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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
Atraumatic shoulder dislocations are usually due to ________ or ________
``` Ligament laxity Repetitive microtrauma (swimmers, gymnasts, pitchers) ```
26
Presentation of shoulder dislocation
- Obvious deformity | - Arm abducted and in external rotation
27
90% young active pts with traumatic shoulder dislocation have ________, too
Inferior labral injuries (Bankart lesions)
28
What is important to assess in shoulder dislocation?
- Axillary and radial nerve function | - Rotator cuff tears
29
Tx shoulder dislocation
- Reduction ASAP → sling immobilization for 2 wks w/ pendulum exercises and PT
30
What counseling point should you provide pt after reducing shoulder dislocation?
Limited ROM and pain may persist for 4-6 wks
31
________ is the only tx shown to decrease recurrence of shoulder dislocation
Surgery
32
_______ pts have high risk of redislocation of shoulder
Age <21
33
Redislocation of shoulder is associated with ______ and ______
Increased arthritis risk | Further bony deterioration
34
Impingement syndrome is also known as ______
Rotator cuff tendonitis
35
Epidemiology of impingement syndrome
Age >40
36
Clinical presentation of impingement syndrome
- 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
37
Special test that suggests impingement syndrome
+Hawkin's impingement test
38
Imaging for impingement syndrome
MRI b/c X-ray may appear normal
39
_________ are one of the most common causes of impingement syndrome
Partial rotator cuff tears
40
Tx impingement syndrome
- Conservative → activity modification, PT, NSAIDs, steroid injection - Surgery → arthroscopic acromioplasty with coracoacromial ligament release, bursectomy, or debridement/repair of rotator cuff tears
41
Rotator cuff muscles
SITS - Supraspinatus - Infraspinatus - Teres minor - Subscapularis
42
Function of supraspinatus
Abduction
43
What special test is used to assess supraspinatus?
Empty the can test
44
Function of infraspinatus
External rotation from neutral position
45
Function of teres minor
External rotation from 90 deg.
46
Function of subscapularis
Internal rotation
47
Most commonly torn tendon in rotator cuff tear
Supraspinatus
48
Common mechanism of injury of acute rotator cuff tear
- Fall on outstretched arm | - Pulling on shoulder
49
Common mechanism of injury of chronic rotator cuff tear
Repetitive injuries with overhead movement and lifting
50
Presentation of rotator cuff tear
- Weakness or pain with overhead movement - Limited AROM but normal PROM - Night pain/inability to sleep on affected side
51
Imaging for rotator cuff tears
MRI b/c X-ray commonly appears normal High-riding humeral head = supraspinatus tendon tear
52
Tx partial rotator cuff tear
Conservative tx but 40% progress to full-thickness tears in 2 yrs
53
Tx full-thickness rotator cuff tears
- Surgery for young, active pts | - PT option for older, sendentary pts
54
SLAP lesion
Injuries of glenoid labrum at long head biceps attachment
55
Imaging for SLAP lesion
MR arthrogram w/ gadolinium injection → high signal fluid in T2
56
Tx SLAP lesion
- Type I → usually asx and doesn't need tx | - Type II and III → surgical reattachment
57
Adhesive capsulitis is also known as _______
Frozen shoulder
58
Pathophysiology of adhesive capsulitis
Thickening and inflammation of shoulder capsule around glenohumeral joint
59
Epidemiology of adhesive capsulitis
Age 40-65 Women > men Endocrine disorders (DM, thyroid)
60
Clinical presentation of adhesive capsulitis
- Pain with decreased AROM *and* PROM - Strength mostly normal - Usually lasts 24 months
61
Different phases of adhesive capsulitis
- Inflammatory phase → pain out of proportion - Freezing phase → stiffness - Thawing phase → resolution
62
Tx adhesive capsulitis
- Conservative tx | - Surgery (rare)
63
Calcific tendonitis most commonly occurs in _______
Supraspinatus
64
Presentation of calcific tendonitis
- Very painful shoulder triggered by minimal or no trauma - Specific point of pain - Acute onset
65
Tx calcific tendonitis
- Conservative tx | - Arthroscopy with aspiration of mineralized material
66
Epidemiology of humeral fracture
Bimodal distribution → Age 20s male, Age 60s female
67
Clinical presentation of humerus fracture
- Severe pain in mid-arm area - Swelling and ecchymosis - TTP, crepitus
68
Tx humerus fracture
- Functional bracing for non-surgical candidates | - ORIF for moderate-severe displacement or young pt
69
Radiologic signs of elbow fracture
Anterior fat pad sign ("sail sign") Posterior fat pad sign May not see fx immediately, may show up on f/u
70
Suggested X-ray views of elbow
AP External oblique Lateral
71
Treat radial head fracture
- Long arm posterior splint for 3-4 days - Sling for 1-2 wks - Analgesics, gentle ROM, PT - Serial radiographs at 2 wks
72
Epidemiology of supracondylar elbow fx
Age 5-9
73
Tx supracondylar elbow fracture
- Conservative if non-displaced | - ORIF, flexion reduction maneuver
74
Epidemiology of olecranon fracture
Bimodal distribution
75
Clinical presentation of olecranon fracture
- Pain localized to posterior elbow with palpable defect | - Inability to extend elbow
76
Tx olecranon fx
ORIF with tension band or plate/screw fixation
77
Most elbow dislocations are ______
Closed and posterior
78
Mechanism of injury of elbow dislocation
Hyperextension, posterolateral rotatory mechanism
79
Treatment of elbow dislocation
- Closed reduction for simple dislocation - ORIF for complex fracture-dislocation - Long arm posterior splint/sling for 1-2 wks
80
Lateral epicondylitis is also known as _______
Tennis elbow
81
Medial epicondylitis is also known as ______
Golfer's elbow
82
Clinical manifestation of lateral epicondylitis
Pain with resisted wrist extension
83
Clinical manifestation of medial epicondylitis
Pain with resisted wrist flexion
84
Tx epicondylitis
``` Rest Ice cube massages Brace NSAIDs PT Cortisone ```
85
Tx both bones forearm fracture
Sugar-tong splint in ED → Casting for nondisplaced, ORIF for displaced (more common)
86
Greenstick fracture
Incomplete fx of long bone
87
Epidemiology of greenstick fx
Forearm of young child
88
Tx greenstick fx
- Sugar tong splint - Analgesics - Casting for 3-4 wks
89
Buckle fracture is also known as _______
Torus fracture
90
Tx buckle fracture
- Volar splint - Analgesics - Casting x3-4 wks
91
Colles fracture
Fx of distal radial metaphyseal region with DORSAL angulation of distal fragment
92
Tx Colles fx
- 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
Smith fracture
Fracture of distal radius with VOLAR angulation of distal fracture fragment

Clin Med IV - Ortho (7 decks)

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