Upper Extremity Trauma

Question 1

Arm held in adduction and internal rotation
Prominent coracoid process
Diagnosis:

Answer 1

posterior shoulder dislocation

Question 2

Arm held in external rotation and slight abduction.
Humeral head usually felt below the coracoid process
Diagnosis:

Answer 2

anterior shoulder dislocation

Question 3

A known complication of shoulder dislocation

sensation of the skin overlying the deltoid should be evaluated before attempting shoulder reduction.

Answer 3

Axillary nerve palsy

Question 4

Next best step in suspected dislocated shoulder?

Answer 4

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

Question 5

Emergent management of shoulder includes:
Immobilization of the joint with a splint/sling
Analgesia

Conservative management: ____

Answer 5

Closed reduction

Question 6

Surgical management of shoulder dislocation
Indicated:

Unsuccessful closed reduction
(2)

Answer 6

Simultaneously dislocated/fractures of nearby bones

Recurrent shoulder dislocations

Question 7

Pain on movement that is worsened by overhead activities
Painful arc and movement restriction
Nocturnal exacerbation of pain

Answer 7

Subacromial impingement syndrome

(compression of tissues around the glenohumeral joint)

*Arc: abduction from 60–120°

Question 8

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

Answer 8

Frozen shoulder (adhesive capsulitis)

inflammation and fibrosis of the joint capsule
SELF RESOLVES

Question 9

Glucocorticoid injections can lead to __ degeneration and should, therefore, be administered with restraint.

Answer 9

tendon

Question 10

Rotator cuff tear most commonly affects the ___ tendon

Answer 10

supraspinatus

Question 11

Sagging of the shoulder
Tenting of the skin
Shortening of the clavicle
Diagnosis & Best initial test

Answer 11

Clavicle fracture
x‑ray in two projections

*Weak pulses: possible injury of the subclavian artery

Question 12

Distal humerus fracture
____ artery injury is common
Absent radial pulse

Answer 12

Brachial artery

Question 13

Injuries to the __ nerve and __ artery, which both
cross the elbow, are common complications of
supracondylar fractures.

Answer 13

median

brachial

Question 14

Distal humerus fracture can affect which 3 nerves?

Answer 14

median
ulnar
radial

Question 15

Humeral shaft fracture can affect which nerve?

Answer 15

radial

Question 16

Proximal humerus fracture can affect which nerve?

Answer 16

axillary

Question 17

↓ Sensation over dorsal hand and posterior arm

indicates damage to which nerve?

Answer 17

radial

Question 18

↓ Sensation over medial 1 ½ fingers (5th digit and half of the 4th digit) including hypothenar eminence
indicates damage to which nerve?

Answer 18

ulnar

Question 19

↓ Wrist flexion
↓ Flexion of lateral fingers and ↓ thumb opposition
indicates damage to which nerve?

Answer 19

median

Question 20

Wrist drop
↓ Grip strength
indicates damage to which nerve?

Answer 20

radial

Question 21

Radial deviation when wrist is flexed

indicates damage to which nerve?

Answer 21

ulnar

Question 22

usually 2/2 Fall onto an outstretched hand
Risk factor → Osteoporosis
indicates damage to which nerve?

Answer 22

distal radius fracture

Question 23

The __(bone) should be realigned to its normal position after fracture reduction.

Answer 23

radius

Question 24

Most common carpal bone fracture

Answer 24

Scaphoid fracture

Question 25

History of Foosh; hyperextended
Pain over anatomical snuffbox
Painful pinching & grasping

Answer 25

Scaphoid fracture

(get an X-ray +/- ulnar deviation)

*displaced fractures > 1 mm = surgery

Question 26

__ fractures are often undetectable on the initial x-ray.

Answer 26

Scaphoid

*If negative → cast the wrist & repeat an x-ray in 10–14d

Question 27

2 complications of Scaphoid fracture

Answer 27

Avascular necrosis

Nonunion

Question 28

First sign: pain on passive extension of the affected tendon
Swelling
Palpable crepitation
diagnosis:

Answer 28

Tenosynovitis

Question 29

Risk factors of Tenosynovitis:
____
sarcoidosis
DM

Answer 29

rheumatoid arthritis

Question 30

Locking of a finger in flexed position which releases suddenly with a snap/pop on extension; often painful
tenderness and a palpable nodule

Answer 30

Stenosing tenosynovitis

Trigger finger

Question 31

Noninflammatory thickening of the tendons of the abductor pollicis longus and extensor pollicis brevis
due to MYXOID degeneration

Answer 31

De Quervain tenosynovitis

Question 32

Pain +/- swelling of the radial styloid (lateral).

(+) Finkelstein test: grip thumb and pull across the palm towards ulnar side causes pain

Answer 32

De Quervain tenosynovitis

Question 33

De Quervain tenosynovitis is 2/2 ___ degeneration

Answer 33

Myxoid

Question 34

Treatment of Tenosynovitis:
Conservative management (first-line)
NSAIDs
___

Intervention (if refractory)
___ into the tendon sheath

Answer 34

Splinting (immobilization)

glucocorticoid injection

Question 35

Treatment of INFECTIOUS tenosynovitis:
Abxs
___

Answer 35

I & D

w/ debridement of necrotic/infected tissue