Upper Extremity Flashcards
Glenohumeral Joint Dislocation/ Subluxation
Anterior?
Posterior?
Hx:
PE?
Imaging?
Tx?
Specific lesions?
Anterior (95%)- Forced abduction + external rotation
Posterior (5%)- Forced addiction + internal rotation
Hx: Pain, deformity, loss of function, arm held in “position of protection”
PE: Access axillary nerve
X-rays: AP, Y-view, or axillary view
- Anterior leads to ligament damage:
1) Bankart lesion: anterior labrum detaches from the glenoid rim
2) Hill-Sachs lesion: humeral head is abraded by the anterior rim of the glenoid. Affects the posterolateral humeral head.
Tx: Immediate reduction of joint, sling/swathe, analgesics, protected ROM and isometric exercises, avoiding recurrence, surgery for recurrent dislocations.
Acromioclavicular Joint Sprain
Grades I, II, III?
PE findings?
Imaging?
Tx?
Injury due to the result of a direct blow to the tip of the shoulder, or by an upward force exerted on the long axis of the humerus.
Grade 1: Joint intact. Mild stretching of acromioclavicular ligaments.
Grade 2: Disruption of superior and inferior AC ligaments. Instability with stree testing
Grade 3: Disruption of inferior AC ligaments AND the corococlavicular ligaments. Deformity with prominence of clavicular head.
Exam: Point tenderness + Can lift arm above shoulder with pain
Imaging: Weighted X-rays
Tx: Sling, analgesics, ROM and strengthening exercises over 2-4 weeks (Grade 2 need 4-6 weeks for fibrous healing)
Rotator Cuff Injuries
PE?
Imaging/Tests?
Tx?
> 40 y.o.: Cuff tear (most commonly supraspinatus)
<40 y.o.: Impingement or tendinitis
Impingement Syndrome: Pain originating from the compression of tissues between the humeral head and corachromial arch.
PE: Inability to actively abduct arm above the horizontal plane. Passive ROM normal and painless. (Drop arm test, empty can test, ne’er impingement test)
Imaging/Dx Tests:
MRI (gold standard for diagnosis), Plane Radiographs, Arthrogram.
Tx: Conservative! Avoid aggravating, NSAIDS, PT, Rest
Infant Brachial Plexus Injury/ Erb’s Palsy “Waiter’s tip”
Hx?
Types of nerve damage?
Tx?
Injury to the brachial plexus during a difficult vaginal delivery as the neck is stretched.
If the upper brachial plexus (C5-C6) is mainly involved, it’s called erb’s palsy.
Hx: Infant does not move one arm or shoulder (older children: weakness in one arm, loss of feeling, partial or total paralysis of the arm)
Types:
Neurapraxia: Does not tear the nerve.
Neuroma: Damages some of the nerve fibers.
Rupture: Nerve is torn/ruptured.
Avulsion:Nerve is torn from the spinal cord.
Tx: Passive shoulder ROM, after 3-6 months nerve grafting or muscle transfer.
Lateral epicondylitis (tennis elbow) & Medial Epicondylitis (golfer/little league elbow)
PE?
Tx?
Lateral: Overuse injury to the tendinitis origin of the extensor supinator muscle group (LES)
Medial: Overuse injury to the tendinous origin of the flexor pronator muscle group (MFP)
PE:
Point tenderness over elbow epicondyle.
Lateral- Reproduce pain w/ resistance to wrist extension supination
Medial- Reproduce pain with resistance to wrist/pronation
Tx: Avoidance, NSAIDS, elbow strap
Olecranon Bursitis
Imaging, Tx?
Usually painless inflammation of the bursa.
Develops gradual = chronic
Develops suddenly = infection or trauma
Imaging/Test: X-ray, Aspirate and culture
Tx: R.I.C.E., Elbow pad, corticosteroid injection (if no infection)
Nursemaid’s Elbow
Hx, PE, Tx?
Subluxation of the radial head caused by rapid extension and pronation of the arm. Could be because the annular ligament is not developed.
Hx: Grabbing arm and pulling a child or swinging child by arms.
PE: Pain and inability to use arm.
Tx: Firm supination and flexion of arm. Ice and use of sling.
Carpal Tunnel Syndrome
PE?
Imaging/Tests?
Tx?
Median nerve is compressed in the carpal tunnel.
PE: Pain, numbness, tingling, decreased grip, strength, thenar wasting
Imaging/Tests: X-ray hand/wrist, electrodiagnostic studies, lab studies to rule out DM, gout, renal and thyroid disorders.
Tx: Conservative 1st- wrist splints, NSAIDS, ergonomic adjustments, PT, steroid injections. Then, surgery.
DeQuervain’s Tenosynovitis
(Gamer’s thumb, Texting thumb)
PE, Tx?
Stenosing tenosynovitis of 1st dorsal compartment of wrist. (Contains the EPB & APL -abductor tendons)
PE: Radial side of wrist pain, burning, swelling, and grip weakness
Tx: Thumb spica cast/splint immobilization, rest, NSAIDS, PT
Jersey Finger
Tx?
Commonly occurs when finger caught in competitor’s jersey. DIP joint is forced into extension, unable to flex.
* Ring finger most common
IMPT: 10-14 days before tendon shrinks. Must treat quickly!
Tx: Surgical repair, splint for 6 weeks
Mallet Finger Treatment
Tx?
Inability to actively extend DIP joint caused by axial compression load. Axial compression load ruptures the thin extensor tendon.
Tx: STAX extension splint for 6-8 weeks. Surgery if joint surfaces subluxed or large fracture fragment.
Swan Neck Deformity
Tx?
Fingers. Hyperextension of PIP joint with flexion of DIP joint. Volta plate attenuation at PIP.
Tx: Extension splinting PIP joint (Tripoint splint) or surgery
Subungal Hematomas & Tuft Fractures
PE, Imaging, Tx?
PE: Pain, throbbing distal pharynx secondary to trauma.
Imaging: X-ray
Tx: Evacuation of blood, repair nail plate, splinting
Gamekeeper’s Thumb (Skier’s Thumb)
Tx?
Injury to the ulnar collateral ligament of the thumb at the MCP joint resulting in instability of the MCP joint and decreased thumb grip strength.
Tx: Thumb spica cast/splint immobilization for 4-6 weeks. Surgery to repair avulsed ligament.
