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Upper Extremity MSK Flashcards

1
Q

What fractures are at a increased risk for AVN?

A
  • Shoulder fx
  • Scaphoid fx: retrograde blood supply
  • Hip fx
  • Femoral neck fx
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2
Q

What is an open and closed fracture?

A
  • Open or “compound”: breaks the skin (risk for infection)

- Close: does not break the skin

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3
Q

What is the SALTER acronym?

A
  • S: straight across
  • A: above
  • L: lower or beLow
  • TE: through everything
  • R: cRush
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4
Q

What is a type 1 salter harris fracture?

A

Through the physis (growth plate) alone

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5
Q

What is a type 2 salter harris fracture?

A

Through the physis and metaphysis

- (MC)

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6
Q

What is a type 3 salter harris fracture?

A

Through the physis and epiphysis

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7
Q

What is a type 4 salter harris fracture?

A

Through the physis, metaphysis, and epiphysis

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8
Q

What is a type 5 salter harris fracture?

A

Crush injury to physis

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9
Q

What is the definition of a fracture?

A

Disruption of all or part of the boney cortex

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10
Q

What is a greenstick or torus fracture?

A

Incomplete disruption of cortex usually in peds

- bone is “bent” but not broken all the way through

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11
Q

What is a stress or hairline fracture caused by?

A

Fatigue induced from repeated stress over time.

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12
Q

What is a transverse fracture?

A

Fracture line is perpendicular to the shaft of the bone

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13
Q

What is a spiral/torsion fracture?

A

Bone has a twist appearance

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14
Q

What is an oblique fracture?

A

Break is diagonal and through the bone

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15
Q

What is a comminuted fracture?

A

Crushed, several little pieces

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16
Q

What is a segmental fracture?

A

Several large pieces of bone

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17
Q

What is an angulation displacement?

A

Deviation from straight (in angle position)

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18
Q

What is displacement?

A

Abnormal position of fragmenets

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19
Q

What is the definition of dislocation?

A

Complete disruption from the joint

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20
Q

What is subluxation?

A
  • Partial disruption of joint

- Altered but bones of the joint still remain in contact

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21
Q

What is a sprain?

A

Injury of the bands of tissue that connect 2 bones together

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22
Q

What is a strain?

A

Injury to a muscle or to the band of tissue that attaches a muscle to a bone

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23
Q

What is a tear?

A

Tendon is torn away from the bone

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24
Q

What historical component is common with a scaphoid fracture?

A
  • Fall on out stretched hand (FOOSH)

- MC carpal bone fracture and highest rate of nonunion occult fracture

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25
Q

What are the PE findings of a scaphoid fracture?

A

Pain at the anatomical snuffbox (base of thumb)

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26
Q

What is the tx for a scaphoid fracture?

A
  • XR: may not show fx, pt should be casted w/ repeat imaging in 7-10 days
  • Thumb spica cast for 6-12 wks depending on fx location.
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27
Q

What is a shoulder tendonitis?

A

Inflammation of the subacromial bursitis

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28
Q

What are S/Sxs of a shoulder tendonitis?

A
  • Pain to lateral shoulder that radiates to the deltoid
  • Pain with active shoulder ROM (overhead)
  • Nocturnal pain is common
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29
Q

What is the tx for shoulder tendonitis?

A

Rest, ice, NSAIDs, cortisone injection, PT, MRI if needed

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30
Q

What is bursitis?

A

Injury or trauma; prolonged pressure; overuse or strenuous activity; crystal-induced arthropathy; and inflammatory arthritis

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31
Q

What are the S/Sx of shoulder bursitis?

A
  • Swelling pain
  • Decreased active ROM
  • Full passive ROM
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32
Q

What are the S/Sx of a rotator cuff inflammation/tear?

A

Pain involving the SITS muscles

  • Supraspinatus (MC)
  • Infraspinatus
  • Teres minor
  • Subscapularis
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33
Q

What are the PE test for a rotator cuff inflammation/tear?

A

Empty can test

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34
Q

What is the tx for a rotator cuff inflammation/tear?

A

Rest, ice, NSAIDs, cortisone injection, PT, MRI

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35
Q

What is shoulder impingement syndrome?

A

Anything that entraps RTC muscles under acromion usually caused by repetitive overhead work or fall on hand.

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36
Q

What are S/Sx of shoulder impingement syndrome?

A

Pain and difficulty moving (abducting arm)

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37
Q

What are the PE finding for shoulder impingement syndrome?

A
  • Pain at greater tuberosity
  • Lateral shoulder pain and difficulty abducting arm
  • Positive Neer and Hawkins signs
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38
Q

What is the tx for shoulder impingement syndrome?

A

Imagining to r/o RTC, rest, ice, NSAIDs, PT, steroid injections

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39
Q

What is thoracic Outlet Syndrome?

A

Idiopathic compression of brachial plexus (MC), subclavian vein or artery as they exit the narrowed space between the shoulder girdle and 1st rib.

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40
Q

Thoracic Outlet Syndrome is Mc’ly seen in who?

A

Women in 20-50 YOA

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41
Q

What are the S/Sx of Thoracic Outlet Syndrome?

A
  • Pain/paresthesia to forearm, arm or ulnar side

- Swelling/discoloring of the arm esp. w/ abduction of the arm

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42
Q

What is the PE test for Thoracic Outlet Syndrome?

A

Adsons test: loss of radial pulse w/ head rotated to affected side

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43
Q

What is the tx for Thoracic Outlet Syndrome?

A

PT, avoid strenuous activities, ortho consult, surgery

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44
Q

What is a Acromioclavicular separation?

A

Tearing of the acromioclavicular and/or coracoclavicular joints

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45
Q

What are S/Sxs of an Acromioclavicular separation?

A
  • Fall on shoulder or impact to tip of shoulder

- Step off deformity

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46
Q

What are the PE findings of a Acromioclavicular separation?

A
  • Pain at the end of the collar bone w/ swelling and “bump” depending on severity of injury
  • Pain with crossover test
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47
Q

What is grade 1 of a Acromioclavicular separation?

A

Simple sprain w/ minor ligament injury and no dislocation

48
Q

What is grade 2 of a Acromioclavicular separation?

A

Rupture of the acromioclavicular ligament

49
Q

What is grade 3 of a Acromioclavicular separation?

A

Rupture of AC and coracoclavicular ligaments w/ superior dislocation of clavicle

50
Q

What is grade 4 of a Acromioclavicular separation?

A

Posterior dislocation of clavicle

51
Q

What is grade 5 of a Acromioclavicular separation?

A

Grade 3 + severe superior dislocation

52
Q

What is grade 6 of a Acromioclavicular separation?

A
  • Inferior dislocation of the clavicle

- Can impinge on nerves

53
Q

What are the txs for grade 1-3 of a Acromioclavicular separation?

A

Non operative- PRICE

54
Q

What are the txs for grade 4-6 and 3 (if not responsive to conservative tx) of a Acromioclavicular separation?

A

Surgery to reconstruct the AC joint.

55
Q

What is the tx for sprains and strains?

A 
RICE, NSAIDs, heat, and XR
P: protect the joint
R: rest
I: ice
C: compression
E: elevate
56
Q

What is a biceps rupture?

A
  • Fall on outstretched arm or rapid extension of arm.

- Long head of the biceps partially tears or ruptures from its attachment to the top of the socket.

57
Q

What is the PE findings in a biceps rupture?

A
  • Visible or palpable mass “Popeye” deformity

- Tenderness along biceps tendon and muscle.

58
Q

What is the tx for a biceps rupture?

A
  • Rest, avoid heavy lifting and overhead activity, NSAIDs, PT
  • Surgery during the first 2-3 wks following injury
59
Q

What is a clavicle fracture?

A

Broken collar bone from forceful fall on outstretched hand

60
Q

What part of the Clavicle shaft is usually fracture and who is this MC’ly seen in?

A
  • Middle third (mid shaft)

- MC fracture in children and adolescents (<25 yrs old)

61
Q

What is the PE findings of a clavicle fracture?

A
  • Pain with ROM
  • Deformity at site: tenting of skin
  • Crepitus
  • May hold arm against chest to protect against motion.
62
Q

What is the tx for a clavicle fracture?

A
  • Sling, pain control, PT
  • For complete fx: primary plate fixation.
  • make sure to r/o brachial plexus injury
63
Q

What is Nursemaid’s elbow (radial head subluxation) caused by?

A
  • Lifting/swinging/pulling a child while the forearm is pronated and extending
  • Radial head wedges into the stretch annular ligament.
  • MC: 2-5 yrs old
64
Q

What is the S/Sxs of Nursemaid’s elbow (radial head subluxation)?

A
  • Tenderness of radial head, arm slightly flexed, unable to use arm, usually no swelling.
  • PE: TTP of radial head, pain with supination and flexion
65
Q

What is the tx for Nursemaid’s elbow (radial head subluxation)?

A

Reduction of pressure on radial head

  • observe function if normal for 15 min no XR needed, but it not XR needed to r/o fracture
  • Consider concomitant dislocation at elbow (Monteggia fracture/dislocation)
66
Q

What is Olecranon bursitis?

A

Inflammation of the bursa over the bony prominence

67
Q

A pt that you suspect has olecranon bursitis usually has a history of what?

A

Hx of gout, RA, OA, direct trauma, and infection

68
Q

What are PE findings of Olecranon bursitis?

A
  • Abrupt goose egg, swelling, tenderness, boggy, red elbow
  • Limited range of motion with flexion.
  • Observe for associated cellulitis
69
Q

What is the tx for Olecranon bursitis?

A
  • NSAIDS, steroid injection, padding, avoid respective motions.
  • If worried about septic bursitis: do bursa aspiration
70
Q

What is Medial epicondylitis (golfers elbow) caused by?

A

Injury or overuse of the wrist forearm tendons

71
Q

What are S/Sx of Medial epicondylitis (golfers elbow)?

A

Pain with wrist flexion and pronation

72
Q

What are the PE findings of Medial epicondylitis (golfers elbow)?

A
  • Pain worsening with pulling activates

- Pain w/ wrist flexion against resistance w/ elbow fully extended

73
Q

What is the tx for Medial epicondylitis (golfers elbow)?

A

RICE, NSAIDs, PT, brace/elbow straps, steroid injection, surgery if needed

74
Q

What is Lateral epicondylitis (tennis elbow) caused by?

A

Injury or overuse of the extensor wrist and forearm tendons at the lateral epicondyle

75
Q

What are the PE findings of Lateral epicondylitis (tennis elbow)?

A
  • Lateral elbow pain with gripping, and with forearm pronation and wrist extension against resistance
  • Pain w/ lifting objects with forearm prone
76
Q

What is the tx for Lateral epicondylitis (tennis elbow)?

A

RICE, NSAIDs, PT, brace/elbow straps, steroid injection, surgery if needed

77
Q

What is Carpal tunnel syndrome caused by?

A

Compression of the median nerve under the transverse carpal ligament

78
Q

What can Carpal tunnel syndrome be precipitated by?

A
  • Premenstrual fluid retention
  • Early RA
  • Acromegaly
  • Trauma
  • Pregnancy
  • Repetitive flexion/extension of wrist
  • Alcohol abuse
  • Diabetes
  • Lupus
79
Q

What are the S/Sx of Carpal tunnel syndrome

A
  • Numbness and tingling in hand (1st, 2nd, and ,1/2 middle) and wrist
  • Night pain
80
Q

What are the PE tests used to dx Carpal tunnel syndrome?

A

Phanels sign and Tinels sign

81
Q

What is the tx for Carpal tunnel syndrome?

A

NSAIDs, splint, surgical infection to decompress the nerve if needed

82
Q

What is a Ganglion cyst?

A

Benign joint or synovial fluid cyst

83
Q

Ganglion cysts are MC’ly located where and are usually seen in who?

A
  • Dorsal wrist

- In women between 20-40

84
Q

What are the S/Sx of a Ganglion cysts?

A
  • Painful or painless
  • Numb
  • Soft and mobile
85
Q

What is the tx for a Ganglion cysts?

A

Reassurance, splint, aspiration, surgical cyst excision

86
Q

What is Dupuytren’s syndrome?

A

Slowly progressive fibrosing disorder of the palmar fascia which can lead to debilitating contractrures of the hand

87
Q

Dupuytren’s syndrome is MC’ly seen in who and is caused by what?

A
  • Men 40-60

- Genetic, ETOH abuse, and DM

88
Q

What are the S/Sx of Dupuytren’s syndrome?

A
  • Fixed flexion deformity and contractures at MCP

- Painful nodules over distal palmar crease of proximal phalanx, esp. little and ring finger

89
Q

What is the tx for Dupuytren’s syndrome?

A
  • Enzyme tx to soften fibrous cords

- Surgery: subtotal fasciectomy

90
Q

What is DeQuervain’s disease (Nursemaids wrist)?

A

Tendonitis of the sheath and tendons of the first dorsal extensor compartment of the thumb.
- MC tendinitis in wrists

91
Q

DeQuervain’s disease is MC’ly seen in what age range and who?

A
  • 30-50 yrs of age
  • Women
  • Diabetics
92
Q

What are the S/Sx of DeQuervain’s disease?

A
  • Swelling near base of thumb
  • Crepitation
  • Pain with lifting at the wrist
  • Pain when grabbing or pinching
  • Radiating pain in forearm
93
Q

What is the PE test used to dx DeQuervain’s disease?

A

Finkelstein test

94
Q

What is the tx for DeQuervain’s disease?

A
  • Rest, ice, NSAIDs
  • Thumb spica splint
  • Cortisone injection
  • XR for recalcitrant case
  • Consider surgery for failed 6-12 mos of conservative tx
95
Q

What other dx should be considered when you are suspecting a pt has DeQuervain’s disease?

A

Consider concomitant dislocation at wrist (Galeazzi fracture/dislocation)

96
Q

What is trigger finger?

A

Inflammation and disparity of the size and flexor tendon and its pulley system which causes catching or locking of the involved finger

97
Q

What are the S/Sx of trigger finger?

A
  • Pain at A-1 pulley
  • Difficulty extending finger
  • Audible snap and pain
98
Q

What is the tx for trigger finger?

A

Cortisone tx, surgery or percutaneous needle release if needed

99
Q

What is Mallet finger?

A

Ruptured EDC w/ possible avulsion fx at the DIP joint

100
Q

What is the cause of Mallet finger?

A
  • Blunt force and axial load to DIP

- Long fingers MC’ly involved.

101
Q

What are S/Sx of Mallet finger?

A
  • Inability to straighten finger

- Pain at the DIP with extension lag

102
Q

What is the tx for Mallet finger?

A

Extension splitting at DIP for 6-8 wks, or surgery ORIF for larger fragments or joint subluxation (pinned)
- Referral to ortho if fracture is >25% of joint space

103
Q

What is the cause of Gamekeeper’s thumb?

A
  • Injury to the ulnar collateral ligament MPJ of the thumb

- aka thumb sprain

104
Q

Gamekeeper’s thumb can be associated with what fracture?

A

Avulsion fracture: base of the proximal phalanx

105
Q

What are the S/Sx of Gamekeeper’s thumb?

A
  • Swelling and laxity of the UCL (UCL functions to resist against valgus forces)
  • Thumb is far away from other digit
  • MCP tenderness, weakness and pain with grip and pinch function
106
Q

What is the Tx of Gamekeeper’s thumb?

A
  • Partial tear: spica splint

- Complete tear: ORIF or extension of fracture fragment

107
Q

What is a Subungual hematoma?

A

Collection of blood under toenail or finger nail caused from blunt trauma

108
Q

What is the tx for a Subungual hematoma?

A
  • Ice and elevate
  • If >50% may need trephination to relieve pain
  • XR is useful if nail bed appears injured
109
Q

What is a boxer fracture?

A

Hand fracture of 4th and 5th metacarpal bones by hitting an object with closed fist

110
Q

What are the PE findings of a boxer fracture?

A
  • Loss of knuckle on exam

- +/- Rotational deformity

111
Q

What is the Tx for a boxer fracture?

A
  • Volar tilt, cast or splint
  • Early protected ROM
  • Consider closed reduction w/ hematoma block or percutaneous pinning for rotational deformity.
112
Q

What are some possible complications caused by a boxer fracture?

A
  • Malunion
  • Non-union
  • Decreased strength and ROM (pseudo-clawing)
113
Q

What is a Colle’s Fracture?

A

Distal radial angulation or displacement caused by FOOSH

114
Q

Colle’s Fracture is MC’ly occurs in who?

A
  • Postmenopausal women
  • Osteoporotic women
  • DM
  • Asians
115
Q

What is the PE finding of a Colle’s Fracture?

A

Dinner fork deformity

116
Q

What is the Tx for a Colle’s Fracture?

A
  • Closed reduction w/ hematoma block
  • Percutaneous pinning for rotational deformity
  • Cast immobilization 4-6 wks
  • XRs if unstable: percutaneous pinning, external fixation, ORIF

MSK (11 decks)

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