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PM&R > Upper Extremity MSK > Flashcards

Upper Extremity MSK Flashcards

1
Q

4 structures that can compress the median nerve at the elbow?

A
  • Ligament of struthers
  • Lacertus fibrosus
  • Pronator teres
  • FDS (between the two heads)
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2
Q

AC Joint Separation Types and Tx

A
  • Type 1: partial AC tear, intact CC - > rehab with return in 2 wk
  • Type 2: complete AC tear, intact CC -> rehab with return in 6 wk
  • Type 3: complete AC and CC tear with clavicle floating upwards - > consider surgery
  • Type 4: complete AC and CC tear with clavicle floating up and back -> need surgery
  • Type 5: complete AC and CC tear with clavicle super up and back -> need surgery
  • Type 6: complete AC and CC tear with clavicle floating down -> need surgery
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3
Q

Anatomic Snuffbox borders

A
  • lateral: APL, EPB
  • medial: EPL
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4
Q

Atraumatic shoulder dislocation management

A

AMBRI A: Atraumatic M: Multidirectional B: Bilateral R: Rehab I: Inferior capsule shift if they require surgery

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5
Q

Bankart lesion

A

Anterior labral tear that allows the humeral head to slip anteriorly

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6
Q

Bennett’s fracture

A

Oblique fracture at the base of the thumb metacarpal

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7
Q

Bone deviations seen in RA at the wrist/hand?

A
  • Ulnar deviation of the MCPs
  • Radial deviation of the wrist
  • Dorsal subluxation of the ulna
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8
Q

Borders and contents of quadrangular space

A
  • Borders: humerus, triceps long head, teres minor, teres major
  • Contents: Axillary nerve and posterior humeral circumflex artery
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9
Q

Borders and contents of triangular interval

A
  • borders: humerus, triceps long head, teres major
  • contents: radial nerve profunda brachii artery
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10
Q

Borders and contents of triangular space

A
  • borders: teres minor, teres major, long head of tricpes (lateral)
  • contents: scapular circumflex artery
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11
Q

Boutonniere deformity cause

A

Tearing of the extensor hood at the PIP

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12
Q

Boxer’s Fracture

A

5th metacarpal fracture

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13
Q

Brachial artery course

A

enters in cubital fossa and divides into radial and ulnar arteries

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14
Q

Carpal bones

A
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15
Q

Carpal Tunnel structures and borders

A

4 FDS tendons, 4 FDP tendons, FPL tendon, median nerve bordered by scaphoid and pisiform

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16
Q

Five changes seen on X-ray in osteoarthritis

A
  • Irregular joint surfaces
  • Joint space narrowing
  • Subchondral sclerosis
  • Osteophytes
  • Cystic changes
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17
Q

Colles Fracture

A

Distal radius fragment is dorsally displaced (CD). Associated with triangular fibrocartilage complex (TFCC) tears.

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18
Q

Common causes of hook of the hamate fractures?

A

direct trauma or forceful twisting of the wrist (racquet-related sports)

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19
Q

Cozen test

A

pain with palpation of common extensor tendon with resisted wrist extension (A)

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20
Q

Cubital fossa boundaries

A
  • lateral: brachioradialis
  • medial: pronator teres
  • base: line through epicondyles
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21
Q

Deep forearm extensors

A

Supinator, APL, EPL, EPB, EIP

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22
Q

DeQuervain’s Tenosynovitis

A

inflammation of APL and EPB tendon due to overuse

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23
Q

Dorsal Compartments of the Wrist

A

1: APL, EPB 2: ECRL, ECRB 3: EPL 4: EDC, EIP 5: EDM 6: ECU

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24
Q

Forearm flexor layers

A
  • Superficial: (lateral to medial) pronator teres, flexor carpi radials, palmaris longus, flexor carpi ulnaris
  • Intermediate layer: flexor pollicis longus, flexor digitorum superficialis, flexor digitorum profundus
  • Deep layer: pronator quadratus
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25
Q

Four fingers as forearm flexors

A

PRLU

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26
Q

Four tests for anterior glenohumeral instability

A
  • Apprehension
  • Relocation
  • Anterior drawer
  • Anterior load-and-shift
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27
Q

Four tests for posterior glenohumberal instability

A
  • Jerk
  • Kim
  • Posterior drawer
  • Posterior load-and-shift
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28
Q

Function of Superior Glenohumeral ligament

A

prevent inferior translation of the humerus

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29
Q

function of the inferior glenohumeral ligament

A

prevent anterior translation of the humerus above 90 degrees

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30
Q

function of the middle glenohumeral ligament

A

prevent anterior translation of the humerus

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31
Q

Fusion position for elbow arthrodesis?

A
  • Unilateral: flexion to 90 degrees
  • Bilateral: flexion to 65 degrees for one arm and 110 degrees for the other
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32
Q

Heberden nodes

A

DIP appears swollen due to osteophytes

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33
Q

Hill-Sachs lesion

A

Posterolateral humeral head compression fracture due to abutment of the rim of glenoid fossa, associted with anterior dislocations. Involvement of more than 30% of the articular surface may cause instability.

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34
Q

How to reduce a Nursemaid Elbow

A

Hyperpronate or supinate while flexing at the elbow

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35
Q

How to test subscapularis strength

A

lift off test

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36
Q

humeral stress fx presentation and treatment

A
  • shoulder pain worse with throwing
  • limit activity for 8 - 12 weeks, gradual return
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37
Q

Indication for MRI arthrogram over gold standard MRI when assessing for RTC injury?

A

suspect labral tear

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38
Q

Indications for surgical treatment of clavical fracture

A
  • open fx
  • grossly displaced with skin tenting
  • lateral fracture with more than 1cm displacement at AC joint
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39
Q

Jerk test

A
  • Test for posterior shoulder instability
  • Flex arm to 90, internal rotate, adduct across and push humerus posteriorly. Pt. will jerk away if positive.
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40
Q

Jersey finger

A

Injury to FDP tendon

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41
Q

Kienbock disease

A

osteonecrosis of the lunate 2/2 to AVN seen in patients with a short ulna

42
Q

Kim test

A
  • test for posterior instability
  • similar to “jerk” test however you simply flex the arm up and apply a posteroinferior force.
43
Q

Labral Tear Test

A

O’Brien: Hold arm out and slightly adducted. Positive test more painful with resistance with palm down than palm up.

44
Q

Lateral Scapular Winging

A

Trapezius weakness 2/2 to nerve injury in posterior triangle of the neck

45
Q

Little Leaguer’s Elbow

A

Medial epicondyle apophysisits secondary to repetitive valgus stress with throwing. Can lead to osteochondritis dissecans of the capitellum (localized fragmentation of bone and cartilage).

46
Q

Medial Scapular Winging

A

Serratus Anterior weakness secondary to bench pressing heavy weights or wearing heavy pack straps

47
Q

Mill’s test

A

pain with elbow extension and wrist flexion/radial deviation (B)

48
Q

Modifications made to tennis racket in patient with lateral epicondylitis (2) ?

A

decrease string tension and increase grip size

49
Q

Most common cause of shoulder pain

A

Impingement syndrome

50
Q

most common direction and cause of shoulder instability

A

anterior and inferior instability in younger people with repeated arm abduction and external rotation (volleyball players, pitchers)

51
Q

Most common joint dislocated in children?

A

elbow

52
Q

Most common location for clavicle fracture

A

middle third

53
Q

Most common presentation of shoulder impingement syndrome?

A

Pain with repetitive overhead activities, occurs during “catch” phase of swimming when the hand enters the water.

54
Q

most common site for biceps tendonopathy

A

proximal long head (inserts on supraglenoid tuberosity)

55
Q

Most common site for humeral fracture? How does this affect abduction?

A

surgical neck, supraspinatus causes abduction of proximal fragment

56
Q

most common site of stenosing tenosynovitis

A

A1 pulley (MCP

57
Q

muscle most commonly involved in lateral epicondylitis?

A

ECRB

58
Q

Muscles in the hand not innervated by ulnar nerve

A

median: LOAF muscles

59
Q

Name 5 scapular stabilizers

A
  • Trapezius
  • Rhomboids
  • Levator Scapulae
  • Serratus Anterior
  • Latissimus Dorsi
60
Q

nerve and artery damaged with humeral midshaft fracture

A

radial nerve, profunda brachii artery

61
Q

nerve and artery damaged with humeral supracondylar fracture

A

median nerve, brachial artery

62
Q

Nerve and artery damaged with humeral surgical neck fracture

A

axillary nerve, posterior circumflex artery

63
Q

Nerve damaged in olecranon fracture

A

Ulnar

64
Q

Osteochondrosis of the Elbow (Panner’s Disease)

A

Aseptic necrosis of the capitellum epiphysis due to poor blood supply. Lateral elbow pain in children worse with activity.

65
Q

Posteromedial elbow pain with pitching

A

Valgus Extension Overload Syndrome (olecranon osteophytosis and loose body formation secondary to repetitive abutment of the olecranon against the olecranon fossa)

66
Q

Range of motion lost first with frozen shoulder

A

abduction and external rotation

67
Q

Relationship between glenohumeral and scapulothoracic joint motion

A

2 degrees of GH for 1 degree of ST motion (120 deg of GH to 60 deg of ST)

68
Q

Risk factors for Dupuytren Contracture

A

Older male with alcoholism, seizures, and diabetes

69
Q

Rolando’s fracture

A

comminuted, “T”, or “Y” fracture at the base of the thumb metacarpal

70
Q

RTC/Impingment Tear Tests (3)

A

Empty Can, Neer, Hawkins

71
Q

scaphoid fx treatment

A
  • long thumb spica cast x 6 weeks with wrist in neutral position
  • Can transition to short thumb spica at 6wk if proper healing
  • surgery if fracture is displaced > 1mm, involves the proximal pole, or delayed presentation
72
Q

Scaphoid site at risk for AVN

A

Proximal 1/3

73
Q

significance of Lister’s tubercle

A

seperates 2nd and 3rd dorsal compartments of the wrist

74
Q

Skier’s Thumb

A

1st digit UCL tear at distal insertion

Tx: thumb spica splint

75
Q

Smith Fracture

A

Distal radius fragment is volarly displaced (Sweater Vest)

76
Q

sport specific recommendations for tennis elbow

A

larger grip and decrease string tension to < 55 lbs

77
Q

Stages of frozen shoulder

A
  • painful: 8 months
  • stiffening: 8 months
  • thawing: 8 months
78
Q

Stener’s lesion

A

Trapping of thumb adductor aponeurosis in the MCP joint due to severe 1st digit UCL tear

79
Q

strongest elbow flexor muscle

A

brachialis

80
Q

strongest forarm supinator muscle

A

biceps

81
Q

Swan neck deformity cause

A

synovitis

82
Q

Test used to detect SLAP lesions

A

O’Brien’s : Arm internally rotated, forward flexed, and adducted 15 degrees. Pain with resisted downward force that improves with hand supination.

83
Q

Testing FDS and FDP

A
84
Q

three joints of the elbow

A
  • radiocapitellar
  • ulnotrochlear
  • radioulnar
85
Q

Traumatic shoulder dislocation management

A

TUBS T: Traumatic U: Unidirectional B: Bankart lesions S: Surgery

86
Q

Treatment for a clavical fracture

A
  • reduce and sling for 3-6 weeeks followed by ROM and PT
  • surgery if very displaced or open fx
87
Q

Treatment for a humerus fracture

A
  • One part (Displaced less than 2 cm): sling x 6 weeks followed by PT
  • 2-4 part: Surgery
88
Q

Trigger finger

A

Tenosynovitis at the A1 pulley

89
Q

Valgus extension overload provocative test?

A

Flex elbow to 30 degrees, repeatedly extend elbow while applying a valgus stress. Positive if pain towards end of extension.

90
Q

What can be seen on X-ray with injury to the elbow’s ulnar collateral ligament?

A
  • 2mm joint space with stress view
  • calcification and spurring along UCL
91
Q

What is the fusion position in shoulder arthrodesis?

A
  • 30 degrees flexion
  • 50 degrees abduction
  • 50 degrees internal rotation
92
Q

What is the maximum amount of shoulder abduction with the humerus interally rotated? Why?

A

120 degrees, due to greater tuberosity being forced under the acromion

93
Q

what part of the elbow ulnar collateral ligament is most commonly sprained?

A

anterior bundle

94
Q

What three structures are commonly involved in shoulder impingement syndrome?

A
  • subacromial bursa
  • biceps tendon
  • supraspinatus tendon
95
Q

Where is supraspinatus prone to injury

A

1 cm from insertion in area of hypovascularity

96
Q

Which forearm bone articulates with the capitulum?

A

radius

97
Q

X-ray findings of chronic rotator cuff tear

A
  • superior migration of the humerus
  • flattening of the greater tuberosity
  • subacromial sclerosis and severe superior medial wear
98
Q

X-ray view used for Bankart lesions

A

West Point Axillary

99
Q

X-ray view used for Hill-Sachs lesions

A

Stryker notch

100
Q

Yergason’s test

A

Pain at the anterior shoulder with resisted supination

PM&R (21 decks)

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