Upper extremity disorders Flashcards
(148 cards)
1
Q
What is rotator cuff tendonitis associated with
A
Repetitive overhead activities
-swimmers
-throwers
-tennis
2
Q
How does rotator cuff tendonitis present
A
Insidious onset shoulder pain (anterior or lateral)
pain with overhead activities
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)
4
Q
What are the special tests for assessing the supraspinatus (Rotator cuff tendonitis)
A
Hawkins Kennedy
Neer
Empty can
5
Q
What is the Hawkins Kennedy test
A
Shoulder flexed and abducted 90 degrees and then passive IR (Positive = pain)
6
Q
What is the neer test
A
Passive forward flexion while arm is pronated (positive = pain)
7
Q
What is the empty can test
A
(0 degrees abduction, 30 degrees forward flexion, arms pronated
resist downward force
pain/weakness = positive
8
Q
What is the diagnostic test of choice for rotator cuff tendonitis
A
MRI
9
Q
What is the treatment for rotator cuff tendonitis
A
NSAIDs
Activity modification & rest
Subacromial corticosteroid injection
PT
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
11
Q
What is the #1 cause of shoulder pain
A
subacromial impingement
12
Q
What is the MOI for subacromial impingement
A
Structural narrowing
degeneration of supraspinatus
Inflammation of subacromial bursa
13
Q
How does impingement present
A
Similar to RCT with added night time pain
14
Q
What tests are helpful for determining impingement
A
Neer test
Hawkins Kennedy test
*Pain will be over the greater tuberosity
15
Q
What is the first line of imaging done for impingement
A
Xray to look for structural abnormalities
16
Q
What is the first line of treatment for impingement
A
Be conservative
-PT
-NSAIDs
-Subacromial steroid injections
17
Q
If conservative treatment fails after 4-6 months, what is the next line of treatment for impingement
A
Surgery - subacromial decompression
18
Q
Where are the most common rotator cuff tears
A
Supraspinatus, infraspinatus, or teres minor
19
Q
how do rotator cuff tears present
A
Similar to tendonitis and impingement
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)
21
Q
What is the best imaging for a rotator cuff tear
A
MRI
22
Q
What is the first line of treatment for a rotator cuff tear
A
Be conservative
23
Q
When do you operate on a rotator cuff tear
A
Complete or significantly symptomatic tears
24
Q
Which gender more commonly has rotator cuff arthropathy
A
Females
25
If a patient comes in with glenohumeral arthritis, RCT insufficiency, Superior migration of humerus and humeral head changes... what is their most likely diagnosis
Rotator cuff arthropathy
26
What is the imaging of choice for rotator cuff arthropathy
Xray
27
What is rotator cuff arthropathy treatment
Non-operative vs shoulder arthroplasty
28
What is bicep tendonitis often associated with
Impingement and rotator cuff pathology
29
How does bicep tendonitis often present
Anterior shoulder pain
may radiate down bicep
tenderness above bicipital groove
30
If you do a speeds test or yergasons test on a patient, what are you looking for
biceps tendonitis
31
What is speeds test
Shoulder flexion, elbow extension, forearm supination and maintain against resistance
32
What is the yergasons test
Arm at side, elbow flexed 90 degrees, patient supinates against resistance and examiner palpates the bicipital groove
33
What is the MOI for a bicep tendon rupture
Sudden or prolonged bicep contraction against resistance
34
If a patient comes in with a characteristic pop-eye deformity, what is their likely diagnosis
Bicep tendon rupture
35
How does a bicep tendon rupture present
Audible pop
pain
+/- ecchymosis
36
What are the options of treatment for a bicep tendon rupture
Acute: ice, sling, pain control
Long term: Non-operative vs. surgery
37
What is another name for adhesive capsulitis
frozen shoulder
38
Which gender is more likely to get frozen shoulder
Women
39
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
Adhesive capsulitis
40
What causes frozen shoulder
Thickening and fibrosis of the capsule
-adheres to itself and the humerus
41
What is the workup for adhesive capsulitis
Mostly clinical
can confirm for arthrogram
42
What is the progression of adhesive capsulitis
Freezing/painful (6wks-9months)
Frozen (4-9 months)
Thawing (5-26months)
43
Who is most likely to get AC joint injuries
Male athletes 10-20 y/o
44
Which patients have their AC joint injury treated with sling, rest, ice, pain control, and early mobilization?
Grades 1-3
45
Which AC joint injuries are treated surgically
4-6 or failed non-op treatment
46
What is the cause of an SC joint dislocation
MVC or sports injury
47
If a patient has force to the anteromedial shoulder, what type of SC dislocation will they have
Posterior
48
If a patient has force to the Anterolateral shoulder, what type of SC dislocation will they have
Anterior (most common)
49
What type of force causes a posterior dislocation of an SC joint
Force to the posterolateral shoulder
50
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
SC joint dislocation
51
What is important to asses in someone with an SC joint dislocation
Neurovascular status
52
What are some complications associated with SC joint dislocations
Pneumothorax
SVC injury
esophageal injury
compression of subclavian artery
compression of carotid artery
voice changes
venous congestion
53
How do you workup an SC joint dislocation
XRAY (especially the serendipity view)
54
What is the best imaging modality to evaluate the SC joint
CT
55
Which type of SC dislocation is least amenable to a closed reduction
anterior
56
Which type of SC dislocation is easily reduced
Posterior
57
What is the most commonly dislocated major joint
Shoulder
58
What is the MOI for an anterior shoulder dislocation
Blow to the shoulder while in abduction, extension, and external rotation
anteriorly directed to posterior shoulder
59
What is the MOI for a posterior shoulder dislocation
Blow to shoulder in adduction, flexion, and internal rotation
blow to anterior shoulder
60
Who is most likely to have posterior shoulder dislocations
Extreme convulsions, either from seizures or electrocution
61
What are the tests you can do to assess for shoulder dislocation
Apprehension tests
sulcus sign
62
What is the apprehension test
Shoulder abducted to 90 degrees, 90degree elbow flexion, slight ER
Examiner applies anterior pressure to posterior shoulder
63
What is the sulcus sign
Inferior traction to the humerus with thumb on acromion, if a sulcus or depression is seen = joint laxity = positive test
64
What is the first line workup for a shoulder dislocation
Xray
65
What is a bankhart lesion
Fx of the anterior inferior glenoid rim, associated with labral injury
66
What is a hill Sachs lesion
depression of the posterolateral humeral head from impaction of the humeral head into the glenoid
67
Whois most likely to get a proximal humerus fx and why
women, usually from osteoporosis
68
What is the most common type of humerus fx
proximal
69
What is important to check with an proximal humerus fx
axillary nerve function to see if there is sensation over the deltoid
70
Who would you do an ORIF or arthroplasty on for a proximal humerus fx
Significantly displace +/- comminuted fxs
71
What is the mechanism of injury for a humeral shaft fx
Direct blow to the arm is most common
FOOSH in elderly females (Spiral / oblique)
72
If a patient present with a deformity +/- shortening of 1 arm, what is their most likely diagnosis
humeral shaft fx
73
What are the indications to do surgery on a humeral shaft fx
no adequate reduction
unstable fx
pathologic fx
neurovascular injury
open fx
multi-trauma
body habitus preventing splinting
74
What is another name for lateral epicondylitis
tennis elbow
75
What is tennis elbow
Inflammation of the extensor tendon insertion
76
What is the #1 cause of elbow pain
Lateral epicondylitis
77
Where does lateral epicondylitis typically occur
The dominant arm
78
What is the MOI or lateral epicondylitis
Tennis player
Manual labor
heavy lifting
repetitive grasping
79
What is the presentation for tennis elbow
Pain on lateral aspect of elbow
pain may radiate down extensors
Associated edema
Pain worsens with activities requires wrist pronation
80
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
lateral epicondylitis or tennis elbow
81
What is golfers elbow called
medial epicondylitis
82
What is medial epicondylitis
inflammation of the flexor tendon insertion site
83
What is the MOI for medial epicondylitis
Golf
Tennis
Weight lifting
Throwers
racket sports
84
What is the standard of care for medial epicondylitis when you need to r/o other pathologies
MRI
85
What is nursemaids elbow
Subluxation of radial head
86
Which elbow is more commonly effected from nursemaids elbow
Left
87
What is the presentation of nursemaids elbow
Audible snap
Initial pain subsides quickly
child refuses to use arm
Forearm resting in pronation, slightly flexed
88
What type of elbow dislocation is most common
posterior
89
What are the three points of articulation in the elbow
ulnotrochlear
radiocapitular
Proximal radioulnar
90
what is the MOI for an elbow dislocation
FOOSH
91
What must be done for all elbow dislocations
serial neurovascular checks
92
If the neurovascularity is intact with an elbow dislocation and is stable through ROM, how do you treat
Splint 90 degrees of flexion and place in a hinged brace
93
If there is an associate fx with an elbow dislocation or the neurovascularity is not in tact, how do you treat
Surgery
94
Which gender is most likely to suffer from radial and ulnar shaft fx
men
95
What is the MOI for a radial and ulnar shaft fx
MVC
Motorcycle accident
sports
altercation (night stick fx)
Fall from height
96
If a patient has a gross deformity in their forearm, tenderness to palpation, pain with movement, and edema, what is the most likely diagnosis
radial and ulnar shaft fx
97
What needs to be assessed with a radial and ulnar shaft fx
Neurovascular function
compartment syndrome
98
How are most radial and ulnar fx treated
ORIF
99
What is a ganglion cyst
Mucin filled synovial cyst on wrist
100
What is the most common soft tissue tumor of the hand and wrist
Ganglion cyst
101
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
Ganglion cyst
102
What is a home remedy for a ganglion cyst
home rupture (Bible bump)
103
What causes carpal tunnel syndrome
Compression of median nerve causing neuropathy
104
What is the most common compressive neuropathy
carpal tunnel syndrome
105
What is the MOI in carpal tunnel syndrome
Inflammation from repetitive motion and or space occupying lesion
106
What does the ulnar nerve control
the 5th and half of the 4th metacarpal (anterior and posterior side)
107
What does the median nerve in the hand control
Half of the 4th - the first metacarpal (anterior side)
108
What does the radial nerve control
Feeling on the lateral half of the dorsal hand
109
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
Carpal tunnel syndrome
110
What is a chronic finding during a carpal tunnel exam
Atrophy of the thenar muscle
111
What is the definitive dx for carpal tunnel syndrome
electromyography
112
What does electromyography test for
nerve motor function and the communication with specific muscle groups
113
What does nerve conduction velocity test for
How fast the nerves conduct electrical impulses
114
What is the stepwise algorithm for treating carpal tunnel syndrome
1. NSAIDs and wrist brace
2. Corticosteroid injection
3. surgery
115
What is the most common fracture of the upper extremity
Distal radius
116
Which gender is more likely to have a distal radius fx
females
117
What are the two types of distal radius fx
colles: dorsal displacement (Posterior)
Smith: volar displacement (Anterior)
118
What is the most commonly fractures carpal bone
Navicular
119
Where on the scaphoid do most of the fx occur
waist
120
what is the MOI of a scaphoid fx
FOOSH
121
When is surgery needed for a scaphoid fx
Displacement, complex, and most proximal pole fx
122
What are the complications of a scaphoid fx
Wait and proximal pole fx at high risk for non union and AVN
unidirected blood flow
123
What is DeQuervians tenosynovitis
Inflammation of the extensor tendon sheath at the 1st MCP joint
124
What is the MOI for DeQuervains tenosynovitis
Overuse
125
A patient present with insidious onset radial sided wrist pain that is exacerbated by gripping and lifting objects, what is their likely dx
DeQuervains Tenosynovitis
126
What is the Finkelstein test and what is it used to test for
Grip thumb and place wrist in ulnar deviation...positive= pain
Used to test for DeQuervains tenosynovitis
127
When is surgery needed with DeQuervains tenosynovitis
If refractory
128
What is dupuytrens contracture
Benign, progressive, soft tissue disorder that leads to contracture of fascia
129
What is the most common finger to be affected by Dupuytrens contracture
Ring
130
What genetic predisposition is dupuytrens contracture
Autosomal dominant
131
Which gender is generally more effected by dupuytrens contracture
Men (Caucasian)
132
What are the risk factors for Dupuytrens contracture
DM
ETOH abuse
HIV
anti-seizure meds
133
What will you find on a physical exam in someone with dupuytrens contracture
Palpable cord in the palmar surface (NOT A TENDON)
134
What is trigger finger
A stenosing tenosynovitis (Nodules in the tendon sheath)
135
Which fingers are most commonly affected with trigger finger
4th and 5th digit
136
Who is at highest risk for developing trigger finger
Diabetics and women
137
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
Trigger finger
138
What is skiers thumb and what is another name for it
Gamekeepers thumb
sprain or tear in the ulnar collateral ligament
139
What is the MOI for skiers thumb
Forced thumb abduction
140
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
Skiers thumb
141
When is surgery needed with skiers thumb
A complete UCL tear
142
MOI of metacarpal fx for someone in their 20-30s
sports
143
MOI for metacarpal fx for someone in the 40-50s
Work related
144
MOI for metacarpal fx for someone in their 60-70s
falls
145
What type of splint will be placed for metacarpal fractures
ulnar gutter splints
either 4th and 5th or 1st,2nd,3rd
146
If a patient has a "fight bite" how would you treat
Augmentin or cefuroxime and don't close the wound
147
What finger joint is most commonly dislocated
PIP and often misdiagnosed as a sprain
148
How are phalangeal injuries treated
Buddy taping and activity as tolerated
