Upper Extremity Injuries Flashcards

1
Q

WHat are the 3 mechanisms of fracture

A

acute-from sudden impact of large force exceeding strength of the bone

stress- from repetitive submaximal stresses

pathologic-from normal forces to diseased bone

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2
Q

what is the difference in history between an actue and chronic fracture?

A
  • acute-sudden blow
    • chronic-
      • repetitive activity
      • increase in activity duration, intensity or frequency
      • pahtologic bone
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3
Q

what 3 things would be found on physical exam if there is a bony fracture?

A
  • deformity
    • bleeding=suspect open fracture=orthopaedic emergency=needs to be surgicaly washed out ASAP
  • bony point tenderness
  • bone pain with loading
    • indirect loading especially useful
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4
Q

what are the 4 indirect loading tests?

A

axial loading

bump test

fulcrum test

hop test

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5
Q

what 4 imaging methods could be used to diagnose . fracture?

A

plain x-rays

CT scan

bone scan

MRI

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6
Q

how do we treat fractures?

A

generally immobilization

avoid NSAIDs (some animal studies and moedls show NSAID interfer with bony healing via PGs, however acetaminophen is okay)

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7
Q

what are the bones of the hand with “vulnerable” blood supply? aka which ones are you worried about after a fall on an outstreached hand

A
  • watershed region
    • central (tarsal) navicular
  • retregrade flow
    • scaphoid talus
    • femoral head

** the proximal peices of bone are more susceptible to ischemic necrosis bc the flor goes from distal to proximal. therefore distal is more likely to still be getting blood flow (bc it gets blood first possibly before blockage) **see image

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8
Q

what would you do to treat if someone fell on an outstreched hand? what can you do to check for a snuff box fracture?

A

cast them

you can have them extend their tumb, and then you push on the snuff box. if there is a fracture it will hurt.

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9
Q

what are the contents of the snuffbox?

A

radial nerve

cephalic vein

radial artery

scaphoid bone

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10
Q

What should you be nervous about if you see this radiograph? what would make this fracture more likely to be a non-union fracture (aka poor healing)?

A

ischemic necrosis! this is a scaphois fracture? tobacco use

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11
Q

Please define the following words associated with musculotendinous injuries. <3

Ethesopathy

Tendinitis

Tendinosis

A
  • Ethesopathy- disorder of muscular or tendinous bondy attachment
  • Tendinitis- technically acute inflammation of tendon
    • traumatic blow or pull
    • note: achilles tendinitis is actually caused due to chronic stress (running) so it is technically a tendinosis, but everyne including the literature calls it tendinitis
  • Tendinosis- chronic degenerative condition of tendon
    • chronic- submaximal repetitive irritation
  • many injuries may be acute or chronic!
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12
Q

Extensors attach to the _____ epicondyle

Flexors attach to the _______ epicondyle

A

extensors attach to lateral epicondyle

flexors attach to the medial epicondyle

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13
Q

What are enthesopathies?

A
  • disorder involving ligamentous or tendinous attachment to bone
  • epicondylitis
  • shin splits
  • pain with stressing structures and to palpation
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14
Q

What is delayed onset of muscle soreness (DOMS)? On the cellular level what causes this?

A
  • 24-72 hours after unaccustomed physical activity that usualyl lasts 5-7 days
  • weakness, tenderness and elevated muscle enzymes
  • disruption of sarcolemma results in influx of intracellular Ca which causes a proteolytic enzyme mediated myoprotein degradation
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15
Q

What type of contraction give the most force and it therefore th most likely to cause strain?

A

eccentric (extension) for example quadriceps when you land jumping

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16
Q

what is strain? what symptoms are assocaited with it?

A
  • muscle fiber damage from overstretching (eccentric loading which is muscle lengthening during firing)
  • symptoms:
    • stiffness
    • bruising
    • swelling
    • soreness
    • weakness (with more severe injury)
17
Q

what are the 3 impingemnet tests?

A
  • empty can testing/ “Jobe”- hold arm in flexed position (with arm protaneted like you are dumping a can of pop) while you push downward
  • Hawkins test-stabilize elbow and have them push up against hard
  • Neers test-swing arm over head
18
Q

what 4 muscles are associated with rotator cuff tear?

A

(SITS)

supraspinatus

infraspinatus

teres minor

subscapularis

19
Q

WHat does a rotator cuff tear look like on imaging?

A
  • if the humoral head is touching the acromion then you must have a full tear bc there is no room for the rotator cuff muscles to sit
  • alo on an MRI you can see the supraspinatus sitting right on top of the humerus, when it should really be more lateral (pulled over humerus)
20
Q

What is the common etiology of an Acromioclavicular sprain (AC)? How does it present? what would you see on exam?

A
  • Etiology- most commonly fall directly onto shoulder
  • Presentation- pain with overhead motions, deformity of superior shoulder
  • Exam- pain and deformity at AC joint
  • pain with cross body adduction of arm (positive cross-chest test)
  • painful arc of abdcution over 150 degrees
21
Q
A
22
Q

How are AC injuries graded? how is the apparent on imaging?

A

Grade I- AC ligament injury (normal even with weights)

Grade II- AC ligament tear and coracoclavicular (CC) ligament stretch (relatively normal without weights, and clavicle elevated with weights)

Grade III-complete tears of both AC and CC (clavicle is sticking up even without weights)

23
Q

What is a sprain? what are the associated symptoms? and how do we classify them?

A
  • ligamentous damage from overloading
  • symptoms:
    • instability or laxity
    • swelling
  • Classify:
    • grade I-microscopic damage
      • no increased laxity but pain with stress
    • grade II- partial tear
      • increased laxity and pain
    • grade III-complete tear
      • significant laxity
24
Q

what is an effusion? what is a bursa? what are common locations of these?

A
  • Effusion- excessive fluid in joint
  • Bursa- synovial lined sac that contains fluid and acts to reduce friction between structures
  • common locations: achilles, olecranon, subacromial, prepatellar and other knee locations
25
Q

what is a ganglion and what is a common location?

A
  • fluid filled soft tissue mass filled with collection of synovial or peritendinous fluid that arises from a joint or tendon sheath (usually in the wrist)
  • common location: wrist
26
Q

how can you distinguish between effusions and bursitis and ganglion? describe common features, and location.

A
  • effusion
    • uniform and diffuse around a joint
    • does not move independently (non-mobile) since its “attached” to joint
  • bursitis
    • localized, mobile
    • small or large
    • located throughout body
    • usually feeel squishable aka when you push on it it indents
  • ganglion
    • usually small (less than 2 cm)
    • usually near joints
    • usually fairly tense (feel like marbles)
27
Q

what kind of injury are strains? when is there pain? is there weakness? what happens when there is a complete rupture

A
  • musculotendinous injury
  • pain with active ROM-especially resisted motions
    • weakness with increasing severity
  • with complete rupture
    • major muscle with “no” secondary muscles-need surgery or immobilization for healing
28
Q

what kind of injury are sprains? how do they present/what is seen on exam?

A

ligament injury

instability

laxity on exam

29
Q

what is seen with a fracture?

A

localized bony tenderness

pain loading of bone

30
Q

what is seen with a dislocation?

A

deformity (if unreduced)

loss of range of motion (ROM)

apprehension