Upper Extremity part 2 Flashcards
Cubital tunnel syndrome
Compression of ulnar nerve at elbow
Caused by trauma, elbow flexed for long periods
PE of cubital tunnel syndrome
Pain/paresthesia
Pos Tinels
+elbow flexion test (flex elbows for 60 secs)
Wasting of intrinsic
Tx for cubital tunnel syndrome
Bracing
Surgery
Olecranon bursitis- causes
Trauma Inflammation/pressure Infection Medical conditions (gout) Acute or chronic
S/sx of olecranon bursitis
Swelling \+/- pain \+/- redness Fluctuant Dec ROM
Tx for non-infected olecranon bursitis
Compression NSAIDs Activity modification Aspiration Surgery PRN
Tx for infected olecranon bursitis
Asp-send off for analysis
Surgical drainage/removal
Abx
Components of tennis elbow
Lateral epicondylitis Overuse injury Origin of ERCB tendon Gradual onset of pain Worse with wrist extension
PE of tennis elbow
Localized tenderness
Pain with resisted extension of wrist
Lift object with palm up and palm down (pain)
Tx for tennis elbow
Activity modification Rest NSAIDs Elbow strap PT/stretching Injection
Golfer’s elbow components
Medial epicondylitis
Origin of flexor/pronator muscles
Less common than lateral
Pain with wrist flexion and pronation
Nursemaid’s elbow components
Subluxation of the radial head
Very common early childhood injury (1-4)
MOA- pulling/swinging
Annular ligament is weak in young children
S/sx of nursemaid’s elbow
Child holds elbow at side
Refuses to move arm
Hard to examine
Dx via X-ray
X-ray for nursemaid’s elbow
Radiocapitellar line
Draw a line through the radial neck
Anterior humeral line should bisect the capitellum
Reduction maneuver steps for nursemaid’s elbow
Elbow in supination Pressure on radial head Gentle traction Full flexion Feel click or pop Immediate relief Post-reduction films
Possible complaints of the AC joint
Prominence/tenting/deformity Bruising Pain Support arm Pain with cross arm adduction
What can aid in an AC joint dx?
Weighted X-rays
Type I AC joint
Ligament stretched
Type II AC joint
Partial rupture of AC ligaments
Type III AC joint
Complete rupture
AC and CC ligaments
Type IV AC joint
Clavicle displaced posterior over acromion
Type V AC joint
Clavicle displaced just under skin
Type VI AC joint
Clavicle underneath coracoid (very rare)
Components of rotator cuff tear
Acute or degenerative
MC= supraspinatus
Older pts
S/sx of rotator cuff tear
Pain with reaching
Nighttime pain
Weakness with overhead activities
PE of rotator cuff tear
Good PROM Dec AROM Pos empty can Pos drop arm test Pos liftoff test Muscle wasting (chronic)
What do X-rays look like with a rotator cuff tear?
Can be nl or high riding humeral head
What is the tx for rotator cuff tear or tendonitis?
PT Injections Activity modification Strengthening NSAIDs Surgical repair
Adhesive capsulitis
Frozen shoulder
DM can be a cause
Age 40+
Unilateral or bilateral
PE of adhesive capsulitis
Loss of both AROM and PROM
Tx of adhesive capsulitis
NSAIDs PT Home stretching Ice/heat Injection Manipulation
Impingement
Inflammation of bursa and RTC tendons
When raised- space between acromion and RTC narrows
What type of rotation is lost first in adhesive capsulitis?
Internal, then external lost
S/sx of impingement
Gradual onset
Anterior/deltoid pain
Nighttime pain
Worse with reaching
What are the special tests for impingement?
Hawkins
Neer
Subluxation of shoulder
Humeral head partially slips
Dislocation of shoulder
Fully slips out of glenoid
Characteristics of recurrent subluxation
Atraumatic Multi-directional Bilateral Rehab Inferior capsule shift
PE of recurrent subluxation
Pos sulcus sign
Pos apprehension sign
General ligament laxity
Characteristics of shoulder dislocation
Traumatic
Unidirectional
Bankart lesion (anterior inferior labrum)
Surgery
What is the most common kind of shoulder dislocation?
Anterior
ANY movement causes pain
Axillary nerve defect
Characteristics of labrum tear
Superior Labral tear from Anterior to Posterior
Painful popping or catching
Deep ache “inside”
Throwing athletes
What is the special test for a labrum tear?
O’Brien
O’Brien steps
90 degree forward flexion 20 degrees adduction Pusch down with arm supinated Then with arm pronated Pos- increased pain when pronated
Tx for labrum tear
MR arthrogram- dx NSAIDs PT Activity modifications Surgery
