Upper Extremity part 2

Question 1

Cubital tunnel syndrome

Answer 1

Compression of ulnar nerve at elbow

Caused by trauma, elbow flexed for long periods

Question 2

PE of cubital tunnel syndrome

Answer 2

Pain/paresthesia
Pos Tinels
+elbow flexion test (flex elbows for 60 secs)
Wasting of intrinsic

Question 3

Tx for cubital tunnel syndrome

Answer 3

Bracing

Surgery

Question 4

Olecranon bursitis- causes

Answer 4

Trauma
Inflammation/pressure
Infection
Medical conditions (gout)
Acute or chronic

Question 5

S/sx of olecranon bursitis

Answer 5

Swelling
\+/- pain
\+/- redness
Fluctuant
Dec ROM

Question 6

Tx for non-infected olecranon bursitis

Answer 6

Compression
NSAIDs
Activity modification
Aspiration
Surgery PRN

Question 7

Tx for infected olecranon bursitis

Answer 7

Asp-send off for analysis
Surgical drainage/removal
Abx

Question 8

Components of tennis elbow

Answer 8

Lateral epicondylitis
Overuse injury
Origin of ERCB tendon
Gradual onset of pain
Worse with wrist extension

Question 9

PE of tennis elbow

Answer 9

Localized tenderness
Pain with resisted extension of wrist
Lift object with palm up and palm down (pain)

Question 10

Tx for tennis elbow

Answer 10

Activity modification
Rest
NSAIDs
Elbow strap
PT/stretching
Injection

Question 11

Golfer’s elbow components

Answer 11

Medial epicondylitis
Origin of flexor/pronator muscles
Less common than lateral
Pain with wrist flexion and pronation

Question 12

Nursemaid’s elbow components

Answer 12

Subluxation of the radial head
Very common early childhood injury (1-4)
MOA- pulling/swinging
Annular ligament is weak in young children

Question 13

S/sx of nursemaid’s elbow

Answer 13

Child holds elbow at side
Refuses to move arm
Hard to examine
Dx via X-ray

Question 14

X-ray for nursemaid’s elbow

Answer 14

Radiocapitellar line
Draw a line through the radial neck
Anterior humeral line should bisect the capitellum

Question 15

Reduction maneuver steps for nursemaid’s elbow

Answer 15

Elbow in supination
Pressure on radial head
Gentle traction
Full flexion
Feel click or pop
Immediate relief
Post-reduction films

Question 16

Possible complaints of the AC joint

Answer 16

Prominence/tenting/deformity
Bruising
Pain
Support arm
Pain with cross arm adduction

Question 17

What can aid in an AC joint dx?

Answer 17

Weighted X-rays

Question 18

Type I AC joint

Answer 18

Ligament stretched

Question 19

Type II AC joint

Answer 19

Partial rupture of AC ligaments

Question 20

Type III AC joint

Answer 20

Complete rupture

AC and CC ligaments

Question 21

Type IV AC joint

Answer 21

Clavicle displaced posterior over acromion

Question 22

Type V AC joint

Answer 22

Clavicle displaced just under skin

Question 23

Type VI AC joint

Answer 23

Clavicle underneath coracoid (very rare)

Question 24

Components of rotator cuff tear

Answer 24

Acute or degenerative
MC= supraspinatus
Older pts

Question 25

S/sx of rotator cuff tear

Answer 25

Pain with reaching Nighttime pain Weakness with overhead activities

Question 26

PE of rotator cuff tear

Answer 26

``` Good PROM Dec AROM Pos empty can Pos drop arm test Pos liftoff test Muscle wasting (chronic) ```

Question 27

What do X-rays look like with a rotator cuff tear?

Answer 27

Can be nl or high riding humeral head

Question 28

What is the tx for rotator cuff tear or tendonitis?

Answer 28

``` PT Injections Activity modification Strengthening NSAIDs Surgical repair ```

Question 29

Adhesive capsulitis

Answer 29

Frozen shoulder DM can be a cause Age 40+ Unilateral or bilateral

Question 30

PE of adhesive capsulitis

Answer 30

Loss of both AROM and PROM

Question 31

Tx of adhesive capsulitis

Answer 31

``` NSAIDs PT Home stretching Ice/heat Injection Manipulation ```

Question 32

Impingement

Answer 32

Inflammation of bursa and RTC tendons | When raised- space between acromion and RTC narrows

Question 33

What type of rotation is lost first in adhesive capsulitis?

Answer 33

Internal, then external lost

Question 34

S/sx of impingement

Answer 34

Gradual onset Anterior/deltoid pain Nighttime pain Worse with reaching

Question 35

What are the special tests for impingement?

Answer 35

Hawkins | Neer

Question 36

Subluxation of shoulder

Answer 36

Humeral head partially slips

Question 37

Dislocation of shoulder

Answer 37

Fully slips out of glenoid

Question 38

Characteristics of recurrent subluxation

Answer 38

``` Atraumatic Multi-directional Bilateral Rehab Inferior capsule shift ```

Question 39

PE of recurrent subluxation

Answer 39

Pos sulcus sign Pos apprehension sign General ligament laxity

Question 40

Characteristics of shoulder dislocation

Answer 40

Traumatic Unidirectional Bankart lesion (anterior inferior labrum) Surgery

Question 41

What is the most common kind of shoulder dislocation?

Answer 41

Anterior ANY movement causes pain Axillary nerve defect

Question 42

Characteristics of labrum tear

Answer 42

Superior Labral tear from Anterior to Posterior Painful popping or catching Deep ache "inside" Throwing athletes

Question 43

What is the special test for a labrum tear?

Answer 43

O'Brien

Question 44

O'Brien steps

Answer 44

``` 90 degree forward flexion 20 degrees adduction Pusch down with arm supinated Then with arm pronated Pos- increased pain when pronated ```

Question 45

Tx for labrum tear

Answer 45

``` MR arthrogram- dx NSAIDs PT Activity modifications Surgery ```