Upper Extremity Clinical Correlates Flashcards
What is the issue with articular surface injuries?
they need to be made perfectly straight otherwise joint pain will contrinue and you may still have dysfunciton or permanent arthritis - you do NOT want to have jagged cartilage
What is a dislocation?
What do you call it when you fix a dislocation?
when a bone goes completely out of anatomical alignment
fixing it is called reduction
What happens when you subluxate a bone?
it goes partially out of anatomic alignment
If there is a rotator cuff pathology with abduction, what muscle is the issue?
supreascapular
( if not rotator cuff, then probably deltoid)
If there is a rotator cuff pathology dealing with internal rotation, what muscle is it?
the subscapularis
IF there is a rotator cuff pathology with external rotation, what muscle is the culprit?
infraspinatus or teres minor
In what group is rotator cuff pathology more likely?
in the elderly - it often involves age-related degenerative tears or tendon degenerative processes
it’s less common in young athletes or acut injuries
Why is it harder to fix rotator cuff injuries that are old?
the long standing tears can lead to tendon retraction and muscle degeneration, making complete repair difficult or impossible
What are some of the potential locations for a “shoulder dislocation”?
- sternoclavicular
- acromiclavicular
- scapulothoracic (this takes A LOT of energy)
- glenohumeral - this is the big one people usually associate with shoulder dislocations
What direction do most glenohumeral dislocations go?
anterior (and inferior0
posterior shoulder dislocations are unusual, but what are some situations in which they can occur?
electrocution or seizure
What X-ray view is best for looking for shoulder locations?
the axillary view (because you can see if it’s anterior or posterior to the bone)
What nerves are likely to be injured with a midshaft humerus fracture? How about a distal humerus fracture?
midshaft - radial nerve
distal - usually the median, but sometimes the ulnar
In what type of humerus fracture are vascular injuries more likely to occur?
can occur with open injuries or lacerations, very rare with closed injuries
True or fals:
the humerus shaft will not tolerate angulation or rotation deformity.
falst - it will tolerate
What are the two tendonitises you can get in the elbow?
lateral epicondylitis = tennis elbow
medial epicondylitis = golfer’s elbow
In children, what type of elbow dislocation is most common?
nuremaid’s elbow - dislocation of the radial head from a traction injury (low energy)
In adults, when is a dislocation more worrisome?
when there is a fracture involved - a fracture dislocation
Why is bone alignment so important in the forearm?
the radius has to be able to rotate around the staionary ulna - this means changes in bone shape are not well tolerated
What are the two places in the wrist that are most likely to be fractures?
the distal radius and the scaphoid
Will carpal tunnel syndrome cause numbness in the palm? How about loss of strengh in thenar muscles?
no to palm numbness, yes to loss of strength in thenar muscles
What three sets of muscles do you lose function in with an ulnar nerve injury?
the intrinsic muscles of the hand:
1/2 of the lumbricals
the dorsal interossei
the palmar interossei
What are the two main places the ulnar nerve can be irritated?
in the cubital fossa of the elbow
in the guyon canal of the wrist
Injury to what radial branch will lose thumb and finger extension but keep sensation? How about lose sensation but keep motor function?
posterior interosseous nerve damage will retain sensation
superficial branch of radial nerve damage will retain motor function
an injury higher up in the axilla will lose both
THe intrinsic muscles of the hand will cause what in the MC joints and what in the IP joins?
MP: flexion
IPs: extension
