Upper Extremity Clinical Correlates

Question 1

What is the issue with articular surface injuries?

Answer 1

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

Question 2

What is a dislocation?

What do you call it when you fix a dislocation?

Answer 2

when a bone goes completely out of anatomical alignment

fixing it is called reduction

Question 3

What happens when you subluxate a bone?

Answer 3

it goes partially out of anatomic alignment

Question 4

If there is a rotator cuff pathology with abduction, what muscle is the issue?

Answer 4

supreascapular

( if not rotator cuff, then probably deltoid)

Question 5

If there is a rotator cuff pathology dealing with internal rotation, what muscle is it?

Answer 5

the subscapularis

Question 6

IF there is a rotator cuff pathology with external rotation, what muscle is the culprit?

Answer 6

infraspinatus or teres minor

Question 7

In what group is rotator cuff pathology more likely?

Answer 7

in the elderly - it often involves age-related degenerative tears or tendon degenerative processes

it’s less common in young athletes or acut injuries

Question 8

Why is it harder to fix rotator cuff injuries that are old?

Answer 8

the long standing tears can lead to tendon retraction and muscle degeneration, making complete repair difficult or impossible

Question 9

What are some of the potential locations for a “shoulder dislocation”?

Answer 9

1. sternoclavicular
2. acromiclavicular
3. scapulothoracic (this takes A LOT of energy)
4. glenohumeral - this is the big one people usually associate with shoulder dislocations

Question 10

What direction do most glenohumeral dislocations go?

Answer 10

anterior (and inferior0

Question 11

posterior shoulder dislocations are unusual, but what are some situations in which they can occur?

Answer 11

electrocution or seizure

Question 12

What X-ray view is best for looking for shoulder locations?

Answer 12

the axillary view (because you can see if it’s anterior or posterior to the bone)

Question 13

What nerves are likely to be injured with a midshaft humerus fracture? How about a distal humerus fracture?

Answer 13

midshaft - radial nerve

distal - usually the median, but sometimes the ulnar

Question 14

In what type of humerus fracture are vascular injuries more likely to occur?

Answer 14

can occur with open injuries or lacerations, very rare with closed injuries

Question 15

True or fals:

the humerus shaft will not tolerate angulation or rotation deformity.

Answer 15

falst - it will tolerate

Question 16

What are the two tendonitises you can get in the elbow?

Answer 16

lateral epicondylitis = tennis elbow

medial epicondylitis = golfer’s elbow

Question 17

In children, what type of elbow dislocation is most common?

Answer 17

nuremaid’s elbow - dislocation of the radial head from a traction injury (low energy)

Question 18

In adults, when is a dislocation more worrisome?

Answer 18

when there is a fracture involved - a fracture dislocation

Question 19

Why is bone alignment so important in the forearm?

Answer 19

the radius has to be able to rotate around the staionary ulna - this means changes in bone shape are not well tolerated

Question 20

What are the two places in the wrist that are most likely to be fractures?

Answer 20

the distal radius and the scaphoid

Question 21

Will carpal tunnel syndrome cause numbness in the palm? How about loss of strengh in thenar muscles?

Answer 21

no to palm numbness, yes to loss of strength in thenar muscles

Question 22

What three sets of muscles do you lose function in with an ulnar nerve injury?

Answer 22

the intrinsic muscles of the hand:

1/2 of the lumbricals

the dorsal interossei

the palmar interossei

Question 23

What are the two main places the ulnar nerve can be irritated?

Answer 23

in the cubital fossa of the elbow

in the guyon canal of the wrist

Question 24

Injury to what radial branch will lose thumb and finger extension but keep sensation? How about lose sensation but keep motor function?

Answer 24

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

Question 25

THe intrinsic muscles of the hand will cause what in the MC joints and what in the IP joins?

Answer 25

MP: flexion

IPs: extension