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Clin Med III: MSK > Upper Extremity Disorders Part 2 > Flashcards

Upper Extremity Disorders Part 2 Flashcards

1
Q

imaging for elbow

A
  1. Standard x-ray views - AP & lateral
  2. Additional views:
    - Oblique (Radiocapitellar) 45° view - Improved radial head visualization
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2
Q

interpretation of lateral view of elbow imaging

A
  1. The anterior humeral line (1-2) should bisect middle third of capitellum.
  2. The radiocapitellar line (drawn through center of radius, 3-4) should also pass through the center of the capitellum.
  3. Disruption of these relationships may indicate fracture.
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3
Q

components of elbow assessment

A
  1. ROM
    - Flexion 0-150°
    - Hyperextension 10-15° (usually kids only)
    - Supination/Pronation 80°
  2. muscle strength
    - Flexion and supination - Bicep, C5-C6, musculocutaneous nerve
    - Extension - Tricep, C7-C8
    - Pronation - Pronator teres muscles, median nerve, C6-C7
  3. ligament testing
    - valgus stress test
    - varus stress test
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4
Q

what is the valgus stress test in elbow assessment

A
  1. Tests the stability of the medial ligamentous structures, primarily the ulnar collateral ligament
  2. Hold elbow in 20° flexion with forearm in supination; apply pressure on lateral side of the elbow, attempting to open medial joint line
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5
Q

how to perform varus stress test in elbow assessment?

A
  1. Tests the stability of the lateral collateral ligament and lateral capsule
  2. Hold the elbow in 20° flexion with the forearm in supination and apply pressure on the medial side of the elbow, attempting to open the lateral joint line
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6
Q

3 fracture patterns of distal humeral fx - which are MC in general and MC in children?

A
  1. Supracondylar (MC in children) - Type A
  2. Epicondylar (medial or lateral) - Type B
  3. Intercondylar - Type C (MC)
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7
Q

complications of distal humeral fx

A
  1. Intra-articular or comminuted fractures
  2. Nerve injury - Ulnar nerve; Radial
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8
Q

presentation of ulnar and radial nerve injury from distal humeral fx

A
  1. Ulnar nerve - Sensory changes; Flexion/adduction wrist, 4th and 5th DIP joint flexion, finger abduction
  2. Radial - Sensory; wrist extension
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9
Q

presentation of distal humeral fx?
what to check in Supracondylar Fx and epicondyle fx?

A
  1. Pain, swelling, tenderness, ecchymosis and crepitus
  2. Elbow ROM limited
  3. Shortening of arm with displaced shaft fx
  4. Skin, joints/bones above and below, NV status
  5. Supracondylar Fx: radial artery, median nerve
  6. Epicondyle Fx: ulnar nerve (medial), radial nerve (lateral)
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10
Q

imaging for distal humeral fx?
findings? MC in who?

A
  1. AP and lateral elbow X-ray
    - Assess fracture details
    - Look for fat pad “sail sign” - Indicates intra-articular bleeding; May be evidence of occult fracture; MC seen in kids
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11
Q

management for supracondylar distal humeral fx

A
  1. Isolated w/o displacement or angulation - Long arm cast/splint with elbow flexed at 90°
  2. Displaced, angulated, or NV compromise: ORIF
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12
Q

management for epicondylar distal humeral fx

A
  1. Isolated, minimally displaced (< 2 mm): Long arm cast/splint with elbow at 90 °
    - Medial condyle fx - forearm pronate
    - Lateral condyle fx - forearm supinate
  2. Moderate displacement (2-4 mm): Percutaneous pinning or ORIF
  3. Severe displacement: ORIF
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13
Q

MC MOI of olecranon fx?
2nd MC?

A
  1. fall on a semi-flexed supinated forearm (avulsion)
  2. 2nd MC: direct trauma
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14
Q

Presentation of olecranon fx?

A
  1. Pain, tenderness, swelling and ecchymosis overlying olecranon process
  2. Limited ROM of elbow
  3. Deformity if associated elbow dislocation
  4. Assess distal NV status and overlying skin
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15
Q

which nerve is MC affected if NV status is compromised in olecranon fx?

A

ulnar nerve

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16
Q

imaging for olecranon fx

A
  1. AP and lateral elbow
  2. Radiocapitellar view - If unclear or complicated presentation
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17
Q

management for nondisplaced olecranon fx

A

< 1-2 mm displacement

  1. Posterior long arm splint with elbow in any degree of flexion, forearm in neutral position
  2. hand/finger ROM/strength: rubber ball x 5 min daily
  3. Repeat x-ray in 7-10 days to ensure alignment is intact
  4. Cast/splint removed after 2-3 wks
    - Start gentle ROM therapy
    - Consider PT referral (improves outcomes)
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18
Q

management for displaced (open & closed) olecranon fx

A
  1. Closed fx: splint and refer for ORIF
  2. Open fx: admit for IV abx and consult ortho
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19
Q

Contraindications for olecranon fx surgery may be present in who?
alt management?

A
  • elderly or multiple comorbid conditions
  • Tx: sling and start ROM as pain allows
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20
Q

MOI of radial head/neck fx

A

FOOSH resulting in compression of radial head into the capitellum

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21
Q

Most common fracture of the elbow?

A

Radial Head/Neck Fracture

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22
Q

classification for Radial Head/Neck Fracture?

A

Mason Classification

  • Type I - < 2 mm displacement
  • Type II - displaced > 2 mm
  • Type III - comminuted
  • Type IV - radial head fracture with associated elbow dislocation
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23
Q
  1. Pain and tenderness along the lateral aspect of elbow (overlying the radial head)
  2. Limited ROM
    - Related to pain or joint effusion
    - Painful pronation/supination
  3. +/- local swelling/ecchymosis

dx?

A

Radial Head/Neck Fracture

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24
Q

imaging for Radial Head/Neck Fracture

A
  1. AP and lateral elbow
    - Fracture line
    - Fat pad sign
  2. Capitellar (oblique) view
    - If unable to appreciate fracture on standard views
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25
Q

management for type 1 radial head/neck fx

A
  1. Sling +/- posterior splint → splint should be removed after 1-2 days
  2. AROM after 24-48 hours
    - Full extension, flexion
    - Pronation and supination with elbow flexed at 90°
  3. F/u with ortho within 1 week
  4. Aspiration if hemarthrosis is present to allow early ROM
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26
Q

Type II - III radial head/neck fx management

A
  1. Sling and splint with ortho evaluation in 2-3 days to discuss consideration of ORIF
  2. Ortho can assess for mechanical block
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27
Q

management for type IV radial head/neck fx

A

Immediate consult for reduction and ORIF

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28
Q

what is Radial Head Subluxation?
MC in what age group?

A
  • Subluxation (partial dislocation) of radial head through annular ligament due to laxity
  • Kids < 5 y/o

AKA: “Nursemaid’s elbow”

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29
Q
  • MOI: Pulling on a pronated forearm while the elbow is extended
  • Hx of mechanism followed by crying which subsides quickly
  • Arm is held semi-flexed, adducted, and pronated
  • ROM is refused - Resistance noted with attempted supination
  • Tender over radial head
  • No swelling or ecchymosis

dx? imaging?

A

radial head subluxation

imaging not needed unless sus of other injury (X-ray)

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30
Q

management for radial head subluxation

A
  1. Reduction
    - Premedicate with Tylenol or Motrin
    - 2 techniques: Supination-flexion; Hyperpronation
  2. Immediate re-assessment of NV status
  3. After 15-30 minutes
    - no improvement (full flexion and supination): reattempt reduction
    - 3-4 attempts would be acceptable
  4. Reduction less successful if 1-2 days after injury
  5. Failed reduction
    - Order radiographs
    - Splint (posterior long-arm) and refer to ortho
  6. Successful reduction
    - Tylenol/Motrin prn
    - +/- sling
    - Parent education
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31
Q

how to perform supination-flexion reduction?

A
  1. Hold the elbow with the your thumb overlying the radial head
  2. Quickly supinate fully
  3. Followed by complete flexion
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32
Q

how to perform hyperpronation reduction?

A
  1. Hold the elbow with the your thumb overlying the radial head
  2. Hyperpronate the forearm
  3. Followed by complete extension then flexion
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33
Q

EBM states that this technique is often more effective the first time and may be less painful for radial head subluxation

A

hyperpronation reduction technique

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34
Q

which epicondylitis is MC

A
  1. Lateral: wrist extensors (aka tennis elbow) - MC
  2. Medial: wrist flexors (aka golfers elbow)
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35
Q

MOI of epicondylitis?
MC in what age group?

A
  • Chronic repetitive overuse resulting in micro-trauma at tendon insertion; Acute strain due to excessive loading
  • MC between 30-50
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36
Q
  1. Pain with wrist extension and gripping
    - Shaking hands, using computer mouse, use of screwdriver, back-handed tennis swing
  2. Point tenderness 1 cm distal to epicondyle
  3. Pain with ROM against resistance (elbow extended) - wrist extension and supination

dx?

A

Lateral (Tennis Elbow) Epicondylitis

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37
Q
  1. Pain with arm pronation and wrist flexion, grip pain/weakness
    - Golf swing, overhead throwing, bowling
  2. Point tenderness 1 cm distal to epicondyle
  3. Pain with ROM against resistance (elbow extended) - wrist flexion and pronation

dx?

A

Medial (Golfer’s Elbow) Epicondylitis

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38
Q

Dx and Tx for epicondylitis

A
  1. Normal AP and lateral elbow (not needed for dx)
  2. Activity modification, NSAIDs (topical or oral), Ice after use
  3. Refer to PT if failure of conservative tx - PT after initial pain subsides
  4. Bracing - Counterforce brace
  5. Steroid injection x 3 max
  6. Refer to ortho if symptoms persist for 6 months of conservative therapy
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39
Q

Causes of olecranon bursitis

A
  1. Trauma - Fall, direct blow to elbow
  2. Inflammation
    - Excessive leaning on the elbow
    - systemic inflammatory conditions - RA, gout etc.
  3. Infection - Septic bursitis - MC staph and strep
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40
Q
  1. Gradual or sudden swelling of the bursa
    - Up to 6 cm in diameter
    - As the swelling subsides small lumps of scar tissue will remain
  2. +/- pain, tenderness, limited ROM
    - More so in trauma and infectious etiologies
    - Chronic recurrent swelling is less tender
  3. Redness and warmth in acute bursitis
A

olecranon bursitis

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41
Q

diagnostics for olecranon bursitis (2)

A
  1. Aspiration - for large, symptomatic bursa - CBC, Gram stain, C&S, Crystals
  2. AP and lateral elbow x-ray - if hx of trauma
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42
Q

management for mild olecranon bursitis w/o sepsis

A

Activity modification and NSAIDs
Use of an elbow pad, compression during acute phase

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43
Q
  • management for significant swelling olecranon bursitis w/o sepsis?
  • management if swelling persists?
A

Aspirate, apply compression bandage, and f/u in 2-7 days

  1. If fluid returns and cx are negative repeat aspiration and re-cx
    - If cx remain negative but swelling persists, aspiration and injection of 1 mL of corticosteroid into the bursal sac
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44
Q

management for Mild, with no immunosuppression, septic olecranon bursitis

A
  1. Oral Bactrim
    - Alt. cephalexin
  2. Abx therapy tailored to culture and sensitivity once available
45
Q

management for septic olecranon bursitis with severe presentation/immunocomp

A
  1. IV vancomycin
    - Add Cipro or pip-taz if associated with trauma
  2. Abx therapy tailored to culture and sensitivity once available
46
Q

presentation of severe olecranon bursitis (septic)

A
  1. Systemic toxicity (fever, hypotension, tachycardia)
  2. Rapid progression or progression 48 hours after abx
  3. Unable to tolerate oral therapy
  4. Close indwelling medical device - ex: prosthetic joint or vascular graft
47
Q

MOI of forearm fx

A
  • Direct blow
  • FOOSH
48
Q

Radial midshaft fracture associated with instability of the distal radioulnar joint (DRUJ)

which type of complicated forearm fx?

A

Galeazzi fracture

49
Q

Fracture of the proximal third of the ulnar shaft associated with dislocation of the radial head due to instability of the proximal radioulnar joint (PRUJ)

which type of complicated forearm fx?

A

Monteggia fracture

50
Q

indications for emergent ( < 1 hr) ortho referral for forearm

A
  1. arterial compromise
  2. open fx
51
Q

Indications for urgent ( < 24 hr) ortho referral for forearm fx in adults

A
  1. ulnar shaft fx with < 50% apposition or >10 degrees angulation
  2. any DRUJ or PRUJ instability
  3. peripheral nerve injury
  4. displacement
52
Q

indications for priority (24-72 hr) ortho referral for forearm fx in adults

A
  1. isolated radial shaft fx with any displacement
  2. both-bones fx, even with min or no displacement
  3. isolated proximal 3rd ulna fx
53
Q

management for Simple, isolated, fx of the ulnar shaft (middle-distal ⅓)

A

< 50% displacement, < 10% angulation before or after closed reduction and no joint involvement

  1. Long-arm posterior splint
    - Elbow at 90 degrees
    - Forearm in neutral position
    - Slight wrist extension
  2. After 1-3 wks - functional forearm brace x 4-6 wks
  3. F/u x-rays to ensure alignment at 1 wk and then q4wk until complete healing has occurred (usually 8 wks)
54
Q

management with Double sugar tong splint and refer these presentations to Ortho: (3)

A
  1. Isolated radial fractures
  2. Combined radius-ulna fracture
  3. Galeazzi or Monteggia fracture
55
Q

MC MOI of wrist fx

56
Q

common types of wrist fx
which is MC?

A
  1. Colles fx (MC) - the distal radius fracture fragment is tilted dorsally
  2. Smith’s fx - the distal radial fragment is tilted volarly
57
Q

presentation of wrist fxs?
diagnostics?

A
  1. Acute pain, tenderness, swelling
  2. Deformity of the wrist
    - Colles - “dinner fork” deformity (dorsal)
    - Smith’s - “garden spade” deformity (volar)
  3. diagnostics - wrist XR series
58
Q

management for nondisplaced or minimally displaced and non-articular wrist fx

A
  1. Sugar tong splint / short arm cast x 2-3 wks
    - Casts should not be placed until 72 hours after injury
  2. AP and lateral radiographs each week x 2 wks
59
Q

management for Displaced and open wrist fractures

60
Q

Most common carpal fx?
MC in what pt demographic?

A

scaphoid fx
young men

61
Q

for scaphoid, blood supply enters where?

A

at the distal ⅓ of the bone

62
Q

complications of scaphoid fx

A
  1. High incidence of delayed diagnosis
  2. Non-union
  3. Avascular necrosis
63
Q
  1. Wrist pain/swelling along radial aspect
  2. Tenderness along the anatomical snuff box
  3. Grip and ROM may be painful/weak/limited
A

scaphoid fx

64
Q

diagnostics for scaphoid fx

A
  1. Wrist series + Scaphoid (navicular) view
    - PA view with the wrist in ulnar deviation
  2. CT/MRI if x-rays remain negative and suspicion is high
65
Q

management for Nondisplaced scaphoid fx or negative x-rays

A
  1. Thumb spica splint/cast x 6 wks
  2. Refer to ortho
  3. Repeat x-rays in 7-14 d if initially negative
    - If negative and tenderness persists → CT/MRI
66
Q

management for displaced scaphoid fx

A
  1. ORIF
  2. Percutaneous pin placement
67
Q

Compression of which nerve that causes carpal tunnel syndrome

68
Q

RF for carpal tunnel syndrome

A
  1. Repetitive wrist movements
  2. Wrist injury
  3. Pregnancy
  4. Sedentary lifestyle
  5. Familial (idiopathic)
  6. Multiple systemic conditions
69
Q
  1. Burning, tingling pain over the median nerve distribution of the hand
    - Exacerbated by activity and at night
  2. Aching pain radiating to elbow and shoulder
  3. Physical Exam
    - Tinel’s and Phalen’s signs
    - Carpal compression test
    - The hand elevation test
    - Grip weakness
    - Thenar atrophy (late)

dx?
w/u?
management

A
  • carpal tunnel syndrome
  • EMG/NCS
  • Activity modification; Cock-up wrist splint; Corticosteroid injection; Refer for to ortho for carpal tunnel release - Failure of >3 m of conservative therapy; Objective neuro findings / thenar muscle atrophy
70
Q

metacarpal fx are MC in what pt demographic?

71
Q

Mc fx in the hand is?

A

Boxer’s fracture: Fracture of 4th and/or 5th metacarpal that results from a closed fist striking an object

72
Q

phalangeal fx are MC in what pt demographic? involving which structure?

A

children - Involving the physis of the 5th phalange

73
Q

MC phalangeal fx in adults?

A

The distal phalanx is the most commonly injured

74
Q

presentation of metacarpal/phalangeal fx?
what type of fx is MC malrotated?

A
  1. History of trauma
  2. Local tenderness, swelling, deformity and decreased ROM
    - Boxer’s fracture are most likely to be malrotated
  3. Assess distal NV status
75
Q

diagnostics for metacarpal/phalangeal fx?

A

XR hand series

76
Q

management for metacarpal neck fx w/ >30 angulation?

A

reduction
open or closed reduction followe by splint/casting

77
Q

management for metacarpal neck fx w/ < 30 angulation?

A

splint x 2-3 wks

  • 4 / 5th metacarpal = Ulnar Gutter Splint
  • 2nd and 3rd metacarpal = Radial Gutter Splint
78
Q

management for Non-displaced fractures of the 2-5th metacarpal/phalangeal shaft

A

Splint for 3-4 weeks

  • Metacarpal - gutter splint
  • Phalangeal fracture - buddy tape or aluminum splint
79
Q

management for Non-displaced 1st metacarpal/phalangeal fx

A

Thumb-spica splint, wrist in 30 degrees of extension

80
Q

management for Non-displaced/non-articular 1st metacarpal base

A

Thumb spica splint/cast x 4 wks

81
Q

management for Displaced/angulated metacarpal/phalangeal shaft fracture or intra-articular fractures

A
  • Refer/consult ortho for further evaluation
  • Closed vs open reduction and fixation
82
Q

cause/MOI of gamekeeper’s thumb

A
  • Rupture of the ulnar collateral ligament of the 1st MCP joint
  • Forced radial abduction
83
Q

presentation of gamekeeper’s thumb

A
  1. Pain, swelling and tenderness along the medial 1st MCP joint
  2. Weak pincer function
  3. Stress testing after local anesthesia
84
Q

diagnostics and tx for gamekeeper’s thumb

A
  • 1st phalange finger series
  • Thumb spica splint; Refer to ortho for surgical repair
85
Q

cause/MOI of mallet finger

A
  • A rupture, laceration, or avulsion of the extensor tendon at the distal phalanx
  • Hyperflexion of DIP
86
Q

presentation of mallet finger

A
  • DIP is flexed at 40° with the inability to actively extend
  • PROM is intact
  • Mild tenderness over dorsal DIP
  • May be associated with an avulsion fx of the distal phalanx
87
Q

diagnostics and tx for mallet finger?
How long?
complication if not tx properly?

A
  1. finger series - r/o avulsion fx
  2. finger splint
    - DIP in full extension x 4-8wks
    - cannot be removed
  3. swan neck deformity - hyperextension of PIP w/ flexion of DIP
88
Q

cause/MOI of boutonniere deformity

A
  • Rupture of the central slip of the extensor tendon where it inserts on the middle phalanx
  • Forced flexion of the PIP
89
Q
  1. Deformity: Finger is held partially flexed at the PIP and extended or hyperextended at the DIP
    - May not be as noticeable due to swelling
  2. Swelling, pain, point tenderness along the dorsal PIP
  3. Limited ROM - Inability to fully extend the PIP - remains flexed at 30°

dx?
w/u?
tx?
When to refer?

A

Boutonniere Deformity

  1. Finger series to r/o avulsion fx
  2. Splint PIP in extension leaving DIP free x 4-8 wks; Refer to ortho if: If conservative therapy fails, Associated irreducible PIP dislocation, or Associated open fx
90
Q

Inflammation of the tendon sheath covering the extensor/abductor tendons of the thumb
Overuse syndrome

dx?

A

De Quervain Tenosynovitis

91
Q
  1. Aching pain and point tenderness along the radial aspect of the wrist with use
  2. Pain may radiate up arm
  3. Thickened 1st dorsal compartment, creating a prominence at the radial styloid
  4. Finkelstein test is diagnostic - Ulnar deviation of an adducted thumb reproduces pain

dx?
tx?

A

De Quervain Tenosynovitis

  1. Thumb spica splint
  2. Activity modification
  3. NSAID’s
  4. Refer to ortho if conservative therapy fails
    - Corticosteroid injections into tendon sheath
    - Surgical release of the first dorsal compartment
92
Q
  • A fluid-filled swelling overlying a joint or tendon sheath - Filled with clear, gelatinous, sticky, or mucoid fluid
  • MC location - dorsal aspect of wrist
  • MC in females ages 10-40
  • Thought to occur as a result of mucoid degeneration of periarticular structures

dx?

A

Ganglion Cyst

93
Q

Localized intermittent pain/tenderness
Cyst is firm, smooth, rounded, rubbery
May fluctuate in size over time
Transillumination will help differentiate cyst from solid lesion

dx?
w/u?
management?

A

Ganglion Cyst

1.X-ray - R/o bony pathology; US/MRI if atypical presentation
2. Observation - MC spontaneously regress; Aspiration +/- injection of a corticosteroid; Surgical removal

94
Q

An idiopathic dysfunction of the flexor tendon of the finger as is glides through the tendon sheath
Often due to a discrepancy in the size of the tendon and is sheath

dx?
which fingers are MC affected?

A

trigger finger
3rd and 4th

95
Q
  1. Catching, snapping or locking of the involved finger(s)
    - Often worse upon awakening
    - More than one finger may be affected
  2. Associated with pain and dysfunction
  3. Painful nodule on the palm

dx?
management?

A

trigger finger

  1. NSAIDs, +/- corticosteroid injection into the tendon sheath
    - If persist: 2nd injection in 3-4 wks
  2. Failure of conservative therapy (including two injections) → surgical release
96
Q

Patients with what other condition are at increased risk for tendon rupture and should only have one corticosteroid injection when treating Trigger finger

97
Q
  • A progressive fibrosis of the palmar fascia
  • MC - men > 50 yrs old

dx?
which structure is MC affected?

A
  • dupuytren contracture
  • 4th phalange
98
Q

RF for Dupuytren Contracture

A
  1. Epilepsy
  2. DM
  3. pulmonary disease
  4. alcoholism
  5. smoking
  6. repetitive vibrational trauma
99
Q
  • One or more painless nodules near the distal palmar crease
  • The nodules gradually thicken leading to a cord that contracts
  • ROM - Flexion is normal, but extension is limited

dx?
w/u?
tx?

A
  • Dupuytren Contracture
  • clinical dx
  • Management:
  1. Night splinting - not curative, but may slow the progression
  2. Surgery release
    - Indicated if 30° fixed flexion of the MCP
    - Involves excising thickened soft-tissue bands and release of joint contractures
100
Q

MOI of brachial plexus syndrome

A
  1. Traction force - the shoulder is forcefully depressed & the head / neck are tilted toward the opposite side
    - Damages C5, C6, and C7 roots
  2. Direct blow to the top of the shoulder
    - Damages C5, C6, and C7 roots
  3. Stretching of the plexus when the arm is abducted forcefully
    - Grabbing something while falling
    - Damages C8 and T1 roots
101
Q

presentation of brachial plexus syndrome

A
  1. Sharp, burning shoulder pain with radiculopathy in the affected nerve root distribution
  2. Weakness is common
  3. Evaluate sensation to light touch, motor function, & DTRs
  4. Any injuries to C8-T1 may be associated with Horner’s syndrome
  5. Assess lower extremities for spinal cord involvement
  6. Look for associated injuries
102
Q

diagnostics for brachial plexus syndrome

A
  1. X-Rays - C-spine and shoulder to look for associated injuries
  2. CT C-spine - r/o C-spine fx if x-ray abnml
  3. MRI - Best for visualizing the spinal cord and nerve roots
    - Indicated if: x-rays abnml or sx persists
  4. EMG/NCS - May help differentiate specific location of nerve dysfunction
103
Q

management for brachial plexus syndrome?
Pt ed for athletes?

A
  1. conservative
    - Strengthening and stretching exercises
    - Splinting in neutral position of any joints affected by paralyzed muscles
    - Encourage PROM to reduce joint stiffness or tendon constrictures
  2. Athletes must have complete resolution of sx and normal PE before allowed to return to activity
104
Q

5 Structures of the Thoracic Outlet

A
  1. First rib
  2. Subclavian artery and vein
  3. Brachial plexus
  4. Clavicle
  5. Lung apex
105
Q
  • Compression of the brachial plexus and/or subclavian vessels as they exit the narrow space between the superior shoulder girdle and the 1st rib
  • Most commonly affects women 20-50 y/o
A

Thoracic Outlet Syndrome

106
Q
  1. Aching pain/paresthesia
  2. Intermittent swelling & discoloration
  3. Fatigue, weakness, and aching pain of extremity
  4. exacerbated by lifting the arm above the head
  5. Palpate supraclavicular fossa to assess for a mass
  6. Palpate for distal UE pulses
  7. Check sensation & motor function cervical nerve roots
  8. (+) Elevated arm stress test

dx?

A

Thoracic Outlet Syndrome

107
Q

how to perform elevated arm stress test?

A
  • Both shoulders abducted at least 90 degrees and supported posteriorly. The patient opens & closes fists at a moderate speed for 3 minutes.
  • POSITIVE test if reproduced neuro &/or vascular s/s
108
Q

diagnostics for thoracic outlet syndrome

A
  1. X-Ray
    - AP & lateral C-spine - r/o congenital anomalies
    - PA/lateral CXR - r/o apical lung tumors
  2. MRI - r/o cervical disc rupture or cervical spondylosis
109
Q

management for thoracic outlet syndrome

A
  1. MC tx non-surgically
    - 3-6 m home exercise programs
    - Emphasize muscle strengthening & posture exercises
  2. Avoid strenuous activities, placing straps over shoulders, and any activity that exacerbates symptoms
  3. NSAIDs, muscle relaxers, TENS unit

Clin Med III: MSK (14 decks)

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