Upper Extremity Emergencies -- SD Flashcards
True or false
Clavicle fractures typically occur in the proximal 1/3?
False
Distal 1/3
What is important to look for on exam when a patient has a clavicle fracture?
Tenting – can convert to an open fracture
How do we treat a clavicle fracture?
Sling and ortho referral in a few weeks
A posterior fracture of the clavicle may result in?
Punctured lung – apex of the lung
Patient presents with a low hanging shoulder – whatcha thinking?
AC separation
How do we treat AC separations?
Put them in a sling and they should heal on their own – more severe grades may require surgery
Humeral head fractures are common in what populations?
Elderly, osteoporotic
How do most humeral head fractures occur?
Fall with arm locked which drives the humeral head straight up into the glenoid
How do we treat shoulder fractures?
Sling, refer to ortho – not much we can do for them
Shoulders most commonly dislocate anteriorly or posteriorly?
Anteriorly
Common cause of shoulder dislocations?
FOOSH
what are the causes of a posterior shoulder dislocation?
Epilepsy, electrocution, EtOH
Why do we need a lateral view x-ray when looking at shoulder dislocations?
Need to know where you are in space! otherwise can’t tell if its posterior or anterior
What actions do we take once a shoulder has been reduced?
Post-reduction films (if first dislocation or trauma)
Make sure they are neurovascularly intact!
Shoulder immobilization
Ortho follow-up
Limited ROM of shoulder is key to diagnosis
Rotator cuff
How do we treat rotator cuff tears in the ED setting?
Sling
Do elbows most commonly dislocate anteriorly or posteriorly?
Posteriorly
Which is elbow fracture is bad?
Supercondylar
Why are supercondylar fractures more serious?
They are prone to malalignment problems – should always refer to ortho
Do we always see an anterior or posterior fat pad?
Anterior
Posterior fat pad on x-ray is pathologic for?
fracture
What is a sail sign on x-ray of an elbow?
It describes the elevation of the anterior fat pad
Whenever we find a fracture in a two bone structure – what else must we do?
Look higher! Energy can move up and create another fracture
What is the classic wrist fracture?
Distal radius +/- ulnar styloid
How are we going to rule out a scaphoid fracture?
Palpate the anatomical snuff box
What type of splint do we put most wrist fractures in?
Volar splint
What kind of splint do we use for scaphoid fractures of even suspected scaphoid fractures?
Thumb spica splint
What test do we use to diagnose DeQuervian’s tenosynovitis?
Finkelstein’s (ulnar deviation)
What people are at risk for developing DeQuervian’s?
Carpenters – repetitive hammering type motion
What two signs can we do for suspected carpal tunnel syndrome?
Tinnel’s and Phalen’s
What can we do to treat carpal tunnel?
Splint at night and when working – can do a release
Are fingers easy to dislocate and reduce?
Yup
What do we call it when your thumb goes backward and you tear the medial collateral ligament?
gamekeeper’s thumb
