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Upper Extremity Disorders Flashcards

1
Q

Most dislocations occur in ____ direction

A

Anterior-inferior

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2
Q

What motion causes an anterior-inferior dislocation

A

ER

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3
Q

What tears with anterior dislocation?

A

Inferior GH ligament
Anterior Capsule
Occasionally Glenoid Labrum

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4
Q

What motion causes a posterior dislocation?

A

Horizontal adduction and IR of glenohumeral joint

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5
Q

Hill-Sachs Lesion

A

Fx of posterior humeral head due to anterior subluxation

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6
Q

SLAP Lesion

A

Tearing of Superior Labrum, Anterior to Posterior

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7
Q

Bankart Lesion

A

Avulsion of anteroinferior capsule and ligaments associated with glenoid rim
Requires Surgery

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8
Q

What nerve can you bruise with a shoulder dislocatino?

A

Axillary Nerve

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9
Q

Following surgical repair for dislocation/chronic subluxation, patients should avoid:

A

Apprehension Position (Flexion to 90*, Horizontal abd to 90 and ER to 80)

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10
Q

Do Bankart Lesions Require Surgery?

A

Yes

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11
Q

If unstable shld has sx, how long kept in sling?

A

3-4 weeks

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12
Q

What Tendon is involved in a SLAP lesion?

A

Biceps Tendon

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13
Q

Location of pain in a labral tear

A

Cannot be localized to a certain point

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14
Q

What activities make labral tears worse?

A

Overhead activities or if arm held behind back

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15
Q

Pain with what movement with Labral Tears?

A

Resisted flexion of biceps

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16
Q

Where is it tender with a labral tear?

A

Front of shoulder

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17
Q

Gold standard of identifying labral tear?

A

Arthroscopic sx of shld

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18
Q

What is compressed in TOS?

A

Neurovascular Bundle

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19
Q

What is in the neurovascular bundle?

A

Bracial Plexus
Subclavian artery/vein
Vagus and Phrenic Nerves
Sympathetic Trunk

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20
Q

Common areas of TOS compression (4)

A
  1. Superior thoracic outlet
  2. Scalene Triangle
  3. Between Clavicle and 1st Rib
  4. Between pec minor and thoracic wall
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21
Q

Mechanism of injury for AC injury

A

Fall onto shoulder with UE adducted

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22
Q

Why are tendons of RC susceptible to tendonitis

A

Relatively poor blood supply near insertion of muscles

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23
Q

After surgical repair of shoulder impingement, what should you limit?

A

Shoulder elevation > 90*

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24
Q

Posterior/Internal Impingement is between what?

A

Rotator Cuff and greater tuberosity
OR
Posterior Glenoid and Labrum

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25
Q

Where is inflmaation typically in bicipial tendonsis?

A

Long head of biceps

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26
Q

Where is the impingement in Bicipital tendonosis

A

Proximal tendon between anterior acromion and bicipital groove

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27
Q

Surgical comments about Proxial Humerus Fx?

A

Generally does not require immobilization or sx because it is a fiarly stable fx

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28
Q

Important part of tx in proximal humerus fx? Why?

A

Early PROM to prevent capsular adhesions

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29
Q

Capsular Pattern ofAdhesive Capsulitis

A

Loss of ER –> Abduction –> Flexion

Least restricted IR

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30
Q

What disease is most commonly seen in Adhesive Capsulitis?

A

DM

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31
Q

Elbow Capsular Pattern

A

Loss of Flexion greater than Loss of Extension

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32
Q

Reason for loss of motion in elbow that doesnt follow capsular pattern?

A

Loose body in joint
Ligamentous Sprain
CRPS

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33
Q

Pattern of loss of motion for an elbow contracture

A

Capsular Pattern

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34
Q

What muscle is affected in Lateral Epicondylosis?

A

Extensor Carpi Radialis Brevis (ECRB)

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35
Q

Motion that causes Lateral epicondylosis

A

Repetitive wrist extension or strong grip with wrist extended

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36
Q

What must you rule out with lateral epicondylosis?

A

Cervical involvement

37
Q

What type of bracing is used with Lateral Epicondylosis?

A

Counterforce bracing to reduce forces along ECRB

38
Q

Muscles involved with Medial Epicondylosis

A

Pronator Teres

Flexor Carpi Trandialis

39
Q

Motion that causes Medial Epicondylosis

A

Strong hand grip and excessive pronation of forearm

40
Q

What type of distal humerus fx must be examined quickly for neurovascular status? Why?

A

Supracondylar Fx

High number of neurological (radilal nerve) and vascular structures

41
Q

What does poor neurovascular status post distal humerus fx lead to?

A

Volkmann’s Ischemia

42
Q

Distal humeral fxs have a high rate of ____

43
Q

Where is osterochondrosis in elbow typically found?

A

Central and/or Lateral aspect of Capitellum

Radial Head

44
Q

What causes osteochondrosis of humeral capitellum?

A

Repetitive compressive forces between radial head and humeral capitellum

45
Q

Most common age for Osteochondrosis of humeral capitellum

A

Children < 10

46
Q

What causes Ulnar Collateral Ligament injuries?

A

Repetitive Valgus stresses with overhead throwing

47
Q

Where in the Ulnar collateral ligament does it usually hurt when it is injuried?

A

distal insertion

48
Q

Where is paresthesias with ulnar collateral ligament injuries?

A

Ulnar Nerve distribution

49
Q

Where does direct trauma have to occur for ulnar nerve entrapment?

A

Cubital Tunnel

50
Q

Traction due to laxity at ___ aspect of elbow causes Ulnar Nerve entrapment

A

Medial Aspect

51
Q

Compression due to hypertrophy of what muscle causes ulnar nerve entrapment?

A

Flexor Carpi Ulnaris Muscle

52
Q

What causes Median Nerve entrapment?

A

Pronator Teres Muscle and under superficial head of flexor digitorum superficialis

53
Q

What action causes median nerve issues?

A

Excessive gripping

54
Q

What causes Radial Nerve Entrapment?

A

Entrapment of distal ranches (posterior interosseus nerve) in radial tunnel

55
Q

Most common direction for elbow dislocations

A

Posterolateral

56
Q

How does a posterolateral dislocation of and elbow occu?

A

Elbow hyperextension from FOOSH

57
Q

What percentage of elbow disloations are anterior or radial head?

A

1-2 percent?

58
Q

What will rupture with a complete elbow dislocaiton

A

Ulnar Collateral ligament, possible anterior capusule

59
Q

What nerve is compressed with Carpal Tunnel syndrome?

A

Median Nerve

60
Q

4 major causes of Carpal Tunnel

A
  1. Repetitive wrist Motions/gripping
  2. Pregnancy
  3. DM
  4. RA
61
Q

3 differential diagnosis of carpal tunnel syndrome

A
  1. C-spine
  2. TOS
  3. Peripheral nerve entrapment (median)
62
Q

Long term compression in carpal tunnel leads to weakness of:

A

Thenar muscles and lateral two lubricles

63
Q

DeQuervain’s Tenosynovitis

A

Inflamatation of extensor poliicis brevis and longus

64
Q

What compartment does dequervain’s tenosynovitis affect?

A

First Dorsal Compartment

65
Q

3 signs of De Quervain’s tenosynovitis

A
  1. Pain at anatomical stuff box
  2. Decreased grip/pinch strength
  3. (+) Finkelstein
66
Q

Most common wrist fx

A

Colles Fracture

67
Q

How long do you immobilze a colles gx?

68
Q

What nerve can be affected with a colles fx

A

Median Nerve

69
Q

Colles fx

A

Posterior displacement of distacl radisus with radial shift of wrist and hand

70
Q

What causes a colles fx?

71
Q

Smith’s Fx

A

Distal radius dislocates anteriorly

72
Q

Most commonly fx carpal?

73
Q

Most common issue with scaphoid fx

A

Avascular Necrosis

74
Q

Carpals immobilized ___ weeks after scaphoid fx?

75
Q

Dupuytren’s Contracture

A

Banding on palm and digit flexion contractures due to contracture of palmar fascia to skin

76
Q

What digits does a dupuytren contracture affect?

77
Q

What digits does a dupuyten contracture affect with DM?

78
Q

Boutonniere’s Deformity Cause

A

Rupture of central tendinous slip of extensor hood

79
Q

Boutonniere’s Deformity Presentation

A

Extension of MCP and DIP with Flexion of PIP

80
Q

Swan Neck Deformity Cause

A

Contracture of intrinsic muscles with dorsal sublux of lateral extensor tendons

81
Q

Swan Neck Presentation

A

Flexion of MCP and DIP with Extension of PIP

82
Q

Mallet Finger Cause

A

Rupture of extensor tendon at insertion into DIP

83
Q

Mallet finger presentation

A

Flexion of DIP joint

84
Q

Ape Hand Deformity

A

Thenar muscle wasting so 1st digit moves dorasally until it is inline with 2nd digit

85
Q

Cause of ape hand

A

Median Nerve dysfunction

86
Q

Gamekeeper thumb cause

A

Sprain/rupture of ulnar collateral ligament of MCP joint of 1st digit

87
Q

Boxer’s Fx

A

Fx of 5th Met

88
Q

How long casted for boxer’s fx?

Muscskel (12 decks)

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