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Clin Med III: MSK > Upper Extremity Disorders Part 1 > Flashcards

Upper Extremity Disorders Part 1 Flashcards

1
Q

with shoulder hx CC - consider in the context of its ___ and ____

A

chronicity
patient’s age

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2
Q

CC with shoulder disorders is typically ___ or ___

A

pain or instability

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3
Q

shoulder hx - < 30 years old MCC

A
  1. traumatic injuries or joint instability
    - Glenohumeral dislocations or AC joint separation
    - Rotator cuff tears and impingement syndrome rarely occur
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4
Q

shoulder hx - MCC for 30-50 years old

A
  • rotator cuff tears or impingement syndrome
  • Dislocations are much less common and should raise a suspicion of a concomitant rotator cuff tear
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5
Q

shoulder hx - MCC >50 years old

A
  • rotator cuff dysfunction / tear, impingement syndrome and degenerative arthritis
  • Acute pain in elderly may indicate pathological fracture due to osteoporosis- common at proximal humerus
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6
Q

difference between acute vs chronic sx in shoulder pain

A
  1. Acute sx (< 2-3 wks duration)
    - Think injury - Fracture, dislocation, rotator cuff tear or biceps tendon rupture
  2. Chronic sx
    - May be due to injury, but typically associated with overuse or arthritis
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7
Q

components of instability in shoulder pain hx

A
  1. Direction of instability
    - Can be anterior, posterior, inferior, or multidirectional
  2. Degree of Instability
    - Partial (subluxation) with spontaneous reduction vs. complete (dislocation)
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8
Q

MC direction of instability in shoulder history

A

anterior

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9
Q

during PE for shoulder cc, patient should be in what position with what removed

A

standing
shirt removed

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10
Q

inspection during shoulder PE

A
  • Assess contours and height of both shoulders
  • Inspect both anteriorly and posteriorly
  • Noteworthy findings: deformity, swelling, ecchymosis
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11
Q

palpation for shoulder PE

A
  1. Start at the sternoclavicular joint and move laterally
  2. Assess all joints and bony structures
  3. Assess the subacromial bursa
  4. Assess long head of the biceps tendon
  5. Noteworthy findings: point tenderness, deformity, swelling
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12
Q

shoulder PE - All 6 directions of movement should be assessed. These include:

A

horizational flexion & extension
extension
flexion
adduction
abduction

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13
Q

things to keep in mind for shoulder PE ROM

A

6 directions

  1. Active followed by passive ROM
  2. Note direction of limited ROM
  3. Assess fluidity and smoothness of movement
  4. Palpate for crepitus
  5. Consider functional disability
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14
Q

deltoid muscle testing

A
  • Abduct shoulder at 90° with the elbow flexed at 90° and the forearm parallel to the floor
  • Ask patient to resist downward pressure to the elbow
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15
Q

special test for Supraspinatus

A

“Empty can test”

  1. Abduct shoulder at 90° with 30° forward flexion and internal rotation with the elbow extended
    - In the “thumbs down” position
  2. Push down as the patient resists
  3. Weakness or pain is indicative of rotator cuff disease
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16
Q

special test for Infraspinatus and Teres Minor

A
  • Flex elbow to 90° with shoulder in neutral position
  • Support the elbow and attempt to externally rotate asking patient to resist movement
  • hornblower’s sign
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17
Q

special test for Subscapularis

A

“Gerber Lift-off Test”

  1. Place the patient’s hand behind the small of the back, palm facing away from back
  2. Have the patient lift the hand off the back against resistance
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18
Q

muscle testing for Serratus Anterior

A
  1. Stabilizes the scapula
  2. Flex the shoulder above 90°
  3. Then with one hand, depress the arm (posteriorly), while the other hand palpates the scapula
  4. The scapula should remain on the chest wall
  5. Winging indicates muscle weakness
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19
Q

muscle testing for rhomboid

A
  1. Have the patient place both hands on their sides, along the side of the iliac crest. Then push the arm forward as the patient resists your passive movement
  2. The scapula should remain on chest wall
  3. Winging indicates muscle weakness
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20
Q

what is Neer impingement

A
  1. With patient seated, depress the scapula with one hand and elevate the arm with the other
  2. This compresses the rotator cuff tendons between the greater tuberosity and the anterior acromion
  3. Discomfort represents rotator cuff tear or impingement syndrome
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21
Q

what is the Hawkins-Kennedy Test

A
  • Forward flex the shoulder to 90° and the elbow flexed to 90°
  • Internally rotate the shoulder
  • Pain indicates impingement of the supraspinatus tendon
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22
Q

what is the crossover test

A
  1. Elevate the shoulder to 90°
  2. Adduct the arm across the body in the horizontal plane
  3. Discomfort over the AC joint suggest arthritis or AC joint pathology
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23
Q

what is apprehension sign

A
  1. Place the arm in supine position
  2. Place the arm in 90° abduction with elbow flexed at 90°
  3. Apply maximal external rotation
  4. Patients with anterior instability report a sense of impending dislocation
  5. Discomfort without apprehension is nonspecific
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24
Q

what is the sulcus sign

A
  1. Apply traction in an inferior direction with the arm relaxed at the patient’s side
  2. Inferior instability: inferior subluxation of the humeral head and a widening of the sulcus between the humerus and the acromion
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25
Q

what is the Jerk Test

A
  1. Place the arm in 90° flexion and maximum internal rotation with the elbow flexed at 90°
  2. Adduct the arm across the body in the horizontal plane while pushing the humerus in the posterior position
  3. If there is posterior instability, this will cause posterior subluxation or dislocation
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26
Q

dx imaging for shoulder injury

A

Radiographs - 1st line

  1. AP view - Can add on AP internal and external rotation views
  2. Scapular “Y” view - Helpful for shoulder dislocation, proximal humerus fracture and scapular fracture
  3. Axillary view
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27
Q
  • Can be obtained with internal and external rotation
  • Internal (lesser tubercle of humerus); External (greater tubercle)

which xray view

A

AP view

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28
Q

which xray view provides better view of scapula

A

Lateral or scapular Y-view

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29
Q

which xray view provides a view of the relationship of the humeral head and the glenoid

A

Axillary view

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30
Q

Group of muscles and their tendons that act to ____ the shoulder, holding the humerus into the fossa of the glenoid

A

stabilize

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31
Q

Rotator Cuff Consists of 4 Muscles:

A
  • Supraspinatus - MC affected
  • Infraspinatus
  • Teres Minor
  • Subscapularis
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32
Q

pathophys of rotator cuff disorders

A
  1. overuse
  2. edema
  3. inflammation
  4. fibrosis
  5. microscopic tear
  6. partial thickness tear
  7. full thickness tear
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33
Q

An inflammation of the subacromial bursa and rotator cuff tendons
Results from repetitive compression of these structures under the coracoacromial arch

A

Impingement

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34
Q

presentation of impingement disorder

A
  1. Gradual onset of shoulder pain
  2. Anteriorly and laterally
  3. Pain worse with overhead activity
    - Can also worsen when reaching behind the back
  4. Night pain and difficulty sleeping on affected side
  5. Prolonged cases: weakness and SITS muscle atrophy
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35
Q

PE for impingement

A
  1. Inspection
    - Usually normal
    - Atrophy if prolonged condition
  2. Palpation
    - Tenderness over the greater tuberosity and subacromial bursa
  3. ROM
    - Pain with abduction (90-120°) and when lowering arm back down
    - Crepitus with movement
  4. Special testing
    - (+) Neer and Hawkins-Kennedy
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36
Q

diagnostics for impingement disorder

A
  1. X-rays typically normal
    - Y-view x-ray could demonstrate subacromial spur
  2. MRI - better, however $$$
  3. Diagnostic anesthetic injection
    - Assess muscle strength with Empty Can test
    - Inject 10 ml of 1% lidocaine into the subacromial space
    - Repeat Empty Can
    - If strength assessment improves impingement is more likely than tear
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37
Q

impingement disorder management

A
  1. Mainstay: Rest & NSAIDs
  2. Home exercise program
    - 6-8 wks (exercises 3-4x daily)
    - Should not have an increase in pain - Muscle soreness and stretching sensation are normal
    - Ice application after exercises
  3. Corticosteroid injection if no improvement after 4-6 wks
  4. Referral indications
    - PT - no improvement after 3-4 wks of home exercise
    - Ortho - no improvement after 2-3 months of PT
    — Possible consideration of surgical subacromial decompression
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38
Q

Repetitive overhead motions increase the demand on the shoulder and the musculotendinous junctions

A

Rotator Cuff Tendonitis

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39
Q

RF Rotator Cuff Tendonitis

A
  1. MC - Repetitive overhead activity
    - Pitching
  2. Increased BMI
  3. DM
  4. Hyperlipidemia
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40
Q

Rotator Cuff Tendonitis - Excessive abduction and external rotation results in compression of what muscles

A

supraspinatus and infraspinatus

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41
Q

early sx of rotator cuff tendonitis

A

Stage I tendonitis

  1. Aching and soreness with repetitive activity (throwing)
    - Anterior shoulder
  2. Athletes
    - Decreased pitching speed and accuracy
  3. Pain with ADL’s
  4. Improves with rest
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42
Q

late sx of rotator cuff tendonitis

A

Stage II tendonitis

  1. Posterior shoulder pain with activity and at night
  2. Loss of ROM - abduction and external rotation
  3. Rest is no longer effective
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43
Q

PE of rotator cuff tendonitis

A
  1. Inspection
    - Most patients are normal
    - Atrophy of supraspinatus/infraspinatus (long-standing dz)
  2. Palpation
    - Tenderness along affected muscles, subacromial space
  3. ROM
    - Pain above 90° abduction
    - Passive ROM > active ROM
  4. Special Testing
    - (+) Empty-can
    - (+) Neer and Hawkins if associated impingement
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44
Q

imaging for rotator cuff tendonitis

A
  1. Shoulder X-ray - Internal and external AP views
  2. MSK Ultrasound
  3. MRI shoulder
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45
Q

pros and cons of rotator cuff tendonitis US? findings?

A
  • Requires trained technician; operator dependent
  • Inexpensive, convenient, and no radiation exposure
  • Will show thickening (>5 to 6 mm), hypoechogenicity, and heterogeneity
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46
Q

indications for MRI shoulder in rotator cuff tendonitis? findings?

A
  1. Indications
    - Unclear presentation (clinical diagnosis is questionable)
    - Inadequate response to conservative therapy
  2. Will show inflammation and edema
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47
Q

management for rotator cuff tendonitis

A
  1. Stage I
    - Rest - no overhead weight training or throwing x 10 days
    - After 10 days of rest - intermittent throwing
    - Physical therapy
  2. Stage II
    - Rest and refer to PT - Complete shoulder rest until after PT has been completed
  3. Referral indications
    - Failure of conservative therapy
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48
Q

Tear in one or more of the 4 rotator cuff muscles (SITS)

A

Rotator Cuff Tear

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49
Q

Which tendon is most common injured for rotator cuff tear

A

supraspinatus

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50
Q

Pathophysiology/Etiology of rotator cuff tear

A

often multifactorial

  1. Age-related degeneration
  2. Chronic mechanical impingement
  3. Altered blood supply to tendons
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51
Q

presentation of rotator cuff tear

A
  1. Chronic shoulder pain
    - Ranging from mild-debilitating
    - Worse with activity and at night
  2. Associated weakness, catching, and crepitus when lifting the arm overhead
  3. Inability to fully perform ADL’s
    - Washing/styling hair
    - Putting on shirt/jacket/bra
    - Reaching for items in higher shelves/cabinets
  4. Older pts may be asx
52
Q

PE of rotator cuff tear

A
  1. Inspection
    - Atrophy of posterior shoulder - if chronic
  2. Palpation
    - Tenderness along greater tuberosity
  3. ROM/Muscle strength
    - Limited, painful/weak AROM - Abduction and external rotation; Internal rotation will be limited if the subscapularis tendon is involved
    - Full PROM
    - + Drop Arm
  4. Specialized Testing
    - (+) Empty can, Neer’s, Hawkins
53
Q

imaging for rotator cuff tear

A
  1. X-rays
    - Rules out other pathologies
    - May show acromial spur or sclerosis of the humeral head
  2. US
    - Highly accurate in detecting full-thickness rotator cuff tears
  3. MRI
    - Helps determine size, location, and characteristics of rotator cuff pathology
    - Less sensitive for partial-thickness tears (but still very sensitive overall - 91%)
  4. Arthrography
    - Less expensive than MRI; invasive procedure
    - High sensitivity with full thickness tears; sensitivity decreases with partial tears
54
Q

XR shows evidence of shallow space between acromion and humerus
indicative of what dx?

A

chronic rotator cuff tear

55
Q

conservative approach for rotator cuff tear

A
  1. Rest - avoid overhead activities
  2. NSAIDs
  3. PT - Minimum of 6 wks
  4. Glucocorticoid injections
    - Only in pts who are not surgical candidates
    - Limited to 3-4
56
Q

surgical indications for rotator cuff tear

A
  1. Tear in patients < 55 y/o
  2. Acute, full-thickness traumatic tear in healthy individual
  3. Acute on chronic tear with loss of function
  4. Failure of conservative therapy after 3-6 months
57
Q

A painful loss of both AROM and PROM due to idiopathic inflammation of the joint capsule

A

Adhesive Capsulitis Aka “frozen shoulder”

58
Q

adhesive capsulitis is MC seen in who?

A

MC in women 40-60 y/o

59
Q

RF for adhesive capsulitis

A
  1. DM I - MC
  2. Hypothyroidism
  3. Dupuytren’s disease
  4. Cervical disc disease
  5. Parkinson’s
  6. Cerebral hemorrhage
60
Q

presentation of adhesive capsulitis

A
  1. “Freezing” phase - Progressive loss of ROM and pain
  2. “Thawing” phase - Gradual improvement in ROM and discomfort
    - Lasting 6 months - 2 years
  3. Exam
    - Significant reduction (>50%) in both AROM and PROM
    - Tenderness at the deltoid insertion - May be diffuse
61
Q

imaging for adhesive capsulitis

A
  1. X-rays
    - Normal
    - Utilized to r/o Ddx
  2. MRI- Indicated only if presentation is atypical
    - Imaging will reveal “contracted capsule and loss of inferior pouch”
62
Q

management for adhesive capsulitis

A
  1. NSAIDS
  2. Moist heat compresses
  3. Home Stretching Program
    - 3-4 wks
    - Ice application after stretching
  4. Image guided intra-articular steroid injection
    - Fluoroscopy or US
    - Limited (3-6 total) over course of disease
  5. Physical Therapy
    - Transcutaneous Electrical Nerve Stimulation (TENS) Unit
  6. Surgical repair
    - Arthroscopic capsular release
    - Indicated for failure of conservative therapy - No improvement 3 mo of consistent rehab
  7. Patient education
    - Prognosis: 1-2 year for full recovery
63
Q

the humeral head partially slips out of the glenoid cavity

A

Subluxation

64
Q

the humeral head becomes completely dislodged from the glenoid cavity

A

Dislocation

65
Q

MOA of anterior shoulder dislocation

A

Blow to abducted, externally rotated and extended arm
Example: blocking basketball shot

66
Q

presentation of anterior shoulder dislocation

A
  1. Arm is slightly abducted and externally rotated
  2. Prominent acromion (thin patients)
  3. Loss of the normal rounded appearance of the shoulder
  4. No ROM
67
Q

MOA of posterior shoulder dislocation

A
  • Blow to the anterior portion of the shoulder
  • Axial loading of an adducted and internally rotated arm
  • Violent muscle contractions following a seizure or electrocution
68
Q

presentation of posterior shoulder dislocation

A
  • Arm is adducted and internally rotated with an inability to externally rotate
  • Shoulder prominence posteriorly with flattening anteriorly
  • The coracoid process may be more prominent
69
Q

MOA of inferior shoulder dislocation

A

Axial loading with the arm fully abducted or forceful hyperabduction of the arm
MC: overhead grasp of object to keep from falling

70
Q

presentation of inferior shoulder dislocation

A

Arm is held above the head, pronated with the inability to adduct

71
Q

Patients can typically voluntarily dislocate the shoulder
Poor prognosis for surgical treatment

what type of shoulder instability

A

Multidirectional Instability

72
Q

Physical exam testing for assessing instability

A
  • Apprehension test (anterior instability)
  • Jerk Test (posterior instability)
  • Sulcus sign (inferior instability)
73
Q

4 complications from shoulder instability

A
  1. axillary nerve damage
  2. Hill-Sachs Lesion
  3. Bankart Lesion
  4. Greater tuberosity fx
74
Q
  1. numbness over the lateral arm and deltoid dysfunction
  2. weakness of the teres minor and deltoid

type of shoulder instability complication?

A

Axillary nerve damage

  1. sensory
  2. motor

ALWAYS perform NV exam

75
Q

Depression fracture of the humeral head created by the glenoid rim during dislocation
MC seen in anterior dislocations

which type of shoulder instability complication?

A

Hill-Sachs Lesion

76
Q
  • Glenoid labrum is disrupted during dislocation
  • MC in patients < 30 y/o
  • May result in a bone fragment avulsion

which type of shoulder instability complication?

A

Bankart Lesion

77
Q

diagnostics for shoulder instability

A
  • X-ray - AP, “Y” view, axillary view
  • CT - only if plain films do not clearly define direction of dislocation
  • MRI - Performed after reduction if soft tissue injury is likely
78
Q

at what ages do Bankart lesions and rotator cuff MC occur?

A
  • Bankart lesion - < 30 year old
  • Rotator cuff - young (< 40) patient with traumatic dislocation
79
Q

management for shoulder instability

A
  1. anterior/inferior/posterior dislocation reduction
  2. Reassess NV status
  3. post-reduction films to verify successful reduction
  4. Immobilize shoulder in sling x 3 wks
  5. Refer to PT for strengthening
  6. Refer to Ortho if concern for complications
80
Q

techniques for anterior shoulder dislocation reduction

A
  1. Stimson Technique (prone)
  2. Longitudinal Traction

May use procedural sedation or intra-articular lidocaine injection
Informed consent required

81
Q

technique for inferior shoulder dislocation reduction

A

axial traction

82
Q

technique for posterior shoulder dislocation reduction

A

Traction-
countertraction
Informed consent required

83
Q
  • Caused by trauma to the AC joint resulting in ligamentous disruption
  • MOA: Fall directly onto adducted shoulder
A

Acromioclavicular (AC) Injuries

84
Q

AC injury classification system

A

I-VI
based upon severity of separation

85
Q
  • Most common
  • AC joint ligaments are partially disrupted and the strong coracoclavicular (CC) ligaments are intact
  • No separation of clavicle from acromion

AC injury classification?

A

Type I - sprain

86
Q
  • AC ligaments are torn but the CC ligaments are intact
  • Partial separation of the clavicle from the acromion

AC injury classification?

A

type II

87
Q
  • Both AC and CC ligaments are completely disrupted
  • Complete separation of clavicle from acromion

which type of AC injury classification?

A

type III

88
Q

Rare
Classified based upon degree and direction of separation

which types of AC injury classifications?

A

Type IV - VI

89
Q
  • Pain in AC joint on abduction
  • Supports arm in an adducted position
  • Deformities (Grade III-VI)
  • Tenderness over AC joint
  • Assess NV status

presentation of which dx?

A

Acromioclavicular (AC) Injuries

90
Q

AC injury imaging and findings of the types?

A
  1. Radiographs
    - AP shoulder
    - Zanca view: AP with 10-15 degree cephalic tilt
  2. Type I - normal
  3. Types II-VI - separation noted
91
Q

Grade I-II AC injury management

A
  1. Ice compresses
  2. NSAIDs
  3. Sling with rest x 2-3 days
  4. ROM exercises and gradual return to activity as pain allows
    - Start within 7-10 days
    - Expectation of full return within 2-4 wks
92
Q

Grade III AC injury management

A
  1. Conservative as in I and II
  2. Refer for surgical consideration if injury affects career - Young manual laborer, athlete
  3. Acceptable deformity is likely without surgical intervention
93
Q

grae IV - VI AC injury management

A
  1. Refer to ortho surgical repair - Emergent if NV compromise
  2. Deformity and weakness will be likely without intervention
94
Q
  • Ligament trauma to the joint connecting the sternum and the clavicle
  • Ranging from microscopic tears (sprain) to complete disruption of ligaments (dislocation/subluxation)

what type of injury?

A

Sternoclavicular Injuries

95
Q

anterolateral force applied to the shoulder with a rolling movement (sports)

which type of MOI sternoclavicular injury

A

anterior

96
Q
  • crushing forces to the chest
  • May be associated with mediastinal injuries
  • Consider airway assessment

which type of MOI sternoclavicular injury?

A

posterior

97
Q

Mild-moderate pain, tenderness and swelling with no change in joint structure

which type of sternoclavicular injury presentation

A

sprain

98
Q
  • Severe pain, swelling, ecchymosis, decreased ROM
  • The medial clavicle is prominent compared to sternum

which type of sternoclavicular injury presentation?

A

anterior dislocation

99
Q
  • Severe pain, swelling, ecchymosis, decreased ROM
  • The medial clavicle is less visible/palpable
  • Hoarseness, dysphagia, dyspnea, UE paresthesias

which type of sternoclavicular injury presentation?

A

posterior dislocation

100
Q

diagnostics for sternoclavicular injuries

A
  1. X-ray is not sensitive for detecting SC dislocation
  2. CT chest - Consider IV contrast to R/O mediastinal injury
101
Q

management for sprained sternoclavicular

A
  1. Rest, sling, ice, NSAIDS
  2. Gradual return to activities (same as AC Grade I)
102
Q

management for anterior sternoclavicular dislocation

A
  1. Reduction
    - After procedural sedation (informed consent)
    - Place rolled towel between scapula and table/bed and apply posterior traction to the affected arm - may not remain in place d/t instability of joint
    - Place in sling/swathe or figure 8 clavicle harness
  2. Ice and analgesics
103
Q

management for posterior sternoclavicular dislocation

A
  1. Immediate ortho consult for open vs closed reduction
  2. Consult trauma/general/vascular/thoracic surgeon for associated injury case based
104
Q

clavicle fx is classified by ?

A

location of fracture

Proximal (medial) ⅓, middle ⅓, distal (lateral) ⅓

105
Q

MC clavicle fx location

A
  1. diaphysis
  2. medial end
  3. lateral end
106
Q
  1. Pain, swelling, deformity
  2. Skin tenting
  3. Tenderness along fracture site
  4. Decreased ROM
    - Grinding sensation noted over fracture site with attempted ROM

presentation of which dx?

A

clavicle fx

107
Q

imaging for clavicle fx?
imaging if initial not confirmatory?
What imaging if medial fx suspected?

A
  1. Clavicle x-ray
    - AP
    - 10 degree AP cephalic view if AP is non-confirmatory
  2. CT chest w/ contrast if medial fx suspected
    - Look for associated mediastinal injury
108
Q

management for uncomplicated clavicle fx

A
  1. Figure 8 strap, sling, ice, analgesics
    - Strap/sling x 3-4 wks (age 12 and under), 6-8 wks for adults
  2. gentle ROM exercises after 2-3 wks (as pain allows)
109
Q

findings that indicate for Ortho consult for closed/open clavicle reduction with internal fixation: (5)

A
  1. Medial fracture
  2. Tenting of the skin
  3. 100% displacement
  4. Displaced distal ⅓ fractures
  5. Severe comminution
110
Q
  • A common inflammatory process of the long head of the biceps tendon
  • overuse (repetitive lifting)
  • Commonly coexists with other conditions
A

Biceps Tendinopathy

111
Q

95% of patients with biceps tendinopathy have what other condition?

A

impingement syndrome

112
Q
  1. Pain reported in the anterior shoulder radiating to the elbow
  2. Worsened by activity - Lifting, pulling, or repetitive overhead activities
  3. Night pain is common
  4. Sx relieved with rest and ice
  5. Tenderness along the bicipital groove
  6. Pain with both active and passive ROM
  7. (+) Yergason’s Test

dx?

A

Biceps Tendinopathy

113
Q

dx and management for biceps tendinopathy

A
  1. Dx is clinical, no use of imaging
  2. Rest/Modification of activities; Ice; NSAIDs
  3. Glucocorticoid injection if after failure of conservative therapy - Medication cocktail injected at subacromial space or bicep tendon sheath
  4. PT if sx don’t improve with conservative management
114
Q

caution with injections for biceps tendinopathy as there is a risk for ?

A

tendon rupture

115
Q

MC location of Biceps Tendon Rupture?
who is it MC seen in?

A
  • proximal end of the long head
  • older adults with chronic shoulder pain or impingement
  • May occur in weight lifters or throwing sport athletes
116
Q
  1. Sudden onset of pain in the upper arm
  2. Audible “snap” may be felt and heard
  3. Ecchymosis noted initially
  4. Bulge / “popeye deformity” - Accentuated with flexion of elbow against resistance
  5. Tenderness in the bicipital groove

dx?

A

bicep tendon rupture

117
Q

diagnostics for bicep tendon rupture

A
  1. X-ray - shoulder
    - May be used to rule out other ddx (i.e. fracture)
  2. MRI - Rule out rotator cuff tear
118
Q

management for bicep tendon rupture

A
  1. Conservative for most patients
  2. Surgical repair indications:
    - Unacceptable deformity
    - Young athletes or laborers (< 40 y/o)
119
Q

Generally a result of a direct blow to the arm such as MVA or falling on an outstretched arm

A

humeral fx

120
Q
  • humeral fx are classfied based on ____?
  • name each
A

location

  1. Proximal - Greater tuberosity, lesser tuberosity, humeral head, anatomical neck, surgical neck, proximal shaft
  2. Shaft
  3. Distal - Supracondylar (MC in children); Epicondylar
121
Q
  • presentation of humeral fx
  • difference if Proximal fx vs Shaft fx
A
  1. Pain, swelling, ecchymosis - Look for evidence of open fracture
  2. Tenderness to gentle palpation over fracture site
  3. Limited ROM of the shoulder (proximal/shaft fx)
  4. Assess NV status
    - Proximal fx - Axillary nerve/artery
    - Shaft - Radial nerve (shaft/distal fx)
122
Q

imaging for humeral fx

A

X-ray

  • Shoulder (proximal fx)
  • Humerus (shaft fx)
123
Q

management for proximal humeral fx with minimal displacement

A
  1. Sling - Full time x 3 wk then part time as pain allows
  2. exercise program / refer to PT after 3 wks
  3. Open Reduction and Internal Fixation (ORIF) as indicated
  4. prosthetic replacement as indicated
124
Q

indications for open reduction and internal fixation (ORIF) for humeral fx

A
  1. Displacement of > 1 cm or > 45° angulation
  2. Displacement of greater tuberosity > 0.5 cm - Affects rotator cuff muscles
125
Q

Prosthetic replacement indicated for ____ due to risk of blood supply disruption of the humeral head

A

4-part fractures

126
Q

management for humeral shaft fx with angulation < 20°?

A
  • U-shaped coaptation splint for 2wks followed by a humeral fracture brace for 6 wks
  • Encourage ROM of the fingers, wrist and elbow
127
Q

surgical indications for humeral fx

A
  1. Open fracture
  2. NV compromise
  3. Pathologic fractures
  4. Ipsilateral forearm fractures

Clin Med III: MSK (14 decks)

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