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Clin Med IV - Ortho > Upper Extremity MSK Problems > Flashcards

Upper Extremity MSK Problems Flashcards

1
Q

Suggested X-ray views for AC joint

A

AP with and without weights

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2
Q

Suggested X-ray views for chest

A

PA

Lateral (full inspiration)

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3
Q

Suggested X-ray views for clavicle

A

AP

Axial (20 deg. cephalad)

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4
Q

Suggested X-ray views for humerus

A

AP

Lateral

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5
Q

Suggested X-ray views for SC joint

A

AP

Obliques (bilateral)

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6
Q

Suggested X-ray views for shoulder

A

AP
Grashey
Y-scapular

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7
Q

Most common location of clavicle fractures

A

Middle 3rd > Distal 3rd > Proximal 3rd

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8
Q

Clinical presentation of clavicle fracture

A

Pain with active and passive ROM, esp. abduction/flexion of shoulder

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9
Q

Tx non- or minimally displaced clavicle fracture (most)

A

Conservative tx b/c usually heal in 6 wks → sling, ICE, NSAIDs, analgesics, PT

**PROM within 3 days to prevent freezing

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10
Q

Tx displaced clavicle fracture

A

ORIF → sling, ROM as soon as tolerated, analgesics, PT

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11
Q

Common mechanism of injury for AC joint injuries

A

Direct force to lateral shoulder with arm adducted → acromion driven inferiorly and medially with respect to clavicle

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12
Q

Grade AC joint injuries (Hint: 3 classes)

A

Grade I - sprain AC ligament (stretched fibers)
Grade II - tear AC ligament
Grade III - tear AC and coracoclavicular ligaments → AC joint dislocation

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13
Q

Clinical manifestation of AC joint injury

A
  • Pain in affected shoulder with decreased ROM

- TTP over AC joint

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14
Q

What special test can be used to determine AC joint injury?

A

Cross-arm test

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15
Q

Tx AC joint injury

A

Grade I, II → Conservative tx
Grade III → +/- surgery
Grade IV-VI → surgery

Note: Mild superior subluxation of AC joint may persist after surgery

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16
Q

Mechanism of injury of sternoclavicular joint dislocation

A

Fall on abducted and extended arm

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17
Q

Clinical manifestation of sternoclavicular joint dislocation

A

Initially presents as SCM muscle pain/spasm → may not dislocate until days after injury

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18
Q

Indications for surgical repair of sternoclavicular joint dislocation

A

Posterior dislocation

Cosmesis

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19
Q

Presentation of proximal humerus fracture

A
  • Moderate/severe shoulder pain, increases with active and passive ROM
  • Swelling and ecchymosis possible
  • Arm adducted against side
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20
Q

What’s important to know about proximal humerus fractures?

A

If fracture in shaft, check radial nerve and vascular integrity → wrist extension and sensory on dorsum of 1st web space

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21
Q

Tx impacted or non-displaced proximal humerus fracture (most)

A
  • Conservative tx w/ sling or collar/cuff

- Begin ROM of elbow/wrist as soon as tolerated**

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22
Q

Tx unstable proximal humerus fracture

A

ORIF or total shoulder replacement

IM rodding falling out of favor d/t lingering pain

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23
Q

Most shoulder dislocations are _______

A

Anterior

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24
Q

Posterior shoulder dislocations are usually due to _______, ______, or ______

A

Falls from height
Epileptic seizures
Electric shock

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25
Q

Atraumatic shoulder dislocations are usually due to ________ or ________

A 
Ligament laxity
Repetitive microtrauma (swimmers, gymnasts, pitchers)
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26
Q

Presentation of shoulder dislocation

A
  • Obvious deformity

- Arm abducted and in external rotation

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27
Q

90% young active pts with traumatic shoulder dislocation have ________, too

A

Inferior labral injuries (Bankart lesions)

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28
Q

What is important to assess in shoulder dislocation?

A
  • Axillary and radial nerve function

- Rotator cuff tears

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29
Q

Tx shoulder dislocation

A
  • Reduction ASAP → sling immobilization for 2 wks w/ pendulum exercises and PT
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30
Q

What counseling point should you provide pt after reducing shoulder dislocation?

A

Limited ROM and pain may persist for 4-6 wks

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31
Q

________ is the only tx shown to decrease recurrence of shoulder dislocation

A

Surgery

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32
Q

_______ pts have high risk of redislocation of shoulder

A

Age <21

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33
Q

Redislocation of shoulder is associated with ______ and ______

A

Increased arthritis risk

Further bony deterioration

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34
Q

Impingement syndrome is also known as ______

A

Rotator cuff tendonitis

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35
Q

Epidemiology of impingement syndrome

A

Age >40

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36
Q

Clinical presentation of impingement syndrome

A
  • Pain with overhead activities
  • Nocturnal pain with sleeping on shoulder
  • Pain on internal rotation (putting on jacket/bra)
  • Tenderness over anterolateral shoulder at greater tuberosity
  • Decreased AROM but preserved PROM**
  • Possible atrophy in supraspinatus fossa
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37
Q

Special test that suggests impingement syndrome

A

+Hawkin’s impingement test

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38
Q

Imaging for impingement syndrome

A

MRI b/c X-ray may appear normal

39
Q

_________ are one of the most common causes of impingement syndrome

A

Partial rotator cuff tears

40
Q

Tx impingement syndrome

A
  • Conservative → activity modification, PT, NSAIDs, steroid injection
  • Surgery → arthroscopic acromioplasty with coracoacromial ligament release, bursectomy, or debridement/repair of rotator cuff tears
41
Q

Rotator cuff muscles

A

SITS

  • Supraspinatus
  • Infraspinatus
  • Teres minor
  • Subscapularis
42
Q

Function of supraspinatus

A

Abduction

43
Q

What special test is used to assess supraspinatus?

A

Empty the can test

44
Q

Function of infraspinatus

A

External rotation from neutral position

45
Q

Function of teres minor

A

External rotation from 90 deg.

46
Q

Function of subscapularis

A

Internal rotation

47
Q

Most commonly torn tendon in rotator cuff tear

A

Supraspinatus

48
Q

Common mechanism of injury of acute rotator cuff tear

A
  • Fall on outstretched arm

- Pulling on shoulder

49
Q

Common mechanism of injury of chronic rotator cuff tear

A

Repetitive injuries with overhead movement and lifting

50
Q

Presentation of rotator cuff tear

A
  • Weakness or pain with overhead movement
  • Limited AROM but normal PROM
  • Night pain/inability to sleep on affected side
51
Q

Imaging for rotator cuff tears

A

MRI b/c X-ray commonly appears normal

High-riding humeral head = supraspinatus tendon tear

52
Q

Tx partial rotator cuff tear

A

Conservative tx but 40% progress to full-thickness tears in 2 yrs

53
Q

Tx full-thickness rotator cuff tears

A
  • Surgery for young, active pts

- PT option for older, sendentary pts

54
Q

SLAP lesion

A

Injuries of glenoid labrum at long head biceps attachment

55
Q

Imaging for SLAP lesion

A

MR arthrogram w/ gadolinium injection → high signal fluid in T2

56
Q

Tx SLAP lesion

A
  • Type I → usually asx and doesn’t need tx

- Type II and III → surgical reattachment

57
Q

Adhesive capsulitis is also known as _______

A

Frozen shoulder

58
Q

Pathophysiology of adhesive capsulitis

A

Thickening and inflammation of shoulder capsule around glenohumeral joint

59
Q

Epidemiology of adhesive capsulitis

A

Age 40-65
Women > men
Endocrine disorders (DM, thyroid)

60
Q

Clinical presentation of adhesive capsulitis

A
  • Pain with decreased AROM and PROM
  • Strength mostly normal
  • Usually lasts 24 months
61
Q

Different phases of adhesive capsulitis

A
  • Inflammatory phase → pain out of proportion
  • Freezing phase → stiffness
  • Thawing phase → resolution
62
Q

Tx adhesive capsulitis

A
  • Conservative tx

- Surgery (rare)

63
Q

Calcific tendonitis most commonly occurs in _______

A

Supraspinatus

64
Q

Presentation of calcific tendonitis

A
  • Very painful shoulder triggered by minimal or no trauma
  • Specific point of pain
  • Acute onset
65
Q

Tx calcific tendonitis

A
  • Conservative tx

- Arthroscopy with aspiration of mineralized material

66
Q

Epidemiology of humeral fracture

A

Bimodal distribution → Age 20s male, Age 60s female

67
Q

Clinical presentation of humerus fracture

A
  • Severe pain in mid-arm area
  • Swelling and ecchymosis
  • TTP, crepitus
68
Q

Tx humerus fracture

A
  • Functional bracing for non-surgical candidates

- ORIF for moderate-severe displacement or young pt

69
Q

Radiologic signs of elbow fracture

A

Anterior fat pad sign (“sail sign”)
Posterior fat pad sign
May not see fx immediately, may show up on f/u

70
Q

Suggested X-ray views of elbow

A

AP
External oblique
Lateral

71
Q

Treat radial head fracture

A
  • Long arm posterior splint for 3-4 days
  • Sling for 1-2 wks
  • Analgesics, gentle ROM, PT
  • Serial radiographs at 2 wks
72
Q

Epidemiology of supracondylar elbow fx

A

Age 5-9

73
Q

Tx supracondylar elbow fracture

A
  • Conservative if non-displaced

- ORIF, flexion reduction maneuver

74
Q

Epidemiology of olecranon fracture

A

Bimodal distribution

75
Q

Clinical presentation of olecranon fracture

A
  • Pain localized to posterior elbow with palpable defect

- Inability to extend elbow

76
Q

Tx olecranon fx

A

ORIF with tension band or plate/screw fixation

77
Q

Most elbow dislocations are ______

A

Closed and posterior

78
Q

Mechanism of injury of elbow dislocation

A

Hyperextension, posterolateral rotatory mechanism

79
Q

Treatment of elbow dislocation

A
  • Closed reduction for simple dislocation
  • ORIF for complex fracture-dislocation
  • Long arm posterior splint/sling for 1-2 wks
80
Q

Lateral epicondylitis is also known as _______

A

Tennis elbow

81
Q

Medial epicondylitis is also known as ______

A

Golfer’s elbow

82
Q

Clinical manifestation of lateral epicondylitis

A

Pain with resisted wrist extension

83
Q

Clinical manifestation of medial epicondylitis

A

Pain with resisted wrist flexion

84
Q

Tx epicondylitis

A 
Rest
Ice cube massages
Brace
NSAIDs
PT
Cortisone
85
Q

Tx both bones forearm fracture

A

Sugar-tong splint in ED → Casting for nondisplaced, ORIF for displaced (more common)

86
Q

Greenstick fracture

A

Incomplete fx of long bone

87
Q

Epidemiology of greenstick fx

A

Forearm of young child

88
Q

Tx greenstick fx

A
  • Sugar tong splint
  • Analgesics
  • Casting for 3-4 wks
89
Q

Buckle fracture is also known as _______

A

Torus fracture

90
Q

Tx buckle fracture

A
  • Volar splint
  • Analgesics
  • Casting x3-4 wks
91
Q

Colles fracture

A

Fx of distal radial metaphyseal region with DORSAL angulation of distal fragment

92
Q

Tx Colles fx

A
  • Conservative → closed reduction, sugar tong splint followed by long/short arm cast for 4-6 wks
  • Surgery → ORIF followed by cast/splint for 4-6 weeks
93
Q

Smith fracture

A

Fracture of distal radius with VOLAR angulation of distal fracture fragment

Clin Med IV - Ortho (7 decks)

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