Upper Extremity Disorders Flashcards
Distal Biceps Tear:
- what is the action of the biceps?
- MC in what ages?
- MC cause is eccentric/concentric contraction?
- dx
- indications for surgery
Action of biceps: supinator
MC in 40-50YO
MC cause is eccentric contraction (lowering biceps curl)
Dx:
- hook test
- MRI (T2)
Indications for surgery:
- laborer (turning door handles, screw drivers)
- perpetual cramping of the popeye deformity
- cosmetic
Tennis/Golf Elbow
- pathophys
- considered Tennis/golf elbow depending upon its location, which is lateral/medial?
- work up
- Tx
Pathophys: Excessive wrist extension, enthesopathy or angiofibromatous
metaplasia.
Tennis elbow is on the outside; lateral epicondyle.
Golf elbow is on the inside, medial epicondyle.
Work up:
- resisted wrist extension
- dont require MRI/XRAY
Tx:
-1st line is time, therapy(OT), NSAIDS, an steroids.
Olecranon Bursitis:
- who gets this?
- what is this?
- PE findings
- Tx
- what are some consequences of a chronic draining sinus?
Who: people who lean on their elbows a lot.
What: fluid filled sac, in normal state a bursa is tiny, it’s a potential space. (two pieces of suranwrap with a little drop of fluid between them.) When this gets inflamed it puffs up.
PE:
-fluid filled, compressible, red sac.
Tx:
- compression sleeve
- if you’re going to tap it you need to do so from the triceps aspect.
Chronic draining sinus may lead to squamous cell carcinoma.
Radial Nerve Palsey:
- aka
- motor and sensory effects
- tx
aka: saturday night palsies
Motor: gives you wrist and finger extension, cant bring wrist up or fingers back.
Sensory: gives sensation to the first dorsal web space, this will be numb.
Tx:
- Watch it, 90% get better on their own.
- may refer to ortho.
Ulnar Nerve Palsies:
- where does this innervate?
- what tests can be used to dx?
- where are the 5 compressible sites?
- what are the sensory effects?
- tx
- indications for surgery
Nerve innervation: flexors and ulnar deviators
Test for dx:
- Wartenberg = abduction/adduction of fingers (cant spread fingers and bring them back together)
- Froments: holding piece of paper with thumbs, if one thumb bulges up then this is a positive test)
- tinnels and phalens of the elbow
5 compressible sites:
- cutbital tunnel (MC, at the elbow)
- Intramuscular septum (brachialis and triceps)
- two heads of the flexor carpi ulnaris
- guyons canal (at the wrist)
Sensory effects: numbness in the pinky and part of the ring finger.
Tx: tell them to keep it straight, could use towel or pillow brace at night.
Indications for surgery:
- subluxation/dislocation of ulnar nerve
- persistant numbness
- instability (nerve rolls)
- muscle atrophy (starting to claw)
Carpal Tunnel:
- sensory effects
- causes
- motor effects
- tests
- tx
- indications for surgery
Sensory: numb/tingle in thumb and 3 radial digits +/- ring finger, never the pinky.
Cause:
- distal radial fx
- arthritis
- DM
- tendonitis
Motor effects:
-weakness in the thenar muscles
Tests:
- palmar adduction (cant do it)
- tinnels
- phalens
- -modified phalens = more sensitive and specific test than phalens..push on the carpal tunnel and flex wrist
Tx:
- NSAIDS & splint
- Cortisone
- carpal tunnel release
Indications for surgery:
- muscle wasting
- persistent numbness
- starting to claw.
What area does each of the following nerve roots innervate?
- C5
- C6
- C7
- C8
C5 = upper arm
C6 = thumb, pointer finger, radial forearm up to the elbow
C7 = F U.
C8 = mirror of C6. Ring finger, pinky, ulnar forearm up to the elbow.
Dupuytrens Syndrome:
- what is this?
- MC occurs in which finger?
- cause
- tx
What is this:
-thickening of palmar fascia, myofibrous contraction. DOES NOT INVOLVE THE TENDONS!
MC occurs in the ring finger
Cause: genetic
Tx:
- refer to ortho
- needle aponeurotomy (cut the cord)
- open palmar fasciectomy (GOLD STANDARD, surgically excise it)
- zyaflex; injecting clostridium toxin. Numb the hand and force the finger straight and it breaks up the cord.
Ganglions:
- pathophys
- dx
Pathophys:
-weakening in the joint capsule, this enlarges with synovial fluid. One way valve so the fluid cannot get back into the joint.
Dx:
- transilluminate:
- -ganglion will be clear
- -schannoma; dark, positive tinnels, can move like guitar string but not proximal distal.
- -AV will be darker, purple in color, will see vessels.
- -lipoma: feel rubbery
Arthritis: OA
- what is this?
- tx
What: loss of cartilage, bone rubbing on bone.
Tx:
- NSAIDS
- Splints
- modify activity
- joint resurfacing, fusion, replacement
Describe where the tendon damage is in each of the following:
- swan neck
- boutonniere
What is a lumbrical?
Swan necK: injury is at the DIP. (flexor digitorum profundus) (deep goes distal)
Boutonniere: injury is at the PIP. (flexor digitorum superficialis)
Mallet/Jersey: -
- what is this ?
- tx
What: tear of tendon off of distal phalenx…
- -mallet: inability to extend the knuckle (stuck in flexion)
- -jersey: inability to actively flex the DIP (stuck in extension)
Tx:
-usually splinted
Scaphoid Fx:
-tx
Tx:
-splint them and re-image in two weeks.
