Upper extremity injury

Question 1

what is most effective passive stabilize of shoulder joint?

Answer 1

• vacuum phenomena of bone in socket
• labrum also very important

Question 2

why avoid NSAIDs in treating fracture?

Answer 2

NSAIDs interere with bony healing via PGs. PGs contribute to bone healing.

Question 2

shoulder dislocation:

-what nerves are vulnerable? what to look for?

Answer 2

• Axillary and musculocutaenous nerves are vulnerable.
• check deltoid function with arm abduction–first 30 degrees is supraspinatus, then deltoid
• check sensory on deltoid and forearm (musculocutaneous)

Question 3

clavicular fractures

-grades

Answer 3

grade 1. fx, no ligament disruption so no displacement

2. fx, with tear of CC ligament. so upward dispacement of medial clavicular fragment
3. fx through AC joint, no displacement

Question 4

capsulitis of shoulder

• mech
• etiology
• clinical findings
• Tx

Answer 4

• inflammation of capsule
• etiology unknown (sometimes follows trauma)

3 clinical stages:

1. freezing (pain, losing ROM)
2. frozen (no pain, no ROM)
3. thawing (no pain, increase ROM)

Tx: reassurance because usually self-limiting. (thawing may take 1/2 to 2 years). can use NSAIDs

Question 5

AC injury grades

Answer 5

grade 1–AC ligament injury

2–AC ligament tear, CC stretch

3–complete AC and CC ligament tears

Question 6

Biceps brachii proximal long head rupture:

tx?

Answer 6

• leave as is. Still have function with other muscles.
• only tx is if person is professional bodybuilder for aesthetics

Question 7

carpal tunnel syndrome

-clinical findings

Answer 7

median nerve.

• sensation: first 3 1/2 fingers.
• motor: thenar muscles. can result in thenar wasting

Question 9

medial epicondylitis

Answer 9

‘golfer’s elbow’

-strain of wrist flexors

Question 11

Bones with vulnerable blood supply (3)

Answer 11

1. scaphoid–radial artery
2. talus
3. femoral head (adults)–medial circumflex femoral

Question 12

lateral epicondylitis

Answer 12

‘tennis elbow’

-strain of wrist extensors (most likely extensor carpi radialis)

Question 13

For OA arthrtitic joint, what 2 things can you inject?

Answer 13

1. steroids
2. hyaluronic acid (viscosupplementation injection)–give building blocks of articular surface

Question 14

what is joint subluxation?

Answer 14

partial displacement, not full dislocaiton

Question 15

AC sprain

-what exam tests/findings?

Answer 15

1. cross-arm flexion test
   - have person raise arm to 90 degrees, then adduct over chest to elicit AC pain.
2. painful arc of abduction over 150 degrees

Question 16

shoulder impingement tests:

(3)

Answer 16

1. hawkin’s (‘like a hawk handler’) –internally rotate shoulder
2. neer’s (‘near the ear’)
3. jobe’s (empty can)