Upper Extremity Trauma Flashcards

1
Q

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

A

posterior shoulder dislocation

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2
Q

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

A

anterior shoulder dislocation

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3
Q

A known complication of shoulder dislocation

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

A

Axillary nerve palsy

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4
Q

Next best step in suspected dislocated shoulder?

A

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

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5
Q

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

Conservative management: ____

A

Closed reduction

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6
Q

Surgical management of shoulder dislocation
Indicated:

Unsuccessful closed reduction
(2)

A

Simultaneously dislocated/fractures of nearby bones

Recurrent shoulder dislocations

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7
Q

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

A

Subacromial impingement syndrome

(compression of tissues around the glenohumeral joint)

*Arc: abduction from 60–120°

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8
Q

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

A

Frozen shoulder (adhesive capsulitis)

inflammation and fibrosis of the joint capsule
SELF RESOLVES

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9
Q

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

A

tendon

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10
Q

Rotator cuff tear most commonly affects the ___ tendon

A

supraspinatus

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11
Q

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

A

Clavicle fracture
x‑ray in two projections

*Weak pulses: possible injury of the subclavian artery

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12
Q

Distal humerus fracture
____ artery injury is common
Absent radial pulse

A

Brachial artery

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13
Q

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

A

median

brachial

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14
Q

Distal humerus fracture can affect which 3 nerves?

A

median
ulnar
radial

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15
Q

Humeral shaft fracture can affect which nerve?

A

radial

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16
Q

Proximal humerus fracture can affect which nerve?

17
Q

↓ Sensation over dorsal hand and posterior arm

indicates damage to which nerve?

18
Q

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

19
Q

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

20
Q

Wrist drop
↓ Grip strength
indicates damage to which nerve?

21
Q

Radial deviation when wrist is flexed

indicates damage to which nerve?

22
Q

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

A

distal radius fracture

23
Q

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

24
Q

Most common carpal bone fracture

A

Scaphoid fracture

25
History of Foosh; hyperextended Pain over anatomical snuffbox Painful pinching & grasping
Scaphoid fracture (get an X-ray +/- ulnar deviation) *displaced fractures > 1 mm = surgery
26
__ fractures are often undetectable on the initial x-ray.
Scaphoid *If negative → cast the wrist & repeat an x-ray in 10–14d
27
2 complications of Scaphoid fracture
Avascular necrosis | Nonunion
28
First sign: pain on passive extension of the affected tendon Swelling Palpable crepitation diagnosis:
Tenosynovitis
29
Risk factors of Tenosynovitis: ____ sarcoidosis DM
rheumatoid arthritis
30
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
31
Noninflammatory thickening of the tendons of the abductor pollicis longus and extensor pollicis brevis due to MYXOID degeneration
De Quervain tenosynovitis
32
Pain +/- swelling of the radial styloid (lateral). | (+) Finkelstein test: grip thumb and pull across the palm towards ulnar side causes pain
De Quervain tenosynovitis
33
De Quervain tenosynovitis is 2/2 ___ degeneration
Myxoid
34
Treatment of Tenosynovitis: Conservative management (first-line) NSAIDs ___ Intervention (if refractory) ___ into the tendon sheath
Splinting (immobilization) glucocorticoid injection
35
Treatment of INFECTIOUS tenosynovitis: Abxs ___
I & D w/ debridement of necrotic/infected tissue