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X Clin Med Exam 3 > Upper Extremity 1 > Flashcards

Upper Extremity 1 Flashcards

1
Q

Actions of the rotator cuff muscles

A

Supraspinatus, infraspinatus, teres minor: external rotation and abduction
Subscapularis: internal rotation
Stabilize shoulder by depressing humeral head against glenoid

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2
Q

What is the most commonly injury rotator cuff muscle?

A

Supraspinatus

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3
Q

Presentation of rotator cuff injury

A

Pain over anterior and lateral aspects of the shoulder (initially with overhead activity and then at rest)
ROM decreased

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4
Q

What tests should you do for a rotator cuff injury?

A

Drop arm, empty can (weakness)

Neers and Hawkins (pain)

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5
Q

Tendonosis vs tendonitis

A

Tendonosis: chronic degeneration of muscles typically with age
Tendonitis: inflammation associated with repetitive trauma associated with everyday movement of shoulder

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6
Q

Reasons for chronic rotator cuff tear

A

Degeneration, impingement, overload
Overhead occupations
Variations in shoulder structure can cause narrowing under outer edge of clavicle
Majority start as partial supraspinatus tear that can progress to rest of SITS and biceps tendon

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7
Q

Reasons for acute rotator cuff tear

A

Trauma
Suspicion of this with acute shoulder pain and negative radiographs
Usually significant amount of force (when person is younger than 30)
Often with labral pathology

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8
Q

What can tendonitis lead to?

A

Impingement (which can lead to chronic tear)

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9
Q

What does patient complain of in tendonitis/impingement?

A

Gradual deep ache in the lateral shoulder radiating to the deltoid

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10
Q

How can you distinguish impingement from a tear?

A

ROM is painful above 90 degrees and gets better with analgesics (with tear they still wouldn’t be able to do it)

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11
Q

In whom is a chronic rotator cuff tear usually seen?

A

Men over 40

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12
Q

Pain of chronic rotator cuff tear

A

Usually worse with overhead activities and at night (worsening pain with gradual weakness)
Subacromial tenderness/bursitis

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13
Q

Hallmark for rotator cuff tear

A

Weakness! (specifically abduction and external rotation)

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14
Q

How to distinguish between tendinopathy and tear?

A

Lidocaine injection test (10 ml of lidocaine injected in subacromial test and then Neers is performed and if still painful then tear)
Radiographs (elevation of humeral head over 1 cm if probably tear)
U/S has limited use
MRI (but only do if planning to do something about it)

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15
Q

Gold standard for evaluation of full thickness rotator cuff tear

A

MR arthrogram

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16
Q

Acute therapy for rotator cuff tear

A

Ice, NSAIDs, weighted pendulum stretching 5 min 2xday, restrict overhead movement, shoulder immobilization for short time (so don’t get frozen shoulder), maybe pt

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17
Q

When would you do a subacromial steroid injection with a rotator cuff tear?

A

When there is secondary bursitis

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18
Q

Surgery for rotator cuff tear

A 
Arthroscopic repair 
Joint arthroplasty (replacement)- trade off for pain versus mobility after
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19
Q

Number 1 reason someone gets rotator cuff tendonitis

A

Shoulder impingement syndrome

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20
Q

Presentation of impingement

A

Nearly identical to rotator cuff tendonitis
Subacromial tenderness
Normal glenohumeral joint ROM (restricted due to pain)
Preserved strength

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21
Q

Hallmark finding of impingement

A

Pain reproduced by the painful arc of flexion-internal rotation maneuvers

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22
Q

Scale of impingement in Neers test

A

Pain at 90 degrees: mild
Pain at 60-70 degrees: moderate
Pain at 45 or below: severe

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23
Q

When do you use radiography in impingement?

A

For the patient’s first visit because do not want to miss bone problem

24
Q

Tx of impingement

A

Ice, NSAIDs, activity modifications
No arm sling recommended
PT referral
May use corticosteroid injections if persistent pain

25
Q

MOI for labral tear

A 
Acute (FOOSH, sudden pull)
Repetitive overuse (throwing athlete, laborer)
26
Q

Clinical presentation of labral tear

A

Acute: pain
Chronic: clicking/catching

27
Q

Bankart lesion

A

labral tear of inferior rim often associated with a dislocation

28
Q

SLAP tear

A

Superior Labrum Anterior Posterior tear (extends anterior to posterior in curved fashion)

29
Q

Physical exam during labral tear

A

Biceps tendon: pain
Glenohumeral joint: restricted internal/external rotation
Scapula: motion dysfunction

30
Q

Specialized exams for labral tear

A

Anterior glide, speeds, o’brien’s

31
Q

Preferred imaging for labral tear

A

MR arthrogram with arthroscopy as definitive for diagnosis

32
Q

Tx for labral tear

A

Nonsurgical preferred

NSAIDs, acetaminophen and PT

33
Q

What is adhesive capsulitis?

A

Chronic shoulder pain with gradual global limitation in ROM due to stiffened glenohumeral joint and may develop adhesions
Frozen shoulder

34
Q

How to diagnose adhesive capsulitis?

A

Loss of ROM is mechanical restriction as opposed to pain restriction (abduction/external rotation)
ROM tests confirm its reduced at GH joint in 2 or more planes

35
Q

Apley scratch test in adhesive capsulitis

A

Normal patients should be able to scratch their midback at T8-T10 (compare!)

36
Q

What you will see in imaging of adhesive capsulitis?

A

Radiography (limited in diagnostics but usually ordered)

MRI or MRA not needed but may see thickening of joint capsule and ligaments

37
Q

Tx of adhesive capsulitis

A

Treat any underlying, stretch lining of joint, restore ROM

Most are self-limiting and respond to conservative therapy

38
Q

MOI for AC injury

A

Frequently injured in fall onto tip of the shoulder with arm tucked into side (will see a bump that is uncomfortable at bed time)

39
Q

Test used in AC injury

A

Passive cross body adduction (cross-over) because see AC compression

40
Q

AC sprain/separation grades

A

I- Sprain with no separation but pain but AC joint intact (probably only see widening of joint)
II-Separation of superior/inferior AC ligaments but coracoclavicular ligaments intact, instabililty with stress testing
III-separate AC ligaments and coracoclavicular ligaments (clavicle popping up)

41
Q

Tx for AC sprain

A

Shoulder immobilizer 3-4 wks for comfort and restriction of overhead, reaching and weights
Ice, rest, NSAIDs and steroid injection if not better in 2-4 wks
Surgery when grade III and need fixation, ligament reconstruction or distal clavicle resection

42
Q

Where do the majority of clavicle fractures occur?

A

Middle 1/3

43
Q

What imaging is needed in a clavicle fracture?

A

Single AP radiograph of clavicle

44
Q

When do you refer clavicle fracture as opposed to normal conservative tx?

A

Displaced mid claficle fx and all proximal/distal 1/3 fxs

45
Q

Subacromial bursitis

A

Inflammation or degeneration of sack-like structure from repetitive movement or systemic disease (RA, gout, sepsis)

46
Q

Presentation of subacromial bursitis

A

Global/achy pain with ROM and rest, localized TTP, some decreased ROM

47
Q

Tx for subacromial bursitis

A

Fluid aspiration if needed if think sepsis

Ice and NSAIDs, restrict overused, aspiration and steroid injection

48
Q

Clinical presentation of biceps tendonitis

A

Pain in anterior shoulder with abduction and external rotation, maximal tenderness along bicipital groove
Popping sensation due to inflamation
Weakness
See popeye deformity in rupture

49
Q

Tests for biceps tendonitis

A

Yergasons, Speeds

50
Q

Tx for biceps tendonitis

A

NSAIDs, rest, PT, steroid injection, surgery

51
Q

Most common shoulder dislocation

A

Anterior

52
Q

Tests for glenohumeral dislocation

A

Sulcus sign, glenohumeral instability assessment with apprehension and relocation test (gold standard)
When see them hold arm in position of protection

53
Q

Radiography for GH dislocation

A

AP, Y and axillary views beneficial to see which direction it moved

54
Q

Tx for GH dislocation

A

Reduction if needed, shoulder immobilizer for 2-4 wks, analgesics, pt, surgery with repeat dislocations

55
Q

Special considerations with anterior shoulder dislocations

A

Bankart lesion, Hills Sachs lesion, axillary nerve

56
Q

Hills Sachs Lesion

A

Cortical depression of posterolateral humeral head when humeral head is impacted by anterior rim of glenoid (fracture humerus)

X Clin Med Exam 3 (8 decks)

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