimal to no motor loss
no sensory loss

55
Q

superficial radial nerve entrapment

A

b/w brachioradialis and ECRL

sensory loss only

56
Q

ulnar nerve entrapment

A

cubital tunnel syndrome
ST- wartenberg’s, froment’s, tinel’s
sensory and motor loss

57
Q

froment’s sign

A

positive if thumb flexes when paper is pulled away, indicating weakness of adductor pollicis

58
Q

wartenberg’s sign

A

passively spread pt. fingers, ask them to bring them together again, positive if they have inability to squeeze little finger to remainder of hand

59
Q

epicondylosis types and AKA

A

epicondylalgia
epicondylitis

tendon degeneration- overuse injury

medial (golfer’s)
lateral (tennis)

60
Q

lateral elbow tendinopathy (LET) MOI

A

trauma, overuse

special tests
Cozen’s
Mill’s
Maudsley’s

MOST COMMONLY INVOLVED WRIST EXTENSOR TENDON IS ECRB

61
Q

medial epicondylosis

A

FCR
FCU
FDS
palmaris longus

62
Q

biceps tendinopathy MOI

A

repetitive motion

interventions: similar to any tendinopathy

63
Q

olecranon bursitis MOI

A

direct trauma / repetitive irritation

64
Q

olecranon fracture MOI

A

FOOSH
avulsion fracture- triceps

interventions
ORIF
closed reduction/ immobilization

65
Q

radial head fracture MOI

A

FOOSH

complications 
stiffness
deformity
arthritis 
neurovascular
compartment syndrome
66
Q

monteggia fracture

A

fracture of proximal half ulna with anterior angulation and anterior dislocation of proximal radioulnar joint

67
Q

supracondylar humerus fracture

A

MOI: hyperextension/ fall on flexed elbow

common in children

68
Q

complications post elbow fracture

A 
post traumatic DJD
stiffness
neurovascular 
delayed union
mal-union
non-union
69
Q

posterior dislocation/ displacement

A

rarely seen- this is a stable joint

MOI- hyperextension injury or fall on hand with elbow flexed

70
Q

pathologic bone formation types

A

heterotopic ossificans- with injured non-osseous structures

myositis ossificans- within injured muscle

71
Q

myositis ossificans most common muscles

A

two most common muscles involved in MO are brachialis and quadriceps

72
Q

pathologic bone formation management

A 
active and active assisted ROM
splinting
slow progressive passive stretching 
chemotherapy NSAIDS
radiation

IMAGING IS NEEDED TO CONFIRM MO

73
Q

complex regional pain syndrome types

A

CRPS 1- noxious event
Type 1 is more common

CRPS 2- direct injury to one/ branch

74
Q

CRPS clinical presentation

A 
burning pain
edema
stiffness
temperature changes
sweating
hyperalgesia
allodynia
diminished function
75
Q

CRPS emotional changes

A

emotional/ behavioral changes can develop as a result of prolonged pain and disability

76
Q

CRPS type 1 stages

A

acute- inflammatory -reversible stage
vasomotor instability- dystrophic stage
cold end phase- atrophic stage

AVC, RDA
acute
vasomotor
cold end phase

reversible
dystrophic
atrophic

77
Q

volkman’s ischemic contracture

A

anterior compartment syndrome

form of compartment syndrome

78
Q

5 P’s of compartment syndrome

A 
pain 
paralysis
paraesthesia 
pallor
pulses

main treatment is to relieve pressure on all tissues ASAP to save limb

79
Q

dupuytren’s contracture

A

palmar fasciitis

associated factors: alcoholism, diabetes, epilepsy, smoking surgery

80
Q

dequervain’s tenosynovitis tendon sheaths affected

A

1st dorsal wrist compartment APL/EPB

finklestein ST
active thumb flexion
active finger flexion
passive ulnar deviation

81
Q

dequervain’s tenosynovitis interventions

A 
pt. education
PRICE
splint/brace 
manual therapy 
therapeutic exercises

invasive
cortisone injection
surgery

82
Q

intersection syndrome

A

tenosynovitis- distal ECRB/ECRL

MSK 1 (3 decks)

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