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Upper Extremity Injuries Flashcards

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1
Q

What types of GLENOID FRACTURES would require surgical fixation?

A
  • if >20% of anterior rim involved

- if unstable neck

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2
Q

CORACOID FRACTURES typically occur with what other pathology? Are they treated SURGICALLY or CONSERVATIVE?

A
  • AC joint trauma

- CONSERVATIVE ~76% of the time

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3
Q

What is the typical MOI for HILL SACH’S LESION?

A
  • Anterior shoulder dislocation (humeral abuts up against glenoid)
  • 100% occurrence in those with recurrent shoulder instability
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4
Q

How should CLAVICLE FRACTURE be managed in the early stage of injury?

A
  • Splint/Sling

- Assess NEUROVASCULAR status

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5
Q

What is the typical TIMEFRAME for bone healing post fracture?

A
  • 6-8 weeks

* can vary based on age, complexity

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6
Q

Regarding instability: DIFFERENTIATE b/t glenohumeral joint LAXITY due to injury and glenohumeral joint HYPERMOBILITY?

A
  • LAXITY = is due to injury (with symptoms) and not considered a true instability
  • HYPERMOBILITY = congenital
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7
Q

What constitutes multi-directional INSTABILITY of the shoulder?

A
  • must have side to side glenohumeral laxity in MORE THAN ONE quadrant
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8
Q

Why do athletes with shoulder instability injuries often present with ROM deficits?

A
  • likely due to HYPERACTIVITY of muscles
  • also seen with: decreased ability to control humeral translation in glenoid OR inability to maintain congruency b/t glenoid and humeral head
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9
Q

In athletic population, what are the primary factors that contribute to ROTATOR CUFF disease?

A
  • RTC dysfunction or weakness (especially the EXTERNAL ROTATORS) and associated ROM deficits
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10
Q

What is the difference in treatment for RTC tears between ATHLETES and the GENERAL POPULATION?

A
  • Athletes need SURGERY = high demands of sport (conservative will fail)
  • General pop’n = CONSERVATIVE
  • if during season - may try rehab and then surgery at end of season
  • Difficult to return to prior levels
  • Re-tear rates HIGH (11-94%) - depends on size and location
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11
Q

What is the ACUTE management of a BRACHIAL PLEXUS injury (stinger, burner)?

A
  • *CLEAR c-spine first
  • assess dermatomes and myotomes
  • Can RTP when strength and sensation are RECOVERED and SYMMETRICAL
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12
Q

What are the signs and symptoms of THORACIC OUTLET SYNDROME?

A

Arm and hand:

  • numbness and tingling
  • decreased sensation (of fingers)
  • muscle weakness
  • swelling
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13
Q

What is PAGET-SCHROETTER SYNDROME?

A
  • aka EFFORT THROMBOSIS
  • THROMBOSIS of axillary-subclavian vein

*may be initially diagnosed as TOS

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14
Q

What is the UE Closed Kinetic Chain Test?

A
  • used for RTP testing
  • pushup position (hands 3 feet apart)
  • alternate touching hands for 15 seconds
  • do 3 trials (rest 45 seconds between)

*Norm values = 21 men, 23 women

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15
Q

What is the Upper Quarter Y-balance test used for?

A
  • UE RTP testing

- calculate limb symmetry (want less than 10% or less difference between sides)

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16
Q

What does the Seated Shotput Test measure?

A
  • Unilateral strength and power (open chain test for possible RTP testing)
  • Shot put of 6 lbs weight
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17
Q

What are the PRIMARY stabilizers of the elbow?

A
  • ulno-trochlear articulation, MCL, LCL complexes
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18
Q

What are the SECONDARY stabilizers of the elbow?

A
  • radial head, capsule, common flexor and extensor muscle origins
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19
Q

Which part of the elbow MCL complex is the primary restraint of valgus force?

A
  • Anterior band/bundle
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20
Q

Which part of the elbow MCL complex is the primary restraint of pronation of ulna on humerus?

A
  • Posterior band/bundle
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21
Q

Which muscle is indicated in ~50% of cases of LATERAL EPICONDYLOSIS?

A
  • Anterior portion of Extensor digitorum (extensor digitorum communis)
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22
Q

How does TENDINOSIS differ from TENDONITIS?

A
  • Tendinosis is degenerative

- see collagen disruption, mucoid degeneration, angiofibroblastic proliferation

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23
Q

What pathology needs to be ruled out with suspected LATERAL EPICONDYLOSIS?

A
  • radial nerve entrapment/compession at elbow
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24
Q

What types of athletes is Medial Epicondylosis common in? Which muscles are most commonly associated with this condition?

A
  • overhead throwing athlete
  • flexor carpi radialis, pronator teres (flex and pronate forearm - with follow through)
  • ALSO, constant valgus force = can lead to tearing
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25
Q

What is the cause of MEDIAL CONDYLE APOPHYSITIS/LITTLE LEAGUER’S ELBOW? What can it progress to?

A
  • VALGUS stress from UCL and flexor-pronator mass tension on medial epicondyle
  • AVULSION fracture (can also be from acute episode)
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26
Q

What are key SIGNS AND SYMPTOMS of MEDIAL EPICONDYLE APOPHYSITIS/LITTLE LEAGUER’S ELBOW?

A
  • insidious onset of pain with history of chronic overuse throwing
  • pain and loss of velocity with throwing
  • point tenderness, swelling

*possible mild loss in elbow ext ROM

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27
Q

What are key SIGNS AND SYMPTOMS of MEDIAL EPICONDYLE AVULSION FRACTURE?

A
  • unable to throw due to pain
  • pain with late cocking, acceleration phases
  • difficulty with elbow extension
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28
Q

What is the TREATMENT for MEDIAL EPICONDYLE APOPHYSITIS/LITTLE LEAGUER’S ELBOW?

A
  • 4-6 weeks rest (from pitching)
  • change positions BUT shut down if pain with playing
  • Normalize ROM and strength
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29
Q

What is the TREATMENT for MEDIAL EPICONDYLAR AVULSION fracture?

A
  • MINIMAL DISPLACEMENT = immobilize shortly; ROM and strength at 2-3 weeks; start throwing if -> pain-free, normal strength/ROM, -ve radiographs
  • LARGE DISPLACEMENT or NON-UNION = surgery (4-6 months until RTP)
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30
Q

How should you treat DISTAL BICEPS TENDON TEAR, RUPTURE ?

A
  • Need SURGERY within 2 weeks to prevent RETRACTION and SCARRING of muscle
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31
Q

What is the typical MOI for POSTERIOR OLECRANON IMPINGEMENT?

A
  • due to VALGUS stress overload, common with OVERHEAD throwing athletes
  • BALL RELEASE = elbow extends –> medial osteophytes impinge with fossa
  • with LAX UCL = stress gets transferred to posterior medial olecranon
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32
Q

What are the conservative TREATMENT options for POSTERIOR OLECRANON IMPINGEMENT?

A
  • Emphasis on ECCENTRIC control of FLEXOR-PRONATORs, shoulder ROM, and dynamic stability during pitching motion
  • RESECTION of osteophytes if conservative tx fails
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33
Q

What are the two MOIs for olecranon stress fracture?

A
  • Repetitive microtrauma from olecranon impingement (oblique fx from valgus overload)
  • Excessive tensile stress from triceps OR extension force (transverse Fx)
34
Q

How is OLECRANON STRESS FRACTURE treated?

A

Conservative = rest, brace/splint, gradual return to throwing

Surgery possible for = osteophytes, loose bodies, chondral damage

35
Q

What is PANNER’s DISEASE? Who does it affect most?

A
  • Osteochondritis of humeral capitellum due to excessive, continued lateral compression (with valgus stress medially)
  • Affects BOYS> girls; 4-9 y/o
36
Q

What are the signs and symptoms of PANNERS DISEASE? How is it treated?

A
  • weeks of pain and stiffness in elbow; worse with activity and valgus stress
  • TX = avoid provoking activities, work on strength and ROM impairments
  • most heal without morbidity
37
Q

What is the TERRIBLE TRIAD of the elbow?

A
  • Ulnohumeral dislocation
  • Coronoid fracture
  • ligament compromise
38
Q

What is the MOI for radial head fracture?

A

FOOSH in pronated position

39
Q

What is the secondary restraint to VALGUS force at the elbow? The

A
  • Radial head

- important for stability with UCL injuries

40
Q

What are the treatment options for RADIAL HEAD FRACTURE?

A
  • use Mason Classification - treatment based on type (4 types of fractures)
  • can be treated conservatively
  • surgery can include: ORIF, excision, or replacement (of radial head)
41
Q

What is the MOI for supracondylar humerus fracture? Who is it most common in?

A
  • FOOSH with elbow extended

- most common elbow fracture in kids

42
Q

How is a SUPRACONDYLAR HUMERAL FRACTURE treated? What is a common concern with this injury in kids?

A
  • depends on severity
  • Garland 1 and 2 classification = conservative (casting); 2 may require surgery if deformity noted (rotation, angled)
  • Garland 3 = surgery ORIF, or closed reduction

*concern in kids = PHYSIS injury (SALTER HARRIS - 4 and 5 poorest prognoses)

43
Q

What is a common MOI in sports for UCL injury?

A
  • throwing - repetitive microtrauma (late cocking, early acceleration)
44
Q

What are the primary stabilizers against valgus force of the elbow? Secondary?

A
  • Primary = anterior band of UCL- tightens <90 deg flex (radial head, ant capsule, flexor muscle group)
  • Secondary = posterior band of UCL - tightens >90 deg flex
45
Q

What is an injury that must be considered with UCL pathology?

A
  • ulnar nerve pathology
  • courses around medial epicondyle
  • traction forces over time can lead to damage
46
Q

What are the signs of UCL ligament pathology? How is it diagnosed?

A
  • vague elbow pain
  • decreased velocity and control over time
  • ulnar symptoms (N&T in 4-5 digits)
  • positive valgus load, milking sign

*MRA more accurate for diagnosis versus MRI

47
Q

What are treatment options for UCL tears?

A
  • PRP may benefit partial tears (~88% RTP and dec valgus laxity)
  • large percentage will require surgery (Docking technique common; internal bracing augments repair and allows for earlier RTP)
48
Q

What are post operative considerations for REHAB following UCL repairs?

A
  • hinge brace to limit full extension initially
  • interval throwing program ~4 months
  • throwing from mound ~ 6 months
  • RTP ~ 10-18 months
  • revision UCL has less predictable rate of return
49
Q

What is CUBITAL TUNNEL SYNDROME? What is the MOI?

A
  • Entrapment of ULNAR NERVE in cubital tunnel (medial epicondyle with retinacular roof)
  • Commonly due to excessive COMPRESSION or TRACTION with sport (baseball, football, wrestling
  • Can be due to: post-med osteophytes, loose bodies, soft tissue mass
50
Q

What are some Special Tests for diagnosing CUBITAL TUNNEL SYNDROME?

A
  • Wartenburg sign = inability to adduct 5th finger
  • Tinnel’s Sign - maintain elbow in flexed position to close cubital tunnel
  • if severe = intrinsic weakness with resulting clawing of 4th and 5th digit
51
Q

What are some TREATMENTS for CUBITAL TUNNEL SYNDROME?

A
  • AVOID repetitive movement OR sustained postures that COMPRESS (direct pressure) or TRACTION (full flexion) the nerve
  • NIGHT splint
  • NEURAL mobilizations
52
Q

Which UE nerve entrapment around the elbow is purely sensory?

A

RADIAL TUNNEL SYNDROME (entrapment of radial sensory nerve)

  • close to lateral epicondyle (differential diagnosis for lateral epicondylosis)
53
Q

What is POSTERIOR INTERROSEUS NERVE SYNDROME? What are the signs and symptoms?

A
  • Compression of the nerve at the Arcade of Frohse (supinator arch)
  • Pain with RESISTED wrist and finger extension
  • Possible lack of full thumb extension
54
Q

What is PRONATOR SYNDROME? What are other potential sites of compression?

A
  • MEDIAN NERVE COMPRESSION through one of:
  • Pronator Teres
  • proximal Flexor digitorum superficialis
  • Ligament of Struthers
  • bicipital aponeurosis
55
Q

What are the signs and symptoms of PRONATOR SYNDROME?

A
  • PARESTHESIA in digits 1-4 (1/2 of ring finger
  • DISCOMFORT/PAIN proximal forearm
  • DISCOMFORT pronation and supination
  • PAIN resisted pronation = entrapment at PRONATOR TERES
  • PAIN resisted middle finger flexion = compression at FIBROUS ARCH
56
Q

Why is it important to manage wrist and hand injuries early?

A
  • TO MINIMIZE LONG TERM ISSUES
57
Q

How do you treat a suspected SCAPHOID FRACTURE acutely?

Why is there greater urgency for surgical intervention?

A
  • IMMOBILIZE and remove from play
  • ICE (for pain)
  • REFER for imaging

*Risk of non-union, collapse of bone

58
Q

What are the two areas of the SCAPHOID that fracture?

A
  • WAIST (TTP at anatomical snuffbox)

- PROXIMAL POLE (TTP at distal radius over scapho-lunate joint)

59
Q

What are the RTP guidelines s/p SCAPHOID fracture treated CONSERVATIVELY and SURGICALLY?

A
  • NONDISPLACED conservative tx = 12-15 weeks
  • SURGERY = 8-12 weeks

REHAB starts @ 6 weeks

  • may be able to return earlier with cast (thumb spica) if allowed
  • will have serial imaging to monitor healing
60
Q

The HOOK OF THE HAMATE is the distal aspect of what structure? What does this structure contain?

A
  • GUYON’S CANAL

- contains ulnar nerve and artery

61
Q

How does a HOOK OF HAMATE FRACTURE occur? What is a complication with this diagnosis?

A
  • MOI = Direct trauma (fall onto palm OR repetitive stressors (gripping club, bat)
  • Risk of NON-UNION (due to poor anastomosis between 2 blood supplies)
62
Q

What are signs of a HOOK OF HAMATE fracture?

A
  • PAIN and tenderness over hypothenar eminence
  • PAIN with gripping and/or movement of 4,5th digits
  • screen for neuro vascular compromise (ulnar n and a)
63
Q

How are suspected hand fractures (scaphoid, hook of hamate, 5th metacarpal), scapholunate dissociation managed ACUTELY?

A
  • IMMOBILIZE and remove from play
  • ICE for pain
  • REFER for imaging
64
Q

What are the TREATMENT options for HOOK OF HAMATE fracture?

A
  • SURGERY (excision of bone) - RTP = 6-8 weeks

- SHORT ARM CAST (including 4 and 5 fingers) for up to 6 weeks

65
Q

What different types of deformity might you see with a Boxer’s fracture?

A
  • VOLAR deformity

- VOLAR and under 4th digit

66
Q

What are the different types of MOI for BOXER’S FRACTURE?

A
  • Punch
  • Direct trauma/blow
  • Fall onto lateral hand
67
Q

How is BOXER’S FRACTURE managed?

A
  • SPLINT/CAST 3-4 weeks (no activity)
  • PROM to AROM and tendon gliding (after cast removed)
  • STRENGTHEN, GRIPPING @ 6 weeks
68
Q

What is the function of the Triangular Fibrocartilage Complex?

A

Rotation, Stability, Transmission of loads through ULNOCARPAL and DISTAL RADIOULNAR joints

69
Q

What is the MOI for TFCC injury? What are the signs and symptoms of injury to this structure?

A
  • FOOSH (wrist extended, pronated with axial load) = similar to MOI for scaphoid fracture
  • Pain (ulnar sided wrist)
  • Painful and weak - grip, ulnar dev, wrist flex
  • Pain with ROM - flex, ext, uln dev

*Assess scaphoid fracture first!

70
Q

How do you ACUTELY manage a TFCC injury?

A
  • STABILIZE IMMEDIATELY (avoid radial and ulnar deviation)
  • Use rigid brace/splint if allowed by sport (otherwise, if MILD = tape) to RTP
  • if stability and strength acceptable = RTP
71
Q

How is a TFCC Injury treated?

A
  • CONSERVATIVE (steroid injection may help decrease pain and increase function short term)

OR

  • SURGERY - immobilize 6 weeks; RTP ~3-4 months
72
Q

What is Stener’s Lesion?

A
  • AVULSION fracture at proximal attachment (1st metacarpal) of Thumb UCL from valgus force
  • EXAMINE FOR SUBSTANTIAL MASS - if present, DON’T VALGUS STRESS THUMB

*If present = REFER FOR RADIOGRAPHS

73
Q

At what angle should you test for VALGUS LAXITY with suspected Thumb UCL sprain? Why?

A
  • @ 30 deg flexion
  • Anatomy = ligament is taut in flexion, loose in extension (origin dorsal side of 1st metacarpal; inserts solar side of 1st phalange)
74
Q

How should a Thumb UCL tear be managed? Acutely? Partial Tear? Complete Tear?

A
  • ACUTE = can RTP immediately if immobilized (with normal functioning hand)
  • PARTIAL tear = immobilize with short arm thumb spica for several weeks; rehab after pain and swelling resolve; pinching and thumb adduction rehab last
  • COMPLETE tear = surgery; immobilize; rehab; RTP ~4 months
75
Q

Which tendon is affected in a MALLET FINGER diagnosis?

A
  • Extensor Digitorum Communis

* middle finger most common

76
Q

What signs of fracture would warrant referral with suspected MALLET FINGER?

A
  • blood under the nail
77
Q

How long should a MALLET FINGER diagnosis be immobilized?

A
  • up to 8 weeks
  • SHOULD continue to immobilize for months after ward (at 12 weeks = still effective)
  • MAY NOT fully heal (up to 10 degree extension lag)
78
Q

What muscle(s) are affected with a suspected JERSEY FINGER diagnosis?

A
  • flexor digitorum profundus (most common)

- flexor digitorum superficialis

79
Q

What injury may include a popping sensation in the palm of the hand followed by loss of AROM into flexion at the IP and/or DIP of the digit?

A
  • Jersey Finger

* may show muscle deformity with rupture and retraction

80
Q

What are the MANAGEMENT consideration for Jersey Finger? Acute

A
  • ACUTE = remove from game, splint, refer to physician (can RTP with splint or buddy tape)
  • CONSERVATIVE = long term splinting (similar to Mallet finger treatment)
  • SURGERY = requires 12-16 weeks healing; early PROM important (to prevent SCARRING and deformity); DON’T lift, carry or grasp first 6-8 weeks; want full grip strength and full extension ROM

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