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MSK clin Med > Upper extremity disorders > Flashcards

Upper extremity disorders Flashcards

1
Q

What is rotator cuff tendonitis associated with

A

Repetitive overhead activities
-swimmers
-throwers
-tennis

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2
Q

How does rotator cuff tendonitis present

A

Insidious onset shoulder pain (anterior or lateral)

pain with overhead activities

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3
Q

What will you see on a physical exam with rotator cuff tendonitis

A

Point of tenderness over the supraspinatus

Decreased ROM and weakness (Abduction especially)

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4
Q

What are the special tests for assessing the supraspinatus (Rotator cuff tendonitis)

A

Hawkins Kennedy
Neer
Empty can

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5
Q

What is the Hawkins Kennedy test

A

Shoulder flexed and abducted 90 degrees and then passive IR (Positive = pain)

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6
Q

What is the neer test

A

Passive forward flexion while arm is pronated (positive = pain)

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7
Q

What is the empty can test

A

(0 degrees abduction, 30 degrees forward flexion, arms pronated

resist downward force

pain/weakness = positive

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8
Q

What is the diagnostic test of choice for rotator cuff tendonitis

A

MRI

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9
Q

What is the treatment for rotator cuff tendonitis

A

NSAIDs
Activity modification & rest
Subacromial corticosteroid injection
PT

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10
Q

What is the sequence of events in a rotator cuff injury

A

Subacromial impingement / bursitis

Partial RTC tear

Complete RTC tear
RTC arthropathy

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11
Q

What is the #1 cause of shoulder pain

A

subacromial impingement

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12
Q

What is the MOI for subacromial impingement

A

Structural narrowing
degeneration of supraspinatus
Inflammation of subacromial bursa

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13
Q

How does impingement present

A

Similar to RCT with added night time pain

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14
Q

What tests are helpful for determining impingement

A

Neer test
Hawkins Kennedy test

*Pain will be over the greater tuberosity

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15
Q

What is the first line of imaging done for impingement

A

Xray to look for structural abnormalities

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16
Q

What is the first line of treatment for impingement

A

Be conservative
-PT
-NSAIDs
-Subacromial steroid injections

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17
Q

If conservative treatment fails after 4-6 months, what is the next line of treatment for impingement

A

Surgery - subacromial decompression

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18
Q

Where are the most common rotator cuff tears

A

Supraspinatus, infraspinatus, or teres minor

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19
Q

how do rotator cuff tears present

A

Similar to tendonitis and impingement

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20
Q

What are the tests for rotator cuff tears dependent on and what are the possible tests you could do

A

Depends on tendon involved
-empty can test
-drop arm test
-Infraspinatus test
-lift off test (Subscapularis)

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21
Q

What is the best imaging for a rotator cuff tear

A

MRI

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22
Q

What is the first line of treatment for a rotator cuff tear

A

Be conservative

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23
Q

When do you operate on a rotator cuff tear

A

Complete or significantly symptomatic tears

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24
Q

Which gender more commonly has rotator cuff arthropathy

A

Females

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25
Q

If a patient comes in with glenohumeral arthritis, RCT insufficiency, Superior migration of humerus and humeral head changes… what is their most likely diagnosis

A

Rotator cuff arthropathy

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26
Q

What is the imaging of choice for rotator cuff arthropathy

A

Xray

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27
Q

What is rotator cuff arthropathy treatment

A

Non-operative vs shoulder arthroplasty

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28
Q

What is bicep tendonitis often associated with

A

Impingement and rotator cuff pathology

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29
Q

How does bicep tendonitis often present

A

Anterior shoulder pain
may radiate down bicep
tenderness above bicipital groove

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30
Q

If you do a speeds test or yergasons test on a patient, what are you looking for

A

biceps tendonitis

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31
Q

What is speeds test

A

Shoulder flexion, elbow extension, forearm supination and maintain against resistance

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32
Q

What is the yergasons test

A

Arm at side, elbow flexed 90 degrees, patient supinates against resistance and examiner palpates the bicipital groove

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33
Q

What is the MOI for a bicep tendon rupture

A

Sudden or prolonged bicep contraction against resistance

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34
Q

If a patient comes in with a characteristic pop-eye deformity, what is their likely diagnosis

A

Bicep tendon rupture

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35
Q

How does a bicep tendon rupture present

A

Audible pop
pain
+/- ecchymosis

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36
Q

What are the options of treatment for a bicep tendon rupture

A

Acute: ice, sling, pain control
Long term: Non-operative vs. surgery

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37
Q

What is another name for adhesive capsulitis

A

frozen shoulder

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38
Q

Which gender is more likely to get frozen shoulder

A

Women

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39
Q

If a patient comes in with functional loss of both passive and active ROM in their shoulder that is not attributed to any other cause and worsens at night, what is their likely diagnosis

A

Adhesive capsulitis

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40
Q

What causes frozen shoulder

A

Thickening and fibrosis of the capsule
-adheres to itself and the humerus

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41
Q

What is the workup for adhesive capsulitis

A

Mostly clinical
can confirm for arthrogram

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42
Q

What is the progression of adhesive capsulitis

A

Freezing/painful (6wks-9months)
Frozen (4-9 months)
Thawing (5-26months)

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43
Q

Who is most likely to get AC joint injuries

A

Male athletes 10-20 y/o

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44
Q

Which patients have their AC joint injury treated with sling, rest, ice, pain control, and early mobilization?

A

Grades 1-3

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45
Q

Which AC joint injuries are treated surgically

A

4-6 or failed non-op treatment

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46
Q

What is the cause of an SC joint dislocation

A

MVC or sports injury

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47
Q

If a patient has force to the anteromedial shoulder, what type of SC dislocation will they have

A

Posterior

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48
Q

If a patient has force to the Anterolateral shoulder, what type of SC dislocation will they have

A

Anterior (most common)

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49
Q

What type of force causes a posterior dislocation of an SC joint

A

Force to the posterolateral shoulder

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50
Q

A patient present with an unwillingness to use their Right arm, their head is tilted toward the right, and there is a point of tenderness of the SC joint with edema, what is their likely diagnosis

A

SC joint dislocation

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51
Q

What is important to asses in someone with an SC joint dislocation

A

Neurovascular status

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52
Q

What are some complications associated with SC joint dislocations

A

Pneumothorax
SVC injury
esophageal injury
compression of subclavian artery
compression of carotid artery
voice changes
venous congestion

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53
Q

How do you workup an SC joint dislocation

A

XRAY (especially the serendipity view)

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54
Q

What is the best imaging modality to evaluate the SC joint

A

CT

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55
Q

Which type of SC dislocation is least amenable to a closed reduction

A

anterior

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56
Q

Which type of SC dislocation is easily reduced

A

Posterior

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57
Q

What is the most commonly dislocated major joint

A

Shoulder

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58
Q

What is the MOI for an anterior shoulder dislocation

A

Blow to the shoulder while in abduction, extension, and external rotation

anteriorly directed to posterior shoulder

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59
Q

What is the MOI for a posterior shoulder dislocation

A

Blow to shoulder in adduction, flexion, and internal rotation

blow to anterior shoulder

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60
Q

Who is most likely to have posterior shoulder dislocations

A

Extreme convulsions, either from seizures or electrocution

61
Q

What are the tests you can do to assess for shoulder dislocation

A

Apprehension tests

sulcus sign

62
Q

What is the apprehension test

A

Shoulder abducted to 90 degrees, 90degree elbow flexion, slight ER

Examiner applies anterior pressure to posterior shoulder

63
Q

What is the sulcus sign

A

Inferior traction to the humerus with thumb on acromion, if a sulcus or depression is seen = joint laxity = positive test

64
Q

What is the first line workup for a shoulder dislocation

A

Xray

65
Q

What is a bankhart lesion

A

Fx of the anterior inferior glenoid rim, associated with labral injury

66
Q

What is a hill Sachs lesion

A

depression of the posterolateral humeral head from impaction of the humeral head into the glenoid

67
Q

Whois most likely to get a proximal humerus fx and why

A

women, usually from osteoporosis

68
Q

What is the most common type of humerus fx

A

proximal

69
Q

What is important to check with an proximal humerus fx

A

axillary nerve function to see if there is sensation over the deltoid

70
Q

Who would you do an ORIF or arthroplasty on for a proximal humerus fx

A

Significantly displace +/- comminuted fxs

71
Q

What is the mechanism of injury for a humeral shaft fx

A

Direct blow to the arm is most common

FOOSH in elderly females (Spiral / oblique)

72
Q

If a patient present with a deformity +/- shortening of 1 arm, what is their most likely diagnosis

A

humeral shaft fx

73
Q

What are the indications to do surgery on a humeral shaft fx

A

no adequate reduction
unstable fx
pathologic fx
neurovascular injury
open fx
multi-trauma
body habitus preventing splinting

74
Q

What is another name for lateral epicondylitis

A

tennis elbow

75
Q

What is tennis elbow

A

Inflammation of the extensor tendon insertion

76
Q

What is the #1 cause of elbow pain

A

Lateral epicondylitis

77
Q

Where does lateral epicondylitis typically occur

A

The dominant arm

78
Q

What is the MOI or lateral epicondylitis

A

Tennis player
Manual labor
heavy lifting
repetitive grasping

79
Q

What is the presentation for tennis elbow

A

Pain on lateral aspect of elbow
pain may radiate down extensors
Associated edema
Pain worsens with activities requires wrist pronation

80
Q

If a patient has tenderness to palpation over the lateral epicondyle, pain with resisted wrist and finger extension, pain with resisted pronation, and pain with deep wrist flexion, what is their most likely diagnosis

A

lateral epicondylitis or tennis elbow

81
Q

What is golfers elbow called

A

medial epicondylitis

82
Q

What is medial epicondylitis

A

inflammation of the flexor tendon insertion site

83
Q

What is the MOI for medial epicondylitis

A

Golf
Tennis
Weight lifting
Throwers
racket sports

84
Q

What is the standard of care for medial epicondylitis when you need to r/o other pathologies

A

MRI

85
Q

What is nursemaids elbow

A

Subluxation of radial head

86
Q

Which elbow is more commonly effected from nursemaids elbow

A

Left

87
Q

What is the presentation of nursemaids elbow

A

Audible snap
Initial pain subsides quickly
child refuses to use arm
Forearm resting in pronation, slightly flexed

88
Q

What type of elbow dislocation is most common

A

posterior

89
Q

What are the three points of articulation in the elbow

A

ulnotrochlear
radiocapitular
Proximal radioulnar

90
Q

what is the MOI for an elbow dislocation

A

FOOSH

91
Q

What must be done for all elbow dislocations

A

serial neurovascular checks

92
Q

If the neurovascularity is intact with an elbow dislocation and is stable through ROM, how do you treat

A

Splint 90 degrees of flexion and place in a hinged brace

93
Q

If there is an associate fx with an elbow dislocation or the neurovascularity is not in tact, how do you treat

A

Surgery

94
Q

Which gender is most likely to suffer from radial and ulnar shaft fx

A

men

95
Q

What is the MOI for a radial and ulnar shaft fx

A

MVC
Motorcycle accident
sports
altercation (night stick fx)
Fall from height

96
Q

If a patient has a gross deformity in their forearm, tenderness to palpation, pain with movement, and edema, what is the most likely diagnosis

A

radial and ulnar shaft fx

97
Q

What needs to be assessed with a radial and ulnar shaft fx

A

Neurovascular function
compartment syndrome

98
Q

How are most radial and ulnar fx treated

A

ORIF

99
Q

What is a ganglion cyst

A

Mucin filled synovial cyst on wrist

100
Q

What is the most common soft tissue tumor of the hand and wrist

A

Ganglion cyst

101
Q

A patient presents with a slightly mobile, palpable mass on their dorsal wrist, that is not tender and transluminates with light, what is the likely diagnosis

A

Ganglion cyst

102
Q

What is a home remedy for a ganglion cyst

A

home rupture (Bible bump)

103
Q

What causes carpal tunnel syndrome

A

Compression of median nerve causing neuropathy

104
Q

What is the most common compressive neuropathy

A

carpal tunnel syndrome

105
Q

What is the MOI in carpal tunnel syndrome

A

Inflammation from repetitive motion and or space occupying lesion

106
Q

What does the ulnar nerve control

A

the 5th and half of the 4th metacarpal (anterior and posterior side)

107
Q

What does the median nerve in the hand control

A

Half of the 4th - the first metacarpal (anterior side)

108
Q

What does the radial nerve control

A

Feeling on the lateral half of the dorsal hand

109
Q

Patient presents with numbness and tingling in the median nerve distribution, hand clumsiness, and complains the symptoms get worse at night, what is their most likely diagnosis

A

Carpal tunnel syndrome

110
Q

What is a chronic finding during a carpal tunnel exam

A

Atrophy of the thenar muscle

111
Q

What is the definitive dx for carpal tunnel syndrome

A

electromyography

112
Q

What does electromyography test for

A

nerve motor function and the communication with specific muscle groups

113
Q

What does nerve conduction velocity test for

A

How fast the nerves conduct electrical impulses

114
Q

What is the stepwise algorithm for treating carpal tunnel syndrome

A
  1. NSAIDs and wrist brace
  2. Corticosteroid injection
  3. surgery
115
Q

What is the most common fracture of the upper extremity

A

Distal radius

116
Q

Which gender is more likely to have a distal radius fx

A

females

117
Q

What are the two types of distal radius fx

A

colles: dorsal displacement (Posterior)
Smith: volar displacement (Anterior)

118
Q

What is the most commonly fractures carpal bone

A

Navicular

119
Q

Where on the scaphoid do most of the fx occur

A

waist

120
Q

what is the MOI of a scaphoid fx

A

FOOSH

121
Q

When is surgery needed for a scaphoid fx

A

Displacement, complex, and most proximal pole fx

122
Q

What are the complications of a scaphoid fx

A

Wait and proximal pole fx at high risk for non union and AVN

unidirected blood flow

123
Q

What is DeQuervians tenosynovitis

A

Inflammation of the extensor tendon sheath at the 1st MCP joint

124
Q

What is the MOI for DeQuervains tenosynovitis

A

Overuse

125
Q

A patient present with insidious onset radial sided wrist pain that is exacerbated by gripping and lifting objects, what is their likely dx

A

DeQuervains Tenosynovitis

126
Q

What is the Finkelstein test and what is it used to test for

A

Grip thumb and place wrist in ulnar deviation…positive= pain

Used to test for DeQuervains tenosynovitis

127
Q

When is surgery needed with DeQuervains tenosynovitis

A

If refractory

128
Q

What is dupuytrens contracture

A

Benign, progressive, soft tissue disorder that leads to contracture of fascia

129
Q

What is the most common finger to be affected by Dupuytrens contracture

A

Ring

130
Q

What genetic predisposition is dupuytrens contracture

A

Autosomal dominant

131
Q

Which gender is generally more effected by dupuytrens contracture

A

Men (Caucasian)

132
Q

What are the risk factors for Dupuytrens contracture

A

DM
ETOH abuse
HIV
anti-seizure meds

133
Q

What will you find on a physical exam in someone with dupuytrens contracture

A

Palpable cord in the palmar surface (NOT A TENDON)

134
Q

What is trigger finger

A

A stenosing tenosynovitis (Nodules in the tendon sheath)

135
Q

Which fingers are most commonly affected with trigger finger

A

4th and 5th digit

136
Q

Who is at highest risk for developing trigger finger

A

Diabetics and women

137
Q

A patient presents with pain at the MCP joint, catching, locking, and clicking with flexion/extension ad a palpable palmar nodule, what is their likely diagnosis

A

Trigger finger

138
Q

What is skiers thumb and what is another name for it

A

Gamekeepers thumb

sprain or tear in the ulnar collateral ligament

139
Q

What is the MOI for skiers thumb

A

Forced thumb abduction

140
Q

A patient present with acute pain, swelling and bruising at the base of their thumb and having difficulty grabbing or throwing objects, what is their likely diagnosis

A

Skiers thumb

141
Q

When is surgery needed with skiers thumb

A

A complete UCL tear

142
Q

MOI of metacarpal fx for someone in their 20-30s

A

sports

143
Q

MOI for metacarpal fx for someone in the 40-50s

A

Work related

144
Q

MOI for metacarpal fx for someone in their 60-70s

A

falls

145
Q

What type of splint will be placed for metacarpal fractures

A

ulnar gutter splints

either 4th and 5th or 1st,2nd,3rd

146
Q

If a patient has a “fight bite” how would you treat

A

Augmentin or cefuroxime and don’t close the wound

147
Q

What finger joint is most commonly dislocated

A

PIP and often misdiagnosed as a sprain

148
Q

How are phalangeal injuries treated

A

Buddy taping and activity as tolerated

MSK clin Med (12 decks)

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