Upper Extremity Injury: Clinical Correlations Flashcards
What are the three mechanisms of fracture?
Acute: from sudden impact of large force exceeding strength of the bone Stress: from repetitive submaximal stresses Pathologic: from normal forces to diseased bone
What do you look for on examination of a fracture?
Deformity: if bleeding with/without fragment suspect open fracture – orthopedic emergency, needs to be surgically washed out Bony point tenderness Pain with loading bone: indirect loading especially useful
What are some examples of indirect loading tests?
Axial loading
Bump test
Fulcrum test
Hop test
What imaging modalities may be used to diagnose a fracture?
Plain x-rays
CT scan
Bone scan
MRI
What should be done for fracture treatments?
Immobilization
Avoidance of NSAIDS: some animal studies and models show NSAIDS interfere with bone healing via PGs
What bones are vulnerable to lack of blood supply with break?
Scaphoid
Talus
Femoral head
What are the contents of the anatomical snuffbox?
- Nerve: radial
- Vein: cepalic
- Artery: radial
- Bone: scaphoid
What is the artery that supplies a large amount of blood to the head of the femur?
Medial circumflex femoral artery = most important blood supply to the head and neck of the femur
What does the history and exam look like for arthritis?
- History: Stiffness – especially after rest, worse after prolonged use
- Exam: joint line tenderness, mild swelling, deformity, symptoms with both passive and active motions
What is arthritis?
Damage to articular cartilage surface
Can be acute or chronic
What is capsulitis?
Capsular thickening – from inflammation or scarrin g
Idiopathic or post injury – risk factors: injury, diabetes, thyroid disease
How does someone with capsulitis usually present their history?
Limited ROM
- Painful early with decreased ROM (freeze phase)
- Non-painful with stable, decreased ROM (frozen phase)
- Non-painful with improving ROM (thawing phase)
What will the exam look like for someone with capsulitis?
- Decreased ROM
- Gradually tightening endpoint
- Exam otherwise consistent with underlying etiology
What is used for the treatment of capsulitis?
- Reassurance
- Educate and set expectations
- Maintenance of ROM
- Pain control
What is a good treatment for a rupture of the long head of the biceps?
Clinical observation (nothing) – usually does quite well on its own
What are some key components to consider when treating musculotendinous ruptures?
- Impact of absence of muscle
- Presence of alternative muscles
- Functional requirements of patient
What is enthesopathy?
A disorder of muscular or tendinous bony attachment
What is tendonitis?
Technically acute inflammation of the tendon
Traumatic – blow or pull
What is tendinosis?
Chronic degenerative condition of tendon
Chronic – submaximal repetitive irritation
How do most AC (acromioclavicular) sprains occur?
Most commonly from a fall directly onto shoulder
What does presentation and exam of AC sprain look like?
Presentation: pain with overhead motions, deformity of superior shoulder
Exam: pain and deformity of AC joint, pain with cross body adduction of arm (positive cross-chest test), painful arc of abduction over 150 degrees
Explain the grading of AC injuries.
Grade 1: AC ligament injury
Grade 2: AC ligament tear and coracoclavicular (CC) liagment stretch
Grade 3: complete tears of both AC and CC ligaments
What is a sprain? What are some symptoms?
Ligamentous damage from overloading
Symptoms: Instability or laxity, swelling
Explain the grading of sprains.
Grade 1: microscopic damage, no increased laxity, but pain with stress
Grade 2: partial tear, increased laxity and pain
Grade 3: complete tear, significant laxity
Which way is the shoulder most likely to dislocate?
Anteriorly – usually due to forced extension, abduction and external rotatin of arm or a direct blow to posterior shoulder
Which nerve is most likely to get hurt with anterior shoulder disloation? How would you test this?
Axillary nerve
Test with ability to abduct the arm because the deltoid is innervated by the axillary nerve
What are the various terms used to describe joint stability?
- Dislocation: complete displacement
- Subluxation: transient, partial displacement
- Laxity: normal varient in “joint looseness”
What is the most effective passive stabilizer of the shoulder?
Vacuum phenomena: negative pressure associated with keeping humoral head in place
What does the exam for shoulder dislocation look like?
- Arm held by opposite hand in slight abduction and external rotation
- Alteration of shoulder contouring: prominent acromion, humeral head anterior to acromion and adjacent to coracoid
- Check sensation of axillary (deltoid area) and musculocutaneous (forearm) nerves
- Positive apprehension test
What causes carpal tunnel syndrome?
Impingement of palmar cutaneous branch of median nerve
What clincal findings are consistent with carpal tunnel?
Patient awakens at night with tingling, pain, or both in sensory distribution of median nerve (volar side of radial 3.5 digits)
Thenar atrophy with PROLONGED carpal tunnel
Do you need surgery with a rotator cuff tear?
Not necessarily. There are a lot of other muscles that can still do the work.
