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ICM Unit 4 MSK > Upper Extremity Disorders > Flashcards

Upper Extremity Disorders Flashcards

1
Q

What kind of joint is the shoulder?

whats unique about it?

A

ball and socket - very shallow socket

more ROM than any other joint

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2
Q

Normal func of shoulder depends on ?

A

normal func of supporting muscles and ligaments - stability

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3
Q

Shoulder pain is how often complained?

A

3rd MC MSK complaint

Traumatic
Atraumatic
Referred

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4
Q

History of present illness - Upper extremity

common chief complaints

A

pain
weakness
stiffness
locking
catching
deformity
lack of function

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5
Q

HPI - upper extremity

A

trauma?
focal vs diffuse pattern
dominant hand?
neurologic complaints?

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6
Q

Imaging

x-rays

A

primary study - painful shoulder

AP in internal/external rotation, axillary & scapular Y views (4 views)

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7
Q

Imaging -

MRI

A

next study of choice

rotator cuff, articular cartilage, labrum path

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8
Q

Imaging

Ultrasound

A

less sensitive/ specific than MRI

to eval. rotator cuff, biceps tendon tears, calcific deposits, impingement

operator dependent

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9
Q

Imaging

CT

A

fractures, dislocations, arthiritis

better at organs and ligaments than bones

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10
Q

Upper extremities - Treatment

A

initially conservative

pain advances = surgery

refer when - trauma; fx; full thickness ligament/ tendon tears; no response to conserv. tx after 3-6 mos

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11
Q

Sub-acromial impingement Syndrome

A

ROTATOR CUFF TENDONITIS

cause unknown (“hooked” acromion; rotator cuff weakness)

MC >40

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12
Q

Sub-acromial impingement Syndrome

S/S

A

grad onset pain/tenderness on TOP/FRONT of shoulder

Hx recent overactivity (often overhead motion)

+/- swelling

mild popping or cracking sensation?

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13
Q

Sub-acromial impingement Syndrome

PE

A

tenderness to palpa

limited ROM

normal strength (+ neer test; + Hawkins Kennedy test)

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14
Q

Sub-acromial impingement Syndrome

Dx

A

x-ray r/o assoc path

MRI - sus for rotator cuff tear or failure response conserv. tx

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15
Q

Sub-acromial impingement Syndrome

TX

A

1st line = activity modification, NSAIDs, PT

steroid injection
refer if no imprvemt 3 mos or full thickness rotator cuff tear
Surgery after 6 mos

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16
Q

Sub-acromial impingement Syndrome

Prognosis

A

most return to normal func w/i 6 mos

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17
Q

Calcific tendinitis

A

calcification of tendon w/ spontaneous resorption

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18
Q

Calcific tendinitis

Clin Pres

A

min. / no sympt. - formative phase

acute pain - resorptive phase

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19
Q

Calcific tendinitis

PE

A

may mimic subacromial impingement

strength diff. to assess from pain

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20
Q

Calcific tendinitis

DX

A

x-rays

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21
Q

Calcific tendinitis

Tx

A

same as subacromial impingement (80% improve non-op tx)

daily exercise when acute pain gone

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22
Q

Rotator Cuff

A

stabilizes shoulder - holds head of humerus against glenoid fossa

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23
Q

Rotator cuff muscles and actions

A

Supraspinatus (aBduction)
Infraspinatus (ex. rotation)
Subscapularis (ex. rotation)
Teres Minor (in. rotation)

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24
Q

Rotator cuff injuries MC in what pop?

A

older

younger - from trauma/overuse

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25
Rotator cuff tear Mechanism
injury during fall FOOSH OR direct blow rep. overhead mvmt and lifting
26
Rotator cuff tear Clin pres
PAIN - OUTSIDE of shoulder and deltoid region worse w/ specific mvmts limited ROM diff. overhead mvmt May have crepitus, catching or stiffness
27
Rotator cuff Injuries PE
Weakness of particular muscle involved Passive ROM normal, painless Inability to abduct (shoulder shrug)
28
Rotator cuff injuries Dx
clinical MRI gold standard x-rays - bone spurs, high-ride humeral head, <7mm space
29
Rotator cuff injuries Tx
conservative if no dramatic/progr. weakness early surgery sometimes surgery if conserv fails
30
Shoulder Instability
common cause disability and pain young adults
31
Shoulder Instability 2 types and MC in who
Unidirectional (males) Multidirectional (females) - overuse
32
Shoulder Instability clin pres
pain varying degree instability sensation of subluxation
33
Shoulder Instability PE
assess ligamentous & joint laxity - if underlying CT disorder (Marfan, Ehlers-Danlos) muscle atrophy? decreased ROM
34
Shoulder Instability DX - x-rays
usually normal Impression fx posterolateral humeral head (Hill-Sachs lesion) posterior or ant glenoid bone loss
35
Shoulder Instability - Dx MRI
if no improve w/ initial tx
36
Shoulder Instability Tx
PT - restore strength muscles Surgery - recurrent sympt.
37
Shoulder Dislocations (2 types and how you get them)
Anterior 95% = MC mech. (FOOSH, abducted arm) Posterior 5% = MC mech - direct blow ant shoulder, seizure, electrocution (forced adduction, in. rotation)
38
Risk of dislocation (shoulder) increased by ..
poor scapular control rotator cuff strength
39
Shoulder dislocations can cause ___ tears
labral increased risk recurrent dislocations ( <21 yo)
40
Shoulder Dislocations Clin pres
pain/instability obvious deformity Arm ABDUCTED AND EXTERNALLY ROTATED (ant.)
41
Shoulder Dislocations Dx
x-rays MRI - soft tissue injury concern (often w/ labral tear, rc injury)
42
Shoulder Dislocations MRI buzzwords
BANKART LESION - detachment ant (inferior) glenoid labrum from rim HILL-SACHS LESION - defect posterolateral hum head when abraded by ant rim glenoid
43
Shoulder Dislocations Tx
reduction ASAP immobilization/pendulum exercises PT pain control surgery = recurrent
44
Acromioclavicular Joint (AC) Sprains/Separations
direct blow to tip/edge shoulder OR upward force exerted on long axis of humerus
45
Acromioclavicular Joint (AC) Sprains/Separations Grade 1
joint intact mild stretching AC lig point tenderness to AC joint
46
Acromioclavicular Joint (AC) Sprains/Separations Grade 2
disruption sup and inf AC lig point tenderness decreased ROM instability w/ stress testing
47
Acromioclavicular Joint (AC) Sprains/Separations Grade 3
disruption sup and inf AC lig & coracoclavicular lig SEVERE pain deformity w prominence instability and decreased ROM
48
Acromioclavicular Joint (AC) Sprains/Separations can do what motion?
lift arm above shoulder - painful
49
Acromioclavicular Joint (AC) Sprains/Separations Tx
sling pain control PT
50
Shoulder osteoarthritis
less common then hip or knee OA pain and stiffness ; gradual, chronic, progress. discomfort worse w/ activity (limited overhead, reaching behind back or under opposite axilla)
51
Shoulder osteoarthritis Dx
x-rays = joint -space narrowing (w/ any arthritis) osteophyte formation; sclerosis; subchondral cysts
52
Shoulder osteoarthritis Tx
acetaminophen, NSAIDs PT steroid injections surgery - last resort, arthroscopic debride -> total joint replacement
53
AC joint arthritis
OA of AC joint
54
AC joint arthritis clin pres
dull, aching deltoid - worse by mvmt pain sleeping on affected side
55
AC joint arthritis Dx
PE x-rays MRI? steroid injection - diagnostic and therapuetic (ortho)
56
AC joint arthritis Tx
activity mod, ice pain control steroid injection surgery? - distal clavicle resection
57
Bicipital Tendinitis
inflamm of long head biceps tendon
58
Bicipital Tendinitis cause
overuse
59
Bicipital Tendinitis occurs in who
yound, middle-aged, elderly
60
Bicipital Tendinitis Clin pres
pain ANTERIOR shoulder extends distally; worse w/ lifting, pulling, supination, overhead weakness pain WORSE AT NIGHT
61
Bicipital Tendinitis PE
point tenderness intertubercular sulcus painful abduction & external rotation
62
Bicipital Tendinitis Dx
clinical x-ray or MRI r/o other path
63
Bicipital Tendinitis Tx
activity mod NSAIDs PT steroid injections
64
Bicipital Tendinitis Test
Speed's test Yergason's test
65
Fractures Scapula
high energy injury look for other trauma/injuries to UE and torso
66
Fractures Clavicle
85% mid 1/3 clavicle MC ped fx (can happen w/ birth)
67
Fracture Humerus (locations)
humeral head Shaft condyle
68
Fractures - treatment
reduce if not in anatomic alignment (sling/cast, immobilize) +/- surgery (refer)
69
DeQuervian Tenosynovitis
radial styloid tenosynovitis stenosing tenosynovitis of 1st extensor compartment of wrist affects APL and EPB
70
DeQuervian Tenosynovitis - MC condition of?
2nd MC entrapement condition of hand/wrist
71
DeQuervian Tenosynovitis cause
overuse condition - rep. use thumb w/ ulnar or radial deviation of wrist
72
DeQuervian Tenosynovitis MC affects who and what age
women 30-50 y/o
73
DeQuervian Tenosynovitis often coexists with who
carpal tunnel syndrome
74
DeQuervian Tenosynovitis S/S
pain, swelling, point tenderness along dorsal RADIAL ASPECT OF WRIST, radial styloid pain radiates proximally symp. increase w/ grasping, pinching
75
DeQuervian Tenosynovitis PE
opening, closing hand passive ROM - no pain -> NOT Dequervains
76
DeQuervian Tenosynovitis Dx
clinical FINKELSTEIN'S
77
DeQuervian Tenosynovitis TX
THUMB SPICA SPLINT activity mod. NSAIDs PT Steroid injections
78
Ganglion Cyst
cystic structure from synovial sheath
79
Ganglion Cyst MC..
soft tissue mass of hand/wrist
80
Ganglion Cyst MC in who
women 3x more likely 20-40 y/o
81
Ganglion Cyst (what symp usually w/ this)
usually PAINLESS 60-70% dorsal
82
Ganglion Cyst PE
well-circumscribed, compressible subQ structure firm, rubbery, slightly moveable
83
Ganglion Cyst Dx
x-ray r/o bony path
84
Ganglion Cyst Tx
observation reassurance aspiration? - recurrence common surgical excision?
85
Dupuytren's Contracture
prog, fibrotic cond. - affects palmar fascia nodules sm cause flexion deformities/contractures rarely painful
86
Dupuytren's Contracture common in who and what age group
men> women >50 y/o
87
Dupuytren's Contracture risk factors
DM Smokers Alcohol use Trauma/ rep. vibratory exposures Antiepileptic meds Hyperlipidemia
88
Dupuytren's Contracture clin pres
stiffness may have loss of ROM in affected digits (MC 4th and 5th) thickening palmar fascia -> nodule on palmar side painless
89
Dupuytren's Contracture PE
progress loss full extension decreased sensation w/ nerve impingement skin dimpling over flexor tendon - initiallyy
90
Dupuytren's Contracture DX
clinical
91
Dupuytren's Contracture Treatment
watchful waiting IL steroid injections Surg? - func. impairment or worsening
92
OA at base of thumb
MC arthritis of hand - requires surg intervention high incidence OA b/c thumb moves in 3 diff planes
93
OA at base of thumb clin pres
grad onset aching pain, stiffness
94
OA at base of thumb dx
x-rays
95
OA at base of thumb tx
activity mod NSAIDs thumb spica splint surg?
96
Finger dislocations MC mechanism..
hyperextension
97
Finger dislocations MC dislocations..
PIP
98
Finger dislocations Clin pres
swelling, pain, deformity, limited ROM
99
Finger dislocations Dx
x-rays
100
Finger dislocations tx
immediate reduction splint
101
Mallet Finger
rupture of extensor tendon (often w. avulsion fx)
102
Mallet Finger inability to do what motion in what joint
extension DIP
103
Mallet Finger usually from...
direct blow to fingertip
104
Mallet Finger tx
extension splint (X6 wks + ) surg?
105
Boutonniere Deformity usually from
improperly tx dislocations/ tendon ruptures
106
Boutonniere Deformity inability to do what motion and where
extend PIP secondary hyperextension at DIP
107
Boutonniere Deformity Dx
x-rays if bony path concern
108
Boutonniere Deformity tX
splint PIP joint (6wks) Leave DIP free to flex Surgery
109
Jersey Finger
rupture flexor digitorum profundus (FDP) from distal attachment
110
Jersey Finger common mechanism
finger caught in jersey
111
Jersey Finger what finger most common?
ring finger
112
Jersey Finger Tx
surgery - w/i 10-14 days before tendon shrinks splint
113
Gamekeeper's Thumb
injury to ULNAR COLLATERAL lig of thumb at MCP joint
114
Gamekeeper's Thumb often assoc w fx where?
at base of proximal phalanx
115
Gamekeeper's Thumb instability of
MCP and decreased thumb grip strength
116
Gamekeeper's Thumb AKA
skier's thumb - FOOSH while gripping pole
117
Gamekeeper's Thumb Tx
thumb spica splint/cast - immob. 6 wks surgery - open repair avulsed ligament
118
Colles Fracture where is fx? where is it displaced?
FX OF DISTAL RADIUS DORSAL DISPLACEMTN
119
Colles Fracture result from
FOOSH
120
Colles Fracture clin pres
swelling, ecchymosis, tenderness, painful ROM distal forearm
121
Colles Fracture PE
DINNER FORK DEFORMITY
122
Colles Fracture DX
x-rays
123
Colles Fracture Tx
non-displaced = long-arm splint -> to short-arm cast displaced = closed reduction, long-arm SUGAR TONG SPLINT -> cast
124
Smith's Deformity where is fx? what direction displacement?
FX OF DISTAL RADIUS PALMAR DISPLACEMENT
125
Smith's Deformity result of..
fall onto flexed wrist
126
Smith's Deformity clin pres
same as Colles fx
127
Smith's Deformity PE
visible abnormilty
128
Smith's Deformity dx
x-rays
129
Smith's Deformity tx
closed reduction (sugar tong splint) surg - ORIF
130
Wrist fx Mnemonics GRUesome MURder, MUGR
Monteggia's - proximal Ulna fx - dislocation of Radial head Galeazzi's fx - distal Radius fx - Ulnar subluxation
131
Scaphoid fx MC..
FX BONE OF WRIST
132
Scaphoid fx receives blood via..
retrograde flow from radial artery
133
Scaphoid fx hallmark -
pain in "anatomic snuffbox"
134
Scaphoid fx clin pres
pain or tenderness in snuffbox + no obvi fx on x-ray = splint and repeat x-rays in 2wks
135
Scaphoid fx tx
thumb spica splint
136
Boxer's Fracture
fx of 5th metacarpal
137
Boxer's Fracture common mech.
closed fist strike
138
Boxer's Fracture tx
reduce and splint ulnar gutter surg if >40 degrees displacement or rotational deformity
139
Subungual hematoma
blood trapped under nail after trauma
140
Subungual hematoma clin pres
pain and throbbing distal pharynx secondary to trauma f
141
Subungual hematoma dx
clinical x-ray r/o fx (esp if >50% nail)
142
Subungual hematoma tx
Trephination - cautery fx + hematoma = open fx = ABX Tetanus!
143
Subungual hematoma refer for
intraarticular fx extensive nail bed injury infected wounds
144
Epicondylitis
acute, injury/inflamm resulting from rep. or overuse
145
Epicondylitis what age group? which arm?
40-50 y/o dominant arm
146
Epicondylitis Lateral epicondylitis
"tennis elbow" - overuse injury to EXTENSOR SUPINATOR - point tenderness over lateral epicondy - reproducible pain w/ resistance to extension/supination
147
Epicondylitis Medial epicondylitis
"golfer/little league elbow" - overuse injury to FLEXOR PRONATOR - point tenderness over medial epicond - reproducible pain w/ resistance to wrist flexion/pronation
148
Epicondylitis PE
tenderness over affected epicond. (1-2cm distal) eval. neck for cervical radiculopathy
149
Epicondylitis dx
clinical MRI only if fail conserv. therapy
150
Epicondylitis tx
Rest NSAIDs elbow strap PT steroid injection? surgical debridement of tendon attachment
151
Cubital Tunnel Syndrome
ulnar n. entrapement at cubital tunnel
152
Cubital Tunnel Syndrome clin pres
paresthesias, tingling, numbness medial hand, 1/2 4th digit, entire 5th worse w/ repeated flexion or pressure of elbow weakness; pain at elbow/arm
153
Cubital Tunnel Syndrome PE
decreased sensation ulnar distribution Tinel sign at elbow (tap on area - shooting pain to hand) weakness/ atrophy of ulnar-innerv. hand muscles
154
Cubital Tunnel Syndrome dx
EMG ultrasound
155
Cubital Tunnel Syndrome TX
avoid aggravating mvmts elbow pads surg to decompress n. in tunnel
156
Olecranon Bursitis
inflamm. of olecranon bursa
157
Olecranon Bursitis common in who and what age group?
males>females 30-60 y/o
158
Olecranon Bursitis cause
rep. motion of microtrauma systemic dz staph aureus
159
Olecranon Bursitis clin pres
swelling, pain over olecranon bursa 50% have warmth If infected - pain, warmth, redness
160
Olecranon Bursitis PE
localized bursal swelling and fluctuance if signif. tenderness or systemic fever, more likely septic bursitis
161
Olecranon Bursitis Dx
clinical x-ray if traumatic aspirate - if infxn concern
162
Olecranon Bursitis Tx
elbow pad rest, ice, NSAIDs, small vol. steroid injection Surg if septic = aspiration and PO abx
163
Fractures of elbow typical mechanism
FOOSH
164
Supracondylar humerus fx
MC occult fx in CHILDREN of elbow
165
Radial head fx
MC occult fx of elbow in ADULTS
166
Fractures (3 types in slides)
supracondylar humerus fx Olecranon fx Radial head fx
167
Fractures of elbow s/s
pain, swelling, decreased ROM
168
Fractures of elbow dx
x-rays SAIL SIGN = presence of joint effusion POSTERIOR FAT PAD SIGN
169
Fractures of elbow Tx
splint/sling Pain control Ortho: f/u x-rays Surg?
170

ICM Unit 4 MSK (5 decks)

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