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Clin Med Exam 3 (Lauren) > Upper Extremity > Flashcards

Upper Extremity Flashcards

1
Q

What muscles will be atrophied in carpal tunnel syndrome?

A

Thenar muscles

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2
Q

Is ultrasound helpful for diagnosing biceps tendinitis

A

Yes because it is much more superficial

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3
Q

How do you distinguish between a rotator cuff tendinopathy and a tear?

A

Lidocaine injection test- they will still have trouble with weakness if its torn

X-ray- elevation of humeral head over 1cm suggests tear

MRI- study of choice when you suspect a full thickness tear

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4
Q

Where would you see a non-ossifying fibroma (NOF)

A

On outside edge of the bone ** (aka “eccentric”

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5
Q

What is the treatment for shoulder impingement

A

ice, NSAIDs etc

NO arm sling (they have ROM and strength, we don’t want to limit those)

Physical therapy referral***

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6
Q

What do you need to know about the benign tumor osteoid osteoma?

A

Severe night pain

NSAIDs relieve the pain

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7
Q

What soft tissue is torn in the shoulder if a patient feels “catching”

A

Labrum

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8
Q

What causes de Quervain’s tenosynovitis

A

Overuse/repetitive gripping

Writing

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9
Q

Which muscle groups are affected by lateral epicondylitis/golfers elbow?

A

Extensors

Supinators

(ESL)

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10
Q

When would you see a “popeye” deformity

A

When the biceps tendon ruptures and the biceps balls up

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11
Q

How do pts injure the acromioclavicular joint

A

Fall onto shoulder with arm tucked into side

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12
Q

What is the treatment for dequervains tenosynovitis

A

Diminish repetitive activity

Thumb spica immobilization 🤚

NSAIDs

Steroids

Surgery to decompress 1st dorsal compartment (very easy)

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13
Q

What direction are 95% of shoulder dislocations?

A

Anterior **

Only 5% are posterior

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14
Q

Who do you need to call right away if you diagnose adhesive capsulitis/frozen shoulder

A

PT- you have to get it moving right away

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15
Q

What do pts complain about if they have an acromioclavicular injury/

A

A “bump” on their shoulder that is worse at bedtime

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16
Q

What are the risk factors of developing dupuytren’s contracture?

A

EtOH abuse

Smoking

Diabetes (sometimes this is how people find out they’re diabetic when they seek treatment for this)

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17
Q

What is a unicameral bone cyst?

A

A fluid filled cavity in the bone, usually in the upper humerus and femur.

Benign

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18
Q

What specialized tests can be done for glenohumeral subluxation

A

Sulcus sign

Apprehension and relocation test

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19
Q

How do you treat ganglion cysts?

A

NSAIDs

May resolve spontaneously (if they rupture on accident)

Aspiration

Surgery if they recur (and they recur a lot)

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20
Q

What are the goals of treating a rotator cuff tear?

A

Recover strength

Improve ROM

Treat concurrent tendonitis (inflammation)

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21
Q

Do most patients know if they have a non-ossifying fibroma?

A

No, they are usually an incidental, benign finding

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22
Q

What is the best imaging modality for a labral tear?

A

MRA

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23
Q

What is the clinical presentation of someone with a labral tear due to overuse

A

Clicking/catching

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24
Q

What is the most common malignant bone tumor in children

A

Osteosarcoma/Ewing’s sarcoma

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25
Q

Can tendinitis/impingement turn into a chronic tear?

A

Yes

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26
Q

Who is most likely to get chondrosarcoma?

A

Males 60-80, usually in their hips, shoulder or pelvis

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27
Q

What is the major risk factor for tendonitis/impingement?

A

Overhead activity

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28
Q

What are the specialized exams you’d do for a labral tear/

A

Anterior glide test

Speeds test

O’Brien’s test

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29
Q

What order do the rotator cuff muscles tear?

A

Supraspinatus, infra, teres minor, subscap

So if subscap is torn, you know the first 3 are torn too

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30
Q

What are the 2 ways the rotator cuff can be torn?

A

Chronic- degeneration, overuse (more common)

Acute- traumatic

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31
Q

What is the treatment for subacromial bursitis

A

Ice

NSAIDS

Aspirate and steroid injection

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32
Q

What is the treatment for trigger finger?

A

NSAIDs’

Steroid injection -works great

Surgery to release A1 pulley

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33
Q

How do you confirm a diagnosis of an acromioclavicular injury?

A

X-rays.

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34
Q

What is the most common primary bone tumor (malignant bone marrow)

A

Multiple myeloma

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35
Q

Where do 70-80% of clavicle fractures happen?

A

Middle 1/3 of clavicle

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36
Q

What is a ganglion cyst?

A

Collection of synovial fluid within a joint or tendon sheath usually on the wrist

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37
Q

How will a pt present if they have a glenohumeral subluxation/dislocation

A

Arm held in a position of protection**

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38
Q

What will a patient complain about if they have trigger finger?

A

Digit snaps, catches or locks when they move it.

Nodule is unable to glide through the A1 pulley, and the pt may need to forcefully unlock the digit.

Progressively becomes painful

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39
Q

If you injected lidocaine into the shoulder of someon with adhesive capsulitis, would it change their Neers perfeormace

A

No, they literally cant move it

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40
Q

What is the specialized test to test for dupuytren’s contracture?

A

Hurston table top test

Assessing ability to flatten hand on table

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41
Q

What tests can be done for a rotator cuff injury?

A

Drop arm (complete tear-weakness and ROM)

Empty can (weakness)

Neers (impingement)

Hawkins (impingement)

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42
Q

What is an osteochondroma?

A

An abnormal growth of bone and cartilage on the surface of a bone.

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43
Q

What is the treatment for a unicameral bone cyst?

A

May resolve spontaneously

Consider surgery if they’re getting fractures. BUT don’t do surgery on a child if it’s near their physis until they are older

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44
Q

What clinical signs will someone with cubital tunnel syndrome have***

A

Ulnar neuropathy- tingling in ring finger and pinky

Decreased grip strength

Muscle wasting along ulnar distribution

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45
Q

What are the 2 ways you can tear your labrum?

A

Acute- FOOSH, or sudden pull

Repetitive overuse- pitchers

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46
Q

What are the muscles of the rotator cuff and which motions does each one do?

A

Supraspinatus-external rotation and abduction

Infraspinatus-“ “ “

Teres Minor-“ “ “

Subscapularis-internal rotation

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47
Q

What do you look for on the MRI of an aneurysmal bone cyst (ABC)?

A

Fluid-fluid levels. The blood and cystic fluid don’t mix.

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48
Q

What is a chondrosarcoma?

A

A malignant bone tumor composed of cartilage producing cells

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49
Q

What is the least common place to fracture the clavicle

A

Proximal 1/3- internal organ evaluation is essential

50
Q

Who usually gets chronic rotator cuff tears?

A

Overhead occupations

51
Q

What are the 3 special considerations for anterior shoulder dislocation

A
  1. Bankart lesion- detachment of the lower part of the labrum from the glenoid rim (3 and 6 o clock)
  2. Hill Sacks lesion- a type of fracture of the humeral head
  3. Axillary nerve- make sure you check sensation and deltoid function
52
Q

What is the number one cause of rotator cuff tendonitis?

A

Shoulder impingement syndrome

53
Q

What’d o you need to know about Giant Cell Tumors

A

Benign but aggressive

Crosses borders-through metaphysis/epiphysis

Requires treatment

54
Q

What are the main 3 features of non-ossifying fibroma?

A

They’re a “MES”
Metaphyseal

Eccentric (on outside edge of bone)

Sclerotic borders (dense all around)

55
Q

What is the clinical presentation of dupuytren’s contracture?

A

Painless nodules develop into palpable cords along palmar surface, causing irreversible contractures

56
Q

Which fingers are most often affected by dupuytren’s contracture

A

Ring finger and pinky (cant extend anymore)

57
Q

What rotator cuff muscle is the most commonly involved in injury?

A

Supraspinatus

58
Q

What is cubital tunnel syndrome?

A

Compression of the ulnar nerve

59
Q

What is the difference between tendonosis v tendonitis?

A

Tendonosis: weakness usually due to aging muscles

Tendonitis: pain causing weakness. Inflammation due to repetitive trauma. Athletes, overhead laborers, etc

60
Q

What is it:
Shoulder pain that is worse with overhead activity and at night and interferes with sleep

Pain followed by weakness**

Decrease in ability to move the arm

Activities of daily living are restricted to ones that don’t involve lifting arm more than 90 degrees

A

Chronic tear of rotator cuff

61
Q

Where does the ulnar nerve run?

A

Behind the medial epicondyle

62
Q

How will a patient present if they have rotator cuff tendonitis?

A

GRADUAL*** pain

Deep ache in lateral shoulder that radiates to deltoid

POINT tenderness*** (pt can point with one finger to pain)

63
Q

What is an aneurysmal bone cyst?

A

A blood filled cyst in the bone.

Benign but aggressive

64
Q

What can cause olecranon bursitis?

A

Trauma

Prolonged pressure like always resting on armrests

Infection

Rheum conditions

65
Q

Who is more likely to get trigger finger (stenosis flexor tenosynovitis)?

A

Women more than men

Can affect adults and children

(This is very different than the 50yo Northern European men who get dupuytren’s)

66
Q

Who is more likely to get de Quervain’s tenosynovitis?

A

Women 30-50 yo (hormonal women)

67
Q

What is the 2nd most common place to break the clavicle

A

Distal 1/3- may be difficult to discern from AC separation

68
Q

How many X-ray views do you need for a glenohumeral subluxation/dislocation

A

Multiple views

AP, Y, and axillary views

69
Q

Is adhesive capsulitis a mechanical restriction or a pain restriction?

A

Mechanical

70
Q

What is a congenital risk for carpal tunnel

A

Congenitally smaller tunnel***

She said this like 15 times

71
Q

Would you do imaging for elbow epicondylitis?

A

Only to r/o some anatomical reason for it

72
Q

What is shoulder impingement?

A

A spectrum of findings that generally mean the tendons and bursa are squished and causing pain

73
Q

What is the difference between trigger finger and dupuytren’s contracture?

A

Trigger finger comes and goes

Demographics: dupuytren’s is older Northern European men, and trigger finger is people of any age, women more than men

74
Q

What constitutes a grade 1 AC sprain

A

No separation, pain only

Xrays look normal

75
Q

What is dequervains tenosynovitis?

A

Inflammation of the 1st dorsal compartment involving the sheath of the APL and the EPB

76
Q

What causes carpal tunnel syndrome?

A

ANYTHING THAT MAKES THE TUNNEL SMALLER:
-autoimmune

  • inflammatin
  • connective tissue disorders
  • pregnancy (swelling)
  • Renal failure (swelling)
77
Q

Who is most likely to get depuytrens contracture?

A

Northern European men 40-50yo**

78
Q

What causes trigger finger?

A

A nodule forms on the palmar aspect of the MCP that prevents the tendon from moving through the pulley smoothly and it “pops” through like a trigger

79
Q

When are carpal tunnel symptoms the worst

A

At night***

Usually 2-3 hours after falling asleep

80
Q

What does it mean if a patient has “catching” in their joint?

A

Soft tissue injury

81
Q

What is the treatment for cubital tunnel syndrome?

A

NSAIDs

Bracing

Pt

Cubital tunnel release/ulnar nerve transposition

82
Q

Do ganglion cysts change in size?

A

Yes***often with activity

83
Q

How will the ROM decrease with a rotator cuff injury?

A

Can’t abduct arm above shoulder

84
Q

If a patient has an acromioclavicular sprain, how will downward traction and the “cross-over test” affect them?

A

Both will aggravate pain.

85
Q

What is the treatment for an aneurysmal bone cyst (ABC)?

A

Refer to ortho for surgery. Even though they’re benign they destroy the bone

86
Q

What will X-rays of multiple myeloma look like?

A

“Punched out” appearance

Affects entire skeleton

87
Q

How does the rotator cuff stabilize the shoulder?

A

By depressing the numeral head against the glenoid.

So if they muscles give out, the humerus will fall out of the socket

88
Q

What types of cancers are most likely to become metastatic bone cancer?

A

Lead Kettle (PB-KTL)

Prostate
Breast
Kidney
Thyroid
Lung
89
Q

What do you have to do if you use the Apley scratch test to evaluate for a frozen shoulder?

A

Compare both sides**

90
Q

What do you need to rule out with oelcranon bursitis?

A

Infection.

Look for redness and warmth, and aspirate if you need to

91
Q

What is it:
Pain in the anterior shoulder with abduction and external rotation

Popping sensation

Max point of tenderness along bicipital groove

Weakness

A

Biceps tendonitis

92
Q

How many X-ray views do we need for a clavicle fracture?

A

Just ONE

93
Q

What are the special tests that can be done for tendonitis/impingement?

A

Neers

Hawkins

94
Q

Where And when will a pt have pain if they injure their rotator cuff?

A

Anterior* and lateral aspects of the shoulder

Occurs initially with overhead activity, then just becomes constant

95
Q

What is the treatment for elbow epicondylitis?

A

Sling

Wrist** brace (think about which muscles need to be immobilized)

Forearm strap

Modify technique when playing sports

Steroid injections

96
Q

What is it:
Chronic shoulder pain with gradual global limitation in ROM.

Stiffened glenohumeral joint

+/- adhesions

A

Adhesive capsulitis/ frozen shoulder

97
Q

Chondrosarcoma (malignant) and chondroblastoma (benign) look exactly the same on x-ray, so how would you tell the difference?

A

Biopsy

98
Q

What two specialized tests can be done to check for carpal tunnel

A

Tinel’s and Phalen’s

99
Q

When do we refer to ortho for a clavicle fracture

A

All proximal and distal 1/3 fractures

Midclavicular fractures when they are displaced

100
Q

What is the most common benign bone tumor

A

Unicameral bone cyst (UBC)

Aka “simple bone cyst”

101
Q

What are the 2 most common types of labral tear?

A

Bankart lesion- inferior tear due to dislocation

SLAP tear- superior labrum anterior Posterior (extends from 10 to 2 on the clock basically)
MUCH more common

102
Q

Should you do imaging for a frozen shoulder

A

Not really

X-ray can really only help you r/o like a giant tumor restricting ROM

MRI might show you thickening of soft tissue and help your dx but its not needed

103
Q

What constitutes a grade 2 AC sprain?

A

AC joint torn, but coracoclavicular ligaments are intact

Xrays show some separation of acromion and clavicle. Bottom of clavicle isn’t entirely above top of acromion

104
Q

What is the treatment for a labral tear?

A

Nonsurgical

NSAIDS and PT

105
Q

Which muscle groups are affected by medial epicondylitis/golfers elbow?

A

Flexors

Pronators

106
Q

What causes the compression of the median nerve with carpal tunnel syndrome

A

Inflammation of the synovium

107
Q

What constitutes a grade 3 AC sprain?

A

Separation of AC ligaments AND the coracoclavicular ligaments

Xrays show LOTS of separation. Bottom of clavicle is way above acromion

108
Q

What is the treatment for a rotator cuff tear?

A

Ice

NSAIDS

Stop reaching overhead

Immobilize shoulder only for a little bit

Stretch- weighted pendulum

Steroid injection- max 3-4/yr

Surgery/joint replacement

109
Q

What is the main difference between rotator cuff tendonitis and shoulder impingement?

A

Impingement has full strength***

Full ROM possible with pain relief

110
Q

What kind of injury will cause an acute rotator cuff tear in someone under 30?

A

Significant amount of force. Labrum will usually be torn too

111
Q

Why should you discourage extended use of a shoulder immobilizer for a rotator cuff tear?

A

Risk of frozen shoulder

112
Q

Does carpal tunnel start as tingling in the medial nerve distribution?

A

No, it starts gradually as intermittent pain and then progresses to burning pain, numbness and tingling in median n. distribution

113
Q

What are the specialized tests for biceps tendonitis

A

Yergason

Speeds

114
Q

What is the hallmark physical finding of shoulder impingement?

A

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

Neers& Hawkins

115
Q

What are the diagnostic studies that should be done for carpal tunnel?

A

Nerve conduction study (non invasive*)- delay in signal due to demyelination?

Electromyelogram-needle! Invasive* but more informative

Grip strength testing-always document lbs of pressure they can do

Wrist xrays if trauma or rheum disease

116
Q

How do you treat an AC sprain?

A

Immobilize shoulder for 3-4 weeks to allow the ligaments to reattach

ice, rest, NSAIDS, steroids

Surgery mauybe for grade 3

117
Q

What is the hallmark sign of a rotator cuff tear?

A

Muscle weakness.

True weakness that is not just due to pain. Does not improve with analgesics.

118
Q

How do chronic rotator cuff tears start?

A

Start as partial tear of supraspinatus that progresses to complete tear of SITS and biceps tendon

119
Q

Do males or females get carpal tunnel more

A

Females

120
Q

What will you find upon urinalysis in a pt with multiple myeloma?

A

Bence-jones proteins

121
Q

How do you make a definitive diagnosis of a labral tear?

A

Arthroscopy

But why would you do this….the only treatment is NSAIDs and PT

Clin Med Exam 3 (Lauren) (7 decks)

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