Upper Extremity Trauma Flashcards
Arm held in adduction and internal rotation
Prominent coracoid process
Diagnosis:
posterior shoulder dislocation
Arm held in external rotation and slight abduction.
Humeral head usually felt below the coracoid process
Diagnosis:
anterior shoulder dislocation
A known complication of shoulder dislocation
sensation of the skin overlying the deltoid should be evaluated before attempting shoulder reduction.
Axillary nerve palsy
Next best step in suspected dislocated shoulder?
Shoulder x‑ray
AP view & lateral view
*Y view, an x-ray in which the body of the scapula forms the letter “Y” with the coracoid process and the acromion, to confirm dislocation and exclude fracture
Emergent management of shoulder includes:
Immobilization of the joint with a splint/sling
Analgesia
Conservative management: ____
Closed reduction
Surgical management of shoulder dislocation
Indicated:
Unsuccessful closed reduction
(2)
Simultaneously dislocated/fractures of nearby bones
Recurrent shoulder dislocations
Pain on movement that is worsened by overhead activities
Painful arc and movement restriction
Nocturnal exacerbation of pain
Subacromial impingement syndrome
(compression of tissues around the glenohumeral joint)
*Arc: abduction from 60–120°
Associated with diabetes mellitus
Dull shoulder pain & stiffness
Severe restriction of both active and passive range of motion in all planes
Especially: External rotation & Passive abduction
Frozen shoulder (adhesive capsulitis)
inflammation and fibrosis of the joint capsule
SELF RESOLVES
Glucocorticoid injections can lead to __ degeneration and should, therefore, be administered with restraint.
tendon
Rotator cuff tear most commonly affects the ___ tendon
supraspinatus
Sagging of the shoulder
Tenting of the skin
Shortening of the clavicle
Diagnosis & Best initial test
Clavicle fracture
x‑ray in two projections
*Weak pulses: possible injury of the subclavian artery
Distal humerus fracture
____ artery injury is common
Absent radial pulse
Brachial artery
Injuries to the __ nerve and __ artery, which both
cross the elbow, are common complications of
supracondylar fractures.
median
brachial
Distal humerus fracture can affect which 3 nerves?
median
ulnar
radial
Humeral shaft fracture can affect which nerve?
radial
Proximal humerus fracture can affect which nerve?
axillary
↓ Sensation over dorsal hand and posterior arm
indicates damage to which nerve?
radial
↓ Sensation over medial 1 ½ fingers (5th digit and half of the 4th digit) including hypothenar eminence
indicates damage to which nerve?
ulnar
↓ Wrist flexion
↓ Flexion of lateral fingers and ↓ thumb opposition
indicates damage to which nerve?
median
Wrist drop
↓ Grip strength
indicates damage to which nerve?
radial
Radial deviation when wrist is flexed
indicates damage to which nerve?
ulnar
usually 2/2 Fall onto an outstretched hand
Risk factor → Osteoporosis
indicates damage to which nerve?
distal radius fracture
The __(bone) should be realigned to its normal position after fracture reduction.
radius
Most common carpal bone fracture
Scaphoid fracture
History of Foosh; hyperextended
Pain over anatomical snuffbox
Painful pinching & grasping
Scaphoid fracture
(get an X-ray +/- ulnar deviation)
*displaced fractures > 1 mm = surgery
__ fractures are often undetectable on the initial x-ray.
Scaphoid
*If negative → cast the wrist & repeat an x-ray in 10–14d
2 complications of Scaphoid fracture
Avascular necrosis
Nonunion
First sign: pain on passive extension of the affected tendon
Swelling
Palpable crepitation
diagnosis:
Tenosynovitis
Risk factors of Tenosynovitis:
____
sarcoidosis
DM
rheumatoid arthritis
Locking of a finger in flexed position which releases suddenly with a snap/pop on extension; often painful
tenderness and a palpable nodule
Stenosing tenosynovitis
Trigger finger
Noninflammatory thickening of the tendons of the abductor pollicis longus and extensor pollicis brevis
due to MYXOID degeneration
De Quervain tenosynovitis
Pain +/- swelling of the radial styloid (lateral).
(+) Finkelstein test: grip thumb and pull across the palm towards ulnar side causes pain
De Quervain tenosynovitis
De Quervain tenosynovitis is 2/2 ___ degeneration
Myxoid
Treatment of Tenosynovitis:
Conservative management (first-line)
NSAIDs
___
Intervention (if refractory)
___ into the tendon sheath
Splinting (immobilization)
glucocorticoid injection
Treatment of INFECTIOUS tenosynovitis:
Abxs
___
I & D
w/ debridement of necrotic/infected tissue
