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Clin Med II MHM - FINAL > Upper Extremity Disorders > Flashcards

Upper Extremity Disorders Flashcards

1
Q

4 articulations of the shoulder

A
  1. GH (2/3 of motion)
  2. Scapulothoracic (1/3 of motion)
  3. AC
  4. SC
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2
Q

Shoulder stability is dependent on:

A

Capsule, ligaments, rotator cuff muscles

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3
Q

Which rotator cuff muscle is most susceptible to injury?

A

Supraspinatus

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4
Q

Which rotator cuff muscle acts as an internal rotator?

A

Subscapularis

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5
Q

Which rotator cuff muscle acts as an external rotator?

A

Teres minor

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6
Q

What are the intrinsic muscles of the shoulder?

A

Rotator cuff muscles (SITS)

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7
Q

What are the extrinsic muscles of the shoulder?

A
  • Deltoid
  • Pec major
  • Lat dorsi
  • Teres major
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8
Q

Is the biceps muscle an intrinsic or extrinsic muscle of the shoulder?

A
  • BOTH
  • Intrinsic function: stabilize GH joint
  • Extrinsic function: flex elbow
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9
Q

Patients younger than 40 w/GH instability are more likely due to:

A

Labral injuries
Chondral injuries
AC separation
Fx

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10
Q

Patients over 40 w/GH instability are more likely due to:

A 
Calcific tendinitis
Fractures
AC and GH OA
Frozen shoulder
Rotator cuff tear
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11
Q

Anterior pain along the shoulder joint line suggests:

A

Labral problems
GH OA
Long head biceps tendinitis

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12
Q

Lateral pain over deltoid area suggests:

A

Impingement syndrome

Rotator cuff tendinitis/tear

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13
Q

Posterior pain or referral to scapular suggests:

A

Tendinopathy of ERs (infraspinatus and teres minor)

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14
Q

Focal pain on top of shoulder suggests:

A

AC joint involvement

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15
Q

Major peripheral nerves of the shoulder that can be injured:

A 
Axillary (C5-6)
Suprascapular (C5-6)
Musculocutaneous (C5-6)
Long thoracic (C5-8)
Spinal accessory (C3-4)
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16
Q

What is the MC injured nerve of the shoulder?

A

Axillary nerve

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17
Q

What shoulder injury MC affects axillary nerve?

A

Anterior dislocation

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18
Q

What nerve is usually injured due to poorly fitting backpack?

A

Spinal accessory nerve

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19
Q

Describe rotator cuff tendinitis

A
  • Thickening of tendon w/inflammation of overlying bursa
  • Results in edema and sometimes micro tears
  • Can occur at any age
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20
Q

Clinical presentation of rotator cuff tendinitis

A
  • Pain in shoulder radiates to upper arm (but NOT past elbow)
  • Worse w/overhead activity
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21
Q

Treatment of rotator cuff tendinitis

A
  • Rest

- Sling is NOT encouraged as it may cause more stiffness

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22
Q

Describe calcific tendinitis of shoulder

A
  • Presents similar to rotator cuff tendinitis but usually more pain w/ROM
  • X ray shows Ca deposit
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23
Q

Treatment of calcific tendinitis of shoulder

A

Steroid injection

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24
Q

What is the MC cause of shoulder pain?

A

Impingement syndrome

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25
Q

Describe impingement syndrome

A
  • Compression of structures around GH joint that occurs w/shoulder elevation
  • Can affect SA bursa, biceps tendon (long head), rotator cuff
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26
Q

Stages of impingement syndrome

A

Stage 1: edema and hemorrhage (under 25 yo pts)
Stage 2: fibrosis and tendinitis (25-40 yo pts)
Stage 3: MC, rotator cuff tear, pts over 40 yo

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27
Q

What is the MC stage of impingement syndrome?

A

Stage 3: rotator cuff tear, patients over 40, have had at least 1 occurrence of Stage 1 or Stage 2

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28
Q

Definitive treatment of impingement syndrome

A

Surgical SA decompression (it opens the space and gives direct visualization to rotator cuff)

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29
Q

2 types of rotator cuff tears

A
  1. Acute traumatic

2. Chronic degenerative

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30
Q

Describe acute traumatic rotator cuff tear

A
  • FOOSH or grabbing on while falling
  • Acute pain referred to deltoid
  • Significant pain when sleeping on affected side
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31
Q

Describe chronic degenerative rotator cuff tear

A
  • Similar to tendinitis and impingement syndrome

- Wear on tendon gradually tears through

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32
Q

What is the gold standard for diagnosis of acute rotator cuff tears?

A

MRI (may need gadolinium)

33
Q

Definitive treatment of degenerative rotator cuff tear?

A

Surgical repair

34
Q

What is the shoulder labrum?

A
  • Cartilaginous rim around glenoid

- Provides additional stability while not compromising mobility

35
Q

What is a Bankart lesion?

A
  • Torn labrum (stripped away from bone)
  • Anterior dislocation can cause this
  • Does NOT heal on its own
36
Q

What is the most obvious finding on exam of a Bankart lesion?

A

Positive apprehension test and relocation sign

37
Q

Describe SLAP tear

A
  • Superior labral tear from anterior to posterior
  • Symptoms similar to RC tear and impingement syndrome
  • Weakness against resistance on affected side w/their palms up and arms extended from body at 90 degrees
38
Q

Definitive treatment of Bankart lesions and SLAP tears?

A

Arthroscopic surgical repair followed by 2-4 weeks of sling and swathe immobilization and pendulum exercises

39
Q

Bursitis in the shoulder can lead to:

A

Impingement syndrome (if chronic)

40
Q

Define frozen shoulder

A
  • Gradual development of global limitation of active and passive shoulder motion
  • Absent radiographic findings (other than osteopenia)
  • Predominantly unilateral
41
Q

How does frozen shoulder develop?

A

Commonly after shoulder injury and extended immobilization

42
Q

Who is affected by frozen shoulder?

A

Women

Over 40 yo

43
Q

Pathophys of frozen shoulder

A
  • Thickening and contraction of GH joint capsule and collagenous tissue surrounding joint
  • Results in reduced joint volume
44
Q

Clinical presentation of frozen shoulder

A
  • Initial painful phase, worse at night and increasing stiffness lasting 2-9 months
  • Intermediate phase w/less pain 4-12 months
  • Recovery phase w/gradual return of ROM that takes 5-24 months
45
Q

Treatment of frozen shoulder

A
  • Very slow process
  • PT
  • Some cases, rupture of adhesions w/manipulation under anesthesia
  • Intra-articular steroid injections
46
Q

What is Yergason’s test?

A
  • To determine biceps tendinitis

- Pain is reproduced w/elbow flexed to 90 degrees and forearm supinated against resistance

47
Q

Describe biceps tendon rupture

A
  • MC males over 50 yo
  • Many have h/o chronic tendinitis
  • Bicep looks like Popeye muscle
  • Permanent injury w/some loss of strength
48
Q

Treatment of biceps tendon rupture

A
  • Nonsurgical is risky bc restoring arm function w/later surgery may not be possible
  • Tendon should be repaired during first 2-3 wks after injury (after this the tendon and muscle begin to scar/shorten)
49
Q

Describe osteolysis of AC joint

A
  • Degenerative disease
  • MC seen in weightlifters
  • Point tenderness at AC joint
50
Q

Definitive treatment of osteolysis of AC joint

A

Distal clavicle resection (done open or arthroscopic)

51
Q

What diagnoses osteolysis of AC joint?

A

Injection of lidocaine and steroid directly into AC joint (resolves pain)

52
Q

Describe lateral epicondylitis

A
  • Tennis elbow
  • Overuse injury of extensor tendons
  • MC in dominant hand
53
Q

Describe medial epicondylitis

A
  • Golfers elbow
  • Less common than tennis elbow
  • Overuse injury
54
Q

Describe olecranon bursitis

A
  • Inflammation of subcutaneous synovial lined sac of the bursa overlying the acromial process
  • Swollen, boggy, sometimes tender olecranon bursa
55
Q

Describe septic olecranon bursitis

A
  • Infected olecranon bursa
  • MC cause is disruption of skin
  • MC organism is S. aureus/MRSA
  • Red, hot, swollen, tender
56
Q

Treatment of septic olecranon bursitis

A
  • Abx with Staph/MRSA coverage

- Keflex, Doxy, Trimetoprim, Sulfametoxazole

57
Q

Describe Boutonniere deformity

A
  • Injury to tendon that prevents full extension at PIP joint

- MOI forceful blow to flexed finger or laceration

58
Q

Describe Mallet finger

A
  • Disruption of extensor tendon at DIP joint

- MOI: ball or other object strikes tip of finger or thumb and forcibly bends it

59
Q

Describe swan neck deformity

A
  • Hyperextended PIP
  • Flexed DIP
  • MC cause is RA
60
Q

MC cause of swan neck deformity?

61
Q

Describe trigger finger

A
  • Flexor tendon becomes thickened and nodules form at A1 pulley
  • Tendon becomes stuck and has to be pulled into extension
  • Cause is unknown
  • MC in women, 40-60 yo, DM, RA, 4th finger
62
Q

Describe Dupuytren’s contracture

A
  • Fixed flexion contracture of hand
  • Caused by nodular thickening of palmar fascial cords
  • MC in 4th and 5th fingers
  • MC in males
  • Bilateral in almost 50%
63
Q

Definitive treatment of Dupuytren’s contracture

A

Surgical release

64
Q

MC joints of hand and wrist affected by OA

A

DIP
PIP
1st CMC

65
Q

Who is affected by OA of hand and wrist?

A

Males more if under 45 yo

Females more if over 45 yo

66
Q

Heberden’s nodes occur at:

67
Q

Bouchard’s nodes occur at:

68
Q

Presentation of first CMC joint OA

A
  • Post menopausal women
  • Nocturnal pain and weakness
  • Aggravated by pinch/grasp
69
Q

Are steroid injections more helpful for OA of hand/wrist or of 1st CMC joint?

A

1st CMC joint

70
Q

Describe DeQuervain’s tendinitis

A
  • 1st dorsal compartment tenosynovitis (tendon sheath)
  • Overuse of thumb
  • Pain is in anatomical snuffbox
  • Finklestein’s test positive
71
Q

Describe carpal tunnel syndrome

A
  • Median nerve compression at carpal ligament
  • Increased incidence in DM, thyroid disease, pregnancy
  • Thenar atrophy
  • Positive Phalen’s or Tinel’s
72
Q

Gold standard for diagnosis of carpal tunnel syndrome?

73
Q

Definitive treatment of carpal tunnel syndrome?

A

Carpal tunnel release

74
Q

Describe cubital tunnel syndrome

A
  • Ulnar nerve compression at elbow in ulnar groove
  • Pain is worse w/elbow flexed
  • Atrophy of intrinsic muscles
  • Positive Tinel’s at ulnar groove
75
Q

Describe paronychia

A
  • Soft tissue infection localized to proximal or lateral nail fold
  • Usually w/fluctuant mass or visible pus
  • S. aureus/MRSA MC
76
Q

Definitive treatment of paronychia

A
  • I&D with digital block (culture and sensitivities)

- Abx for 5 days

77
Q

Describe felon

A
  • Closed space infection of pulp of finger
  • S. aureus MC
  • Wooden splinters and minor cuts MC cause
  • Pack loosely w/gauze and change every 2-3 days
  • Abx to cover S Aureus/MRSA
78
Q

Describe herpetic whitlow

A
  • Digital herpes (viral)
  • Common in children, HC workers in dentistry
  • Self limiting (2-3 wks)
79
Q

Describe acute compartment syndrome

A
  • May occur in area of any long bone injury
  • Five P’s: pain out of proportion, pallow, paresthesias, pulselessness, paralysis
  • Absolute emergency
  • Fasciotomy is treatment

Clin Med II MHM - FINAL (16 decks)

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