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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
subacromial/ subdeltoid bursitis clinical presentation
acutely very painful and inflamed active/ end range PROM painful in same directions symptoms with stretch/ contraction of overlaying musculature palpable tenderness
26
subacromial/ subdeltoid bursitis treatment
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
27
rotator cuff pathology
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
28
shoulder impingement syndrome (SIS) types
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
29
SIS etiology/predisposing factors
``` age arm positioning (pitcher) structure-acromion and scapula (hook, straight, curve acromion) ``` muscle imbalance capsule tightness postural imbalance impaired scapular kinetics
30
SIS muscle imbalance
``` 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
31
SIS posture
increased thoracic kyphosis forward head rounded shoulders
32
GH instability
slipping, popping out during overhead activities laxity vs instability could lead to internal impingement
33
GH instability most common direction
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
Bankart Hill-sachs SLAP
Bankart anterior inferior labral avulsion hill-sachs compression fracture of posterior humeral head SLAP superior labral lesions in anterior/posterior direction
35
TUBS | AMBRI
TUBS traumatic unilateral bankart lesion requiring surgery AMBRI atraumatic multidirectional bilateral instability' R stands for rehab or requiring surgery with inferior interval shift
36
bankart MOI
trauma/ acute or repetitive subluxation clicky, popping, special test
37
hill sachs MOI
trauma compressive force w/ dislocation "soft" humeral head hits "hard" glenoid rim
38
SLAP MOI
trauma compressive force w/ sublux repetitive microtrauma: eccentric biceps load, "peel back" full external rotation in overhead athletes
39
GH labral pathology management
``` immobilization pain and inflammation control activity mod dynamic stabilization closed-chain ex. ``` post surgery: overall stability protect repair restore ROM
40
scapular dyskinesis types
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
scapular dyskinesis dynamic pattern
loss of upward rotation excessive scapula IR excessive scapula anterior tilt/ tipping
42
scapular dyskinesis muscular force couple
rotator cuff and deltoid subscap, infraspinatus, teres minor, prevents superior migration of humeral head rotator cuff is for shoulder stability
43
scapular stability/ dyskinesis tests
``` repeated motions lateral slide test (magee) scap assistance scap retraction scapular reposition ```
44
repeated motions
elevation (flexion/abduction) 5-10 reps watch for consistent winging/ dysrhythmia
45
elbow capsular pattern
classical- flexion>extension accessory- radial head P/A>A/P end feel: tight capsule
46
MCL sprain MOI
acute chronic valgus/ ER stress iatrogenic clinical presentation history special test- valgus PFT
47
MCL sprain intervention
``` PT activity mod pt. education manual therapy modalities ``` surgery: tommy john
48
median nerve entrapment sites
``` scalene ligament of struthers (pronator teres ligament) biceps aponeurosis FDS pronator teres carpal tunnel ```
49
pronator syndrome
median nerve entrapment at elbow
50
anterior interosseous syndrome entrapments ite
FPL FCR PT FDS
51
radial nerve entrapment sites
high radial nerve compression- mid arm posterior interosseous nerve syndrome (PINS) radial tunnel syndrome (RTS) superficial radial nerve entrapment- sensory
52
high radial nerve entrapment MOI
strenuous activity mid-shaft humerus fracture motor and sensory loss
53
posterior interosseous nerve syndrome (PINS) site
b/w brachialis and brachioradialis radial neck ECRB supinator (arcade of frohse) motor loss only
54
radial tunnel syndrome
deep branch of radial nerve minimal to no motor loss no sensory loss
55
superficial radial nerve entrapment
b/w brachioradialis and ECRL | sensory loss only
56
ulnar nerve entrapment
cubital tunnel syndrome ST- wartenberg's, froment's, tinel's sensory and motor loss
57
froment's sign
positive if thumb flexes when paper is pulled away, indicating weakness of adductor pollicis
58
wartenberg's sign
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
epicondylosis types and AKA
epicondylalgia epicondylitis tendon degeneration- overuse injury medial (golfer's) lateral (tennis)
60
lateral elbow tendinopathy (LET) MOI
trauma, overuse special tests Cozen's Mill's Maudsley's MOST COMMONLY INVOLVED WRIST EXTENSOR TENDON IS ECRB
61
medial epicondylosis
FCR FCU FDS palmaris longus
62
biceps tendinopathy MOI
repetitive motion interventions: similar to any tendinopathy
63
olecranon bursitis MOI
direct trauma / repetitive irritation
64
olecranon fracture MOI
FOOSH avulsion fracture- triceps interventions ORIF closed reduction/ immobilization
65
radial head fracture MOI
FOOSH ``` complications stiffness deformity arthritis neurovascular compartment syndrome ```
66
monteggia fracture
fracture of proximal half ulna with anterior angulation and anterior dislocation of proximal radioulnar joint
67
supracondylar humerus fracture
MOI: hyperextension/ fall on flexed elbow | common in children
68
complications post elbow fracture
``` post traumatic DJD stiffness neurovascular delayed union mal-union non-union ```
69
posterior dislocation/ displacement
rarely seen- this is a stable joint | MOI- hyperextension injury or fall on hand with elbow flexed
70
pathologic bone formation types
heterotopic ossificans- with injured non-osseous structures myositis ossificans- within injured muscle
71
myositis ossificans most common muscles
two most common muscles involved in MO are brachialis and quadriceps
72
pathologic bone formation management
``` active and active assisted ROM splinting slow progressive passive stretching chemotherapy NSAIDS radiation ``` IMAGING IS NEEDED TO CONFIRM MO
73
complex regional pain syndrome types
CRPS 1- noxious event Type 1 is more common CRPS 2- direct injury to one/ branch
74
CRPS clinical presentation
``` burning pain edema stiffness temperature changes sweating hyperalgesia allodynia diminished function ```
75
CRPS emotional changes
emotional/ behavioral changes can develop as a result of prolonged pain and disability
76
CRPS type 1 stages
acute- inflammatory -reversible stage vasomotor instability- dystrophic stage cold end phase- atrophic stage AVC, RDA acute vasomotor cold end phase reversible dystrophic atrophic
77
volkman's ischemic contracture
anterior compartment syndrome form of compartment syndrome
78
5 P's of compartment syndrome
``` pain paralysis paraesthesia pallor pulses ``` main treatment is to relieve pressure on all tissues ASAP to save limb
79
dupuytren's contracture
palmar fasciitis | associated factors: alcoholism, diabetes, epilepsy, smoking surgery
80
dequervain's tenosynovitis tendon sheaths affected
1st dorsal wrist compartment APL/EPB finklestein ST active thumb flexion active finger flexion passive ulnar deviation
81
dequervain's tenosynovitis interventions
``` pt. education PRICE splint/brace manual therapy therapeutic exercises ``` invasive cortisone injection surgery
82
intersection syndrome
tenosynovitis- distal ECRB/ECRL

MSK 1 (3 decks)

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