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MSK final > upper extremity > Flashcards

upper extremity Flashcards

1
Q

what does a fracture of the clavicle look like?

A

proximal portion is displaced superiorly by pull of the SCM, distal portion is pulled inferiorly from weight of upper limb

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2
Q

mechanism of clavicle fracture

A

fall or direct blow

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3
Q

treatment of clavicle fracture

A

nonsurgical sling for minimal displaced, surgical fixation for displaced fractures

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4
Q

2 types of common shoulder injuries

A
  • acromioclavicular joint - shoulder separation

- glenohumeral joint - shoulder dislocation

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5
Q

shoulder separation

A

acromioclavicular injury

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6
Q

mechanism of AC injury

A

direct fall onto shoulder (football, cycling)

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7
Q

symptoms of AC injury

A

pain, swelling around shoulder

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8
Q

stages of AC injury

A
  1. partial tear of AC
  2. complete tear of AC and partial tear of CC ligament
  3. complete tear of AC and CC

AC ligaments tear first than CC

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9
Q

AC injury looks like

A

prominent distal clavicle - may buttonhole through trapezius, pain with motion

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10
Q

golf ball on a tee

A

glenohumeral joint injury

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11
Q

shoulder dislocations - direction

A

anterior more common than posterior

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12
Q

anterior shoulder dislocation mechanism

A

abduction, external rotation/lateral injury

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13
Q

most common shoulder dislocation

A

anterior

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14
Q

posterior shoulder dislocations

A

rare - can happen from trauma, electrocution, seizures

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15
Q

most common nerve deficit from shoulder dislocation

A

axillary

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16
Q

what do you need to confirm a posterior dislocation?

A

axillary x ray

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17
Q

muscles that cross two joints are

A

more commonly injured

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18
Q

strongest flexor of the elbow

A

brachialis

injury is essentially unheard of

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19
Q

_______ of the biceps can be injured or inflamed

A

long head ( in the bicipital groove )

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20
Q

main action of bicep

A

supination

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21
Q

Popeye finding

A

biceps injury, tenderness and ecchymosis

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22
Q

function of rotator cuff

A

stabilize the proximal humerus

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23
Q

most common rotator cuff injury

A

supraspinatus

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24
Q

in patients greater than 60, don’t be too quick to order further studies

A

many asymptomatic patients have attritional tears

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25
Q

adhesive capsulitis

A

frozen shoulder

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26
Q

causes of adhesive capsulitis

A

diabetes, breast/lung surgery, thyroid disorders, extended use of sling

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27
Q

physical findings of adhesive capsulitis

A

loss of motion - external rotation

28
Q

radiograph findings of adhesive capsulitis

A

usually normal, as opposed to abnormal in osteoarthritis

29
Q

treatment of adhesive capsulitis

A

NSAIDs, steroid injections, physical therapy, manipulation under anesthesia, operative capsular release

30
Q

subacromial bursitis/impingement

A

common cause of shoulder pain, can be associated with RC pathology

will have positive impingement maneuvers

31
Q

calcific tendinitis as a cause of bursitis/impingement

A

most common in supraspinatus,

-diabetes, idiopathic, hypothyroid, 30-60 y-o most common ages

32
Q

causes of winged scapula

A

protraction weakness

iatrogenic, positioning from surgery, trauma, repetitive activities, post-viral

long thoracic nerve damage

33
Q

muscle of winged scapula

A

serrates anterior

34
Q

example of single nerve deficit leading to straightforward physical finding

A

long thoracic nerve

35
Q

impingement

A

normal motion, pain is only with abduction of shoulder at extreme motions

36
Q

innervation of radial nerve

A

BEST

  • brachioradialis
  • extensors - wrist/fingers
  • supinator
  • triceps
37
Q

humeral shaft affects

A

radial nerve

38
Q

carpal tunnel syndrome

A

median nerve - up to 10% of population has

39
Q

causes of carpal tunnel

A

repetitive motions/activities, ergonomic, diabetes, pregnancy, RA/synovitis, hypothyroidism

40
Q

how osteoarthritis causes carpal tunnel

A

narrowing of the carpal canal affects the median nerve

41
Q

rheumatoid tenosynovitis or tumor

A

increases the size of contents in carpal canal and compresses median nerve

42
Q

signs of carpal tunnel

A

weakness, numbness, tingling, symptoms often worse at work (occupational) or in the night/morning

43
Q

symptoms of carpal tunnel

A

+ provocative tests

diminished sensation radial fingers

thenar atrophy (late)

44
Q

why are carpal tunnel syndrome symptoms worse at night?

A

the wrist is naturally flexed at night

45
Q

cubital tunnel syndrome

A

compressive ulnar neuropathy at elbow (nerve wraps around medial epicondyle)

46
Q

symptoms of cubital tunnel syndrome

A

numbness, tingling in ring/small fingers, weakness and atrophy

47
Q

causes of cubital tunnel syndrome

A

pressure on area, occupational, anatomic predisposition

48
Q

how to treat cubital tunnel syndrome

A

nighttime splinting to keep elbow relatively extended

49
Q

wrist drop

A

midhumerus fracture can cause “Saturday night palsy” from axillary compression

50
Q

distal humerus fracture

A

supracondylar fracture

muscle necrosis of the forearm flexors (volkman contracture); trauma to brachial artery or iatrogenic

51
Q

common pediatric fracture

A

supracondylar fracture

52
Q

volkmann ischemic contracture

A

early or relatively early -

  • pain
  • paresthesias
  • pallor
  • pulselessness

(the Ps of compartment syndrome)

late:
- flexion contractors of elbow, wrist, fingers

53
Q

colles fracture

A

distal radius fracture, silver fork finding

54
Q

carpal bones prone to injury

A

scaphoid

lunate

55
Q

FOOSH in children

A

will break distal radius or distal humerus

56
Q

FOOSH in elderly

A

will break distal radius

57
Q

FOOSH in young adults and adults

A

scaphoid fracture

58
Q

tenderness in anatomic snuff box

A

scaphoid fracture

59
Q

treatment for scaphoid fracture

A

consider splinting and reimagine in 7-10 days for fracture

60
Q

commonly injured carpal bone

A

scaphoid fracture

61
Q

why do we care about scaphoid fracture

?

A
  1. commonly injured
  2. tenuous blood supply
  3. fracture can lead to osteonecrosis, non union
  4. potential source of morbidity and liability
62
Q

lateral epicondylitis

A

tennis elbow

63
Q

medial epicondylitis

A

golfers elbow

64
Q

which epicondylitis is more common?

A

lateral

65
Q

trigger finger

A

stenosing tenosynovitis of flexor sheath

66
Q

tenosynovitis of first dorsal compartment

A

de Quervian’s tenosynovitis - abductor pollicis longs and extensor polices brevis iinflammation

67
Q

osteoarthritis tends to affect which aspect of fingers?

A

distal (DIP) - remember flexor profundus controls DIP movement

MSK final (11 decks)

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