Upper extremities + Peds Fx Flashcards
Thoracic Outlet Syndrome
- describe
- etiology—MCC?
- MC in who
- other etiologies
- CMs
- PE
- imaging—how to confirm
- tx
- group of symps
- positional/intermittent compresion of BRACHIAL PLEXUS and/or SUBCLAVIAN ARTERY / VEIN
MCC=hypertrophied scalene muscles that compress vesels/nerves against the clavicle and b/w 1st rib
MC in women 20-25 YO
OTHER ETIOLOGY:
- secondary to neck trauma
- sagging of shoulder girdle—age, obesity, pendulous breasts
- occupation
- faulty posture
- thoracic muscle hypertrophy–>weight lifting, baseball pitching
CM: MAIN symp dep on which structure is compressed (nerve, artery or vein)
*neurologic: shoulder + arm pain, weakness, pain or paresthesia to arm or forearm, ulnar neuropathy (volar aspect of 4th and 5th digits)
- artery: claudication, pallor of fingers on elevation of extremity, sensitivity to cold, ischemic tissue loss and gangrene
- vein: edema, cyanosis of affected arm, esp w/ abduction of arm
***some combo of 4 s/s= pain, numbness, weakness and swelling
PE:
*(+) Adson sign–>loss of the radial pulse with deep breath, head rotated & toward affected side
DIAGNOSIS:
- MRI to confirm
- doppler
- EMG/NCV studies can help
TX:
- conservative management for 95% cases
- PT
- pain relief
- avoid activities that compress neurovasc bundle
- **surgical decompression if the above doesnt work
Olecranon Bursitis
- Etiologies
- CM
- diagnosis
- Tx
ETIOLOGIES:
*direct trauma, repetitive microtruama, gout, inflammation
CM
- goose egg–boggy swelling to the posterior olecranon process area
- if etiology is trauma or chronic: mild tenderness, discomfort with full flexion
- if infectious/inflammatory cause: erythema, warmth, tenderness with painful limited ROM—–>have to examine skin for breaks or cellulitis if considering infection
DIAGNOSIS:
*aspiration of bursa if suspected septic bursitis or gout (WBC >2,000=septic)
MANAGEMENT:
- olecranon bursitis=padding to area, NSAIDS, ACE wrap for compression
- septic bursitis= drainage and ABX—-Dicloxacillin or Clindamycin
Olecranon Fracture
- MOA
- CM
- complications
- tx: displced and nondisplcaed
MOA: direct blow— fall on flexed elbow
CM
pain, swelling, inability to fully extend the elbow*****
Comps
- ulnar neuropathy
- post-traumatic arthritis
- anterior interosseous nerve injury
- loss of extension strength
TX:
- non-displaced: reduction and posterior long arm splint–90 degrees flexion
- *ALLLL are considered intraarticular and need reduction
- –>after splinting–TAKE XR
*displaced: ORIF
Elbow Dislocation
- MOA
- MC way to dislocate?
- often asosc with
- PE
- tx
- complications (5)
- MC sequelae
MOA: FOOSH with hyperextension (high energy) and axial loading
MC dislocation= posterior dislocation–falling forward
–>ASSOC with: radial head or coronoid process fx
PE:
- flexed elbow
- marked olecranon prominence
- inability to extend elbow
TX:
- stable (+pulses)= EMERGENT reduction w/ long (posterior) arm splint at 90 degrees—XR— ortho follow up
- Unstable=ORIF
COMPS
- must r/o brachial artery injury
- r/o. median, ulnar, radial nerve injuries
- lost of terminal extension is MC sequelae
- joint stiffness or contracture if split is left on > 3 weeks
- compartment syndrome
Radial head FX
MOA
PE
DX
MOA: FOOSH
PE: lateral (radial) elbow pain, inability to fully extend elbow
DX: very hard to see on XR–> (+) posterior or displaced anterior fat pad sign (hemarthrosis)
TX
- nondisplaced= immobilization: sling, long arm splint 90 degrees
- displaced: surgical ORIF
Radial head FX MOA PE DX TX--displaced and nondisplaced
MOA: FOOSH
PE: lateral (radial) elbow pain, inability to fully extend elbow
DX: very hard to see on XR–> (+) posterior or displaced anterior fat pad sign (hemarthrosis)
TX
- nondisplaced= immobilization: sling, long arm splint 90 degrees
- displaced: surgical ORIF
whats a normal fat pad
visible
anteriorly
NOT Posteriorly
Ulnar Shaft Fracture
- also called
- MOA
- describe fx
- management
- –>nondisplaced distal 1/3
- –>nondisplaced mid-prox 1/3
- —>displaced
Nightstick fx
MOA: direct blow
Nightstick=fx of the middle portion of the ulnar shaft w/o any associated fxs
Management:
- nondisplaced distal 1/3=short arm cast
- nondisplaced mid-proximal 1/3=long arm cast
- displaced (>50%)= ORIF
Monteggia Fracture
- MOA
- define the fracture
- CM
- TX
MOA: direct blow to forearm
*fx of the proximal 1/3 of the ulnar shaft and radial head dislocation
CM
- elbow pain and swelling
- thumb parasethesias
- sometimes radial nerve injury (17% of cases)—>may develop wrist drop
TX
*unstable fractures require ORIF
difference b/w Monteggia and Galeazzi
MONTEGGIA: proximal 1/3 of ulnar shaft fx + radial head dislocation
GALEAZZI: mid-distal radial shaft fx + dislocation of distal radioulnar joint
Galeazzi Fx
- MOA
- desc fx
- CM
- tx
- complications
MOA: direct blow or fall on outstretched arm
**mid-distal radial shaft fracture with dislocation of the distal radioulnar joint
CM
- fracture and deformity on radial side of wrist
- ulnar head will appear prominent at the wrist (popping out)
TX
- this is unstable fx—needs ORIF
- long arm/sugar tong splint before surgery
complications
- anterior interosseous nerve injury
- loss of pinch b/w thumb and index finger
Lateral Epicondylitis aka? -descrbe/MOA -CM--what motion makes it worse -tx -how long can it take to heal
tennis elbow
*inflamm of tendon insertion of the extensor carpi radialis brevis muscle
MOA: repetitive pronation of the forearm and excessive wrist extension
CM:
- lateral elbow pain–esp with gripping, forearm pronation and wrist extension against resistance
- may rad down the forearm or worsen when lifting objects
MANAGEMENT
- conservative: activity modifications, RICE, NSAIDS, counterbalance braces, interarticular steroid injections for short-term relief
- can take up to 6 MO to heal
- surgery if refractory to conserv management
Medial Epicondylitis aka? -describe -CM -PE -tx
Golfer’s elbow
*inflam of the pronator teres-flexor carpi radialis muscle due to rep overuse and stress at the tendon insetion of the flexor forearm
CM
*tenderness over the medial epicondyle worse with pulling activities
PE
*pain repoducted by perfomring wirst flexion against resistance with the elbow fully extended
MANAGEMENT
- sim to lateral but harder to treat
- conservative=activity modification, RICE, NSAIDS, counterbalance braces, intraarticular steorid injections for short term relief,
- can take up to 6 MO to heal
- srugery if refractory
Cubital Tunnel Syndrome
- describe
- CM–worse with?
- PE
- management
*ulnar nerve compression @ the cubital tunnel along the medial elbow
CM
- Paresthesia and pain along the ulnar nerve distribution
- worse with elbow flexion
PE
- (+) Tinel’s sign at the elbow
- decr sensation to the 5th and the ulnar side of the fourth finger
- (+) Froment sign
MANAGEMENT
- wrist immobilization esp with sleep
- NSAIDS
- chronic=intraarticular steroids
Scaphoid (navicular) fx
- CM
- DX
- TX
CM
*pain along the radial surface of the wrist with anatomical snuffbox tenderness
DX
*radiographs=fx may NOT be evident for up to 2 weeks
**if snuffbox tenderness=tx as a fracture bc of the high tenderness of avascular necrosis or nonunion (since the blood supply to scaphoid is distal to proximal)
TX
- nondisplaced fx or snuffbox tenderness=thumb spica splint
- displaced= >1mm: ORIF or pin placement
what is the MC fractured carpal bone
scaphoid aka navicular
Scapholunate Dissocation
- what is it
- MOA
- CM
- DX
- TX
**widened space b/w scaphoid and lunate bones
MOA: FOOSH
CM
- pain on the dorsal radial side of the wrist with minimal swelling
- pain is incr with dorsiflexion
- might have a click with wrist movement
DX
*widened scapholunate spaces >3mm
TX
- initial: radial gutter splint
- surgical repair of the scapholunate ligament usually req to prevent degenerative arthritis
