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ORTHO > UPPER EXTREMITY > Flashcards

UPPER EXTREMITY Flashcards

1
Q

function of biceps brachii

A

supination of forearm

flexion at elbow

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2
Q

function of brachialis muscle

A

flexion at the elbow

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3
Q

test if concerned for bicep rupture

A

hook test - hook at elbow with fingers, then pronate/supinate - won’t feel bicep if ruptured

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4
Q

TENNIS ELBOW

A

lateral epicondylitis

  • inflammation of tendon insertion of ECRB (extensor carpi radialis brevis muscle) due to repetitive pronation of forearm and excessive wrist extension
  • Lateral elbow pain - especially with gripping, forearm pronation, and wrist extension against resistance
  • radiates down forearm, or worsens when lifting objects with forearm prone

TREATMENT = RICE, NSAIDS, PT, brace

  • can do intraarticular steroid injection
  • surgery if failure of conservative management
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5
Q

GOLF ELBOW

A

medial epicondylitis

  • inflammation of pronator teres-flexor carpi radialis due to repetitive stress and tendon insertion of flexor forearm muscle

MC in golfers, and patients who do household chores

  • tenderness over medial epicondyle that is worse with pulling activities - reproduced with wrist FLEXION against resistance

TREATMENT = RICE, NSAIDS, PT, brace

  • can do intraarticular steroid injection
  • surgery if failure of conservative management
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6
Q

treatment of __________ epicondylitis is more difficult

A

medial

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7
Q

angiofibromatous metaplasia

A

epicondylitis

guest speaker says epicondylitis is not actually inflammation, but that the tendinous fibers are being replaced with angiofibromatous tissue

so steroid injections are for pain, not for the inflammation (because not actually inflamed!)

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8
Q

test for tennis elbow

A

“resistant wrist extension” - arm straight out, resist the pt trying to extend their wrist upwards

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9
Q

test for golfers elbow

A

resistant wrist flexion

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10
Q

OLECRANON BURSITIS ETIOLOGIES

A

⦁ gout
⦁ inflammation
⦁ direct trauma (repetitive, microtrauma)
⦁ infection

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11
Q

OLECRANON BURSITIS

A
  • inflammation of bursa over bony prominences
  • potential space or sac, but isn’t fluid filled (bursitis = then gets filled with fluid)
  • more common in men
  • can drain as long as its not infected, but if you try to drain out, now have a connection to outside world - can now get infected. fluid will continue to drain and drain
  • so if you want to drain it = have to drain it from above

TREATMENT = NSAIDS & compression; the body will naturally absorb the fluid; don’t have to treat

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12
Q

clinical manifestation of olecranon bursitis

A
  • abrupt “goose egg” swelling - boggy/red elbow
  • can be tender or painless
  • limited ROM with flexion
  • evaluate for skin breaks (to rule out septic bursitis)

treatment = rest, NSAIDS, compression, can do steroid injections. avoid repetitive motions

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13
Q

RADIAL NERVE PALSY

A
  • radial nerve comes off the brachial plexus - starts in back / neck / shoulder –> triceps –> antecubital fossa –> down forearm to thumb region
  • can occur when you fall asleep on nerve for too long
  • get paralysis (temporary) of the thumb extensor, wrist extensors, and triceps
  • the radial nerve innervates the back of the first web space
  • the median nerve innervates the thumb, index, middle and 1/2 of the ring finger

PARSONAGE TURNER SYNDROME = radial nerve palsy after a cold (URI)

Most radial nerve palsies get better on their own

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14
Q

most common site for compression of ulnar nerve –> ulnar nerve palsy

A

cubital tunnel of the elbow

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15
Q

radial nerve palsy after a cold

A

parsonage turner syndrome

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16
Q

ulnar nerve is what allows finger _________

A

adduction - putting fingers together - so do froment test

17
Q

FROMENT’S SIGN

A

for ulnar nerve palsy
make an OK sign with thumb and index finger

adducting fingers = difficult with ulnar nerve palsy - weakness = have weakness of pinch grip

18
Q

WARTENBURG SIGN

A

for ulnar nerve palsy

lay hand down flat - pinky will abduct away

19
Q

WARTENBURG SIGN

A

for ulnar nerve palsy

lay hand down flat - pinky will abduct away

20
Q

ulnar nerve palsy tests

A

paper test - froment’s sign
wartenburg sign
can do tinnel’s at elbow (tap)
can hold flexion at elbow - pinches off ulnar nerve

21
Q
  • median nerve entrapment / compression
A

CARPAL TUNNEL

22
Q

increased incidence of carpal tunnel with

A

diabetes

23
Q

CARPAL TUNNEL SYNDROME

A
  • median nerve entrapment / compression at carpal tunnel
  • increased incidence with DIABETES
  • paresthesias / pain of first 3 digits and 1/2 of ring finger - especially at night - due to normal wrist flexion during sleep
  • pain may radiate to neck, shoulder, chest
  • Thenar muscle wasting is seen if advanced

CLINICAL MANIFESTATIONS

  • paresthesias / pain in thumb/index/middle and 1/2 of ring finger
  • worse at night*****
  • increased pain with repeated flexion of wrist
  • decreased pain when shaking hands

DIAGNOSIS

  • Tinel’s sign
  • Phalen’s sign
  • modified Phalen’s = better = flex at wrist, just like with Phalen’s, but compress median nerve at same time

TREATMENT = volar splint + NSAIDS. Steroid injections. May need surgery in refractory cases

24
Q

CLINICAL MANIFESTATIONS OF CARPAL TUNNEL SYNDROME

A
  • paresthesias / pain in thumb/index/middle and 1/2 of ring finger
  • worse at night*****
  • increased pain with repeated flexion of wrist
  • decreased pain when shaking hands

feels better when arm held down - increased blood flow; carpal tunnel pressure is inhibiting blood flow to median nerve

  • pain may radiate to neck, shoulder, chest
  • Thenar muscle wasting is seen if advanced
25
Q

TESTS FOR CARPAL TUNNEL

A
  • Tinel’s sign (tap on median nerve)
  • Phalen’s sign (praying mantis)
  • modified Phalen’s = better = flex at wrist, just like with Phalen’s, but compress median nerve at same time
26
Q

TREATMENT FOR CARPAL TUNNEL

A

volar splint - make sure STRAIGHT SPLINT - worn at night

  • NSAIDS
  • steroid injection
  • surgery in refractory cases
27
Q

DUPUYTREN’S CONTRACTURE

A
  • most often confused with trigger finger
  • thickening of palmar fascia
  • can’t move ring finger (vs trigger finger = cogwheeling of finger)

Most common in men 40-60

RISK FACTORS

  • genetic predisposition: Northwestern Europeans
  • Alcohol abuse
  • diabetes
  • Contracture of the palmar fascia due to nodules/cords –> fixed flexion derformity at the MCP - especially seen in the ring finger, and pinky finger
  • have nodules over the distal palmar crease or proximal phalanx - nodules are often painful

**Fixed flexion deformity at MCP joint

Treatment = intralesional steroid injections, collagenase injections, PT
- can do surgical correction if contracture is > 30 degrees at MCP joint, or if any PIP contracture

28
Q

RISK FACTORS FOR DUPUYTRENS

A

Most common in men 40-60

RISK FACTORS

  • genetic predisposition: Northwestern Europeans
  • Alcohol abuse
  • diabetes
29
Q

which fingers mostly affected by Dupuytren’s contracture

A

ring & pinky fingers

30
Q

dupuytren’s treatment

A

intralesional steroid injections, collagenase injections, PT

  • can easily perform surgery to correct contracture
  • Xiaflex = new medication - injection that breaks down collagen in the fascia
31
Q

GANGLION CYST

A
  • joint fluid leaks into cyst
  • don’t drain these! will continuously drain (like bursa) and lead to infection
  • need to completely excise it and cauterize it to fully go away to where it won’t fill back up
  • can diagnose with transillumination
    (can also aspirate fluid to test it, or ultrasound)

Form in the presence of joint or tendon irritation or mechanical changes; occur in patients of all ages. May change in size or disappear completely. May or may not be painful
- not cancerous, and don’t spread

Treatment = don’t drain these! will get infected. Surgery if bothersome. If asymptomatic = don’t need to do anything

32
Q

Swan Neck & Boutonniere deformity = characteristics of

A

RA

33
Q

Swan neck

A

flexion at DIP

hyperextension at PIP

34
Q

Boutonniere’s deformity

A

hyperextension at DIP

flexion at PIP

35
Q

differentiation for swan neck vs boutonniere’s is important because of

A

treatment approach

ORTHO (15 decks)

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