Upper Extremity Talk Flashcards
What is this?
Distal biceps tear
- What is the action of the biceps?
- What deformity is associated with this?
- What test helps dx this?
- What kind of injury is this?
- Indications for surgery? 3
- At what point is the tendon strong enough to lift one lb?
- Which part of the picture is the tendon and which is edema?
- Bicep supinates more than flexes.
- Popeye’s deformity
- Hook test- lateral to medial through the anticubital fossa. theres only one this thats there
- This is an enthesopathy
- Indications for surgery to fix distal biceps tear:
- laborer- screwdrivers, door handles,
- Pain/cramps - popeye deformity
- Cosmetic- girls or skinny guys - Steriods will weaken these. at the three months the tendon is strong enough to lift a 1lb
- 2- white is water, edema. balled up stuff is biceps tendon
What is this?
Tennis/Golf Elbow
- Histology?
- What kind of collagen is this?
- What parts of the elbow do each present on?
- How should we examine it? 3
- Imaging?
- Tx? 3
- If not getting better when do something else?
- Angiofibromistic metaplasia: METAPLASTIC!
- Type 1 collagen- looks like a rope under the microscope
- Tennis is on the outside and golf on the inside
4.
- Feel it/reciprocate the pain
- Tennis -resisted wrist extension
- push down on the long finger
5. don’t really need much imaging but possibly routine plain films
6. TX: - FIRST LINE tx- time and physical therapy 95%
- NSAIDs- metaplastic tissue does get inflamed
- Cortisone injections- fenestrate it- stimulate the body’s natural response- 3 shots
7. If its not getting better after 6-9 months do something else
Surgery- 80%
For soft tissue injuries such tennis elbow and tendonitis what steriod injection should we use?
use betamethasone
What is this?
Olecranon Bursitis
Olecranon Bursitis
- Who gets this?
- What is a bursa?
- DDx? 3
- Why shouldnt you drain it?
- First line?
- If you need to drain, Drain it where?
- Indications for removal? 3
- people who alternate from each elbow.
- Bursa- fluid filled sac- but no room besides the liquid layer.
- DD:
- RA (thicker, have other dz processes, rice bodies),
- septic bursitis,
- lipoma - Made of fluid producing cells so if you drain it will come back.
- COMPRESSION SLEEVE- keeps from irritating and helps drain: FIRST LINE especially for traumatic
- drain right along the triceps, don’t do it on the big bump
- Indications for removal:
- Drain fails
- Nerve damage
- Infection
What could be a complication with draining a olecranon bursitis?
Will turn into a chronic draining sinus. squamous cell carcinoma > chronic tissue necrosis!!!!
What is this?
AKA?
- Radial/Ulnar Nerve palsies
- saturday night palsies- pass out on their arm
- What does the radial nerve innervate for motor?
- Sensory?
- What will the hand look like?
- Radial nerve - extensors-
- sensation to first dorsal web space
- What does the ulnar nerve supply for motor?
- What can you do for PE?
- What will a palsie make the hand look like?
- Ulnar- flexion/deviator -ab/adduction of the hand. little bit of clawing on the pinky
- Push on the pinky
What are the 4 sites of compression for the ulnar nerve/cubital tunnel (2nd most common nerve compression)?
There are five principal locations where the ulnar nerve may be compressed around the elbow:
- Two heads of the Felxor Carpi Ulnaris
- medial intermuscular septum
- cubital tunnel
- Guyon’s canal
Where do we always need to palpate for ulnar palsies?
What tests? 3
- ALWAYS NUMB HERE- push here.
2.
- Tinel’s sign.
- Phalen’s sign- hold their elbow up. 10 seconds to a minute. Minute and a half then its probably not too bad.
- May also be able to feel the nerve dislocate
Indications for fixing the ulnar nerve palsie?
4
Causes? 2
Indications for fixing
- Sublexation/dislocation
- persistant numbness
- instability- can feel nerve clicking
- muscle atrophy
Causes?
- Arhtritis,
- osborns ligament pathology
Where is the site of impingement for Carpal Tunnel/Median Nerve?
- What does the medial nerve supply sensation to? 2
- How will they complain?
- Where should we tap for stimulation?
- What motor actions will they not be able to accomplish?
Most common peripheral nerve compression neuropathy
1.
- radial three digits
- +/- the ring finger-
2. they will say the whole hands numb besides the small finger.
3. Distal the the site of impingement - tap right here for stimualtion
4. Thenar muscle- won’t be able to palmarly adduct. Push against my thumb.