upper extremity Flashcards
dupuytren contracture
affects what
causes what
tx
palmar aponeurosis, ring and little, middle fingers
causing painful nodules, pitting, and contractures
surgical release for metacarpal phalangeal joint greater than 30 degrees and for proximal phalangeal contractures of any degree, or nerve compression
rotator cuff syndrome characteristics
eccentric loading; common cause is impingement of supraspinatus tendon as it passes beneath the subacromial arch
sx of rotator cuff syndrome
dull pain
exacerbated by abduction of arm
pain interferes with sleep
common method of shoulder dislocations
fall on outstretched arm in abduction and extension.
PE shows loss of shoulder contour with elbow pointing outward
anterior should dislocation
hill sachs lesion
humoral head deformities noted in recurrent dislocations
bankart lesion
tear of the glenoid labrum picked up on MRI
diagnostic imaging for shoulder
AP view as well as a transthoracic “Y” view.
tx for shoulder dislocations
reduction, do films, check NV status, velpaeus sling. PT after 3 wks for people under 40 y/o and after 1 wk for pts older then 40
common shoulder problem with pts with DM
adhesive capsulitis
adhesive capsulitis comes from what? characteristics? DX and tx
inflammatory process that may follow injury. pain and restricted glenohumeral movement. arthrography may show decreased volume of joint capsule and capsular contraction. tx is NSAIDS, PROM.
why is proximal portion displaced superiorly in a fracture clavicle
attachment of sternocleidomastoid muscle
AC separation involves what and occurs how
tearing of the AC and/or coracoclavicular ligaments; caused by a fall on or impact to the tip of the shoulder
AC separation PE, Xray, Tx
PE: apparent step off the the AC joint. AP xray both shoulders, maybe do stress/weighted films. tx; sling or sx
what is carpel tunnel syndrome
compression of median nerve under the transverse carpel ligament
thenar atrophy can be a sign of what
carpel tunnel syndrome late in the disease
tennis elbow aka…
lateral epicondylitis
golfers elbow aka
medial epicondylitits
lateral epicondylitis, pt age, involves what structure
30s, tendinous insertion of extensor carpi radialis brevis
lateral epicondylitis PE,, tx
pain with lifting(when arm is pronated). duplicate pain with elbow in extension and forearm pronated, extend fingers against resistance. tx: counterbalance braces, PT, OT, maybe NSAIDS, sx, inj
medial epicondylitis affects what structures and how to reproduce the pain
flexor/pronator group; resisted pronation or flexion of wrist
organism in olecranon bursitis
staph aureus. NSAIDS and warm compresses
what is nursemaids elbow
longitudinal traction and the radial head slips anteriorly out of the annular ligament
what is de Quervain’s disease and who does it occur in
stenosing tenosynovitis involving the abductor pollicis longus and extensor pollicis brevis; woman >30y/o and DM
deQuervains PE and tx
pain at base of thumb, +Finklestein’s test; NSAID, thumb spica splint, PT/OT, inj, sx decompression
common shoulder dislocation
anterior 95%
shoulder pain can be referred pain caused by
cervical spondylosis
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
Supraspinatus – abducts the arm (This is the most commonly injured muscle)
Infraspinatus – externally rotates the arm
Teres minor – externally rotates the arm
Subscapularis – internally rotates the arm
carpel tunnel syndrome parathesias spares what finger
pinky
anterior shoulder dislocation presentation
pt hold arm in slight abduction and ER
elbow pointing outward
post shoulder dislocation position
pt hold arm in adduction and IR
shoulder dislocation risk for what
axillary nerve injury
velpeau sling for what
shoulder dislocation
and humeral head fx
subacromial decompression for what
rotator cuff
secondary to osteonecrosis, trauma, septic arthritis, endocrine, neuropathic d/o
can cause OA of humeral head
humerus fracture
from what
nerve?
may lead to what 2 things
from direct trauma
radial nerve palsy
may lead to wrist drop and loss of thumb EXTENSION
humerus fx tx
coaptation sling/splint
then
hanging arm cast
humeral head fx
etio and age
pain where
signs?
presentation
old pts with osteoporosis
pain at greater tuberosity
ecchymosis 24-48 hrs later
hold extremity against chest wall
humeral head fx
dx
tx
AP, lateral, y views
“neer classification”
ORIF, CRIF, pendulum, velpeau sling
clavicle fx
age
3% of what
kids
live births due to trauma
humeral head fx look for injuries to what
brachial plexus and axillary artery
supracondylar humerus fx
mechanism
symptoms
fall on outstretched hand with hyperextension of elbow
pain and MINIMAL swelling
watch for what with supracondylar humeral fx
varus and valgus deformity from arrest of medial and lateral growth plate
check for brachial artery injury
volkman
supracondylar humeral fx
tx
kids: CRIF with post splint
adults: ORIF
clavicle fx presentation and tx
arm supported by other arm
kids: figure 8 sling 4-6 weeks
adults: sling 6 weeks
clavicle fx description
proximal portion displaced superiorly due to attachment of sternocleidomastoid muscle
night stick fx
definition and tx
ULNAR shaft from direct trauma often from self defense with blunt object
tx
ORIF if bad displacement
monteggia fracture
description
mechanism
tx
DIAPHYSEAL fx of radius with dislocation of distal radio/ulnar joint
from direct blow to radius
ORIF radius and casting fx forearm in supination to reduce radioular joint
colles fx
description
ages
mechanism
distal radius
elderly and kids
fall on outstretched hand, leading to dorsally displaced dorsally angulated fx
SILVER FORK DEFORMITY
SILVER FORK DEFORMITY TX
CRIF then long arm cast,
ORIF if fx is intra-articular
boxers fx
metacarpal neck of 4th or 5th finger
look for puncture wound
25-30 degrees angulation: ulnar splint, maybe pinning
gamekeeper’s thumb
UCL sprain/tear
instability and weak pinch
partial rupture: immobilize, thumb spica cast
complete: surgical repair
