Week 3 Flashcards
(35 cards)
which is more common, an anterior or posterior shoulder dislocation?
anterior (95%)
what tests would you use to test if someone has a shoulder dislocation?
apprehension test, AP xray and lateral scapula (glenohumeral) xray. MRI to detect soft tissue injury.
Tx for shoulder dislocation?
reduction, sling 2-4 weeks, PT. Bankart lesion requires surgery (anterior inferior tear of the glenoid labrum).
acromioclavicular joint sprain/separation clinical presentation.
result of downward force to superior acromion while clavicle remains in fixed position. graded by Rockwood classification (1-6 scale w/ 6 most severe)
acromioclavicular joint sprain/dislocation workup
PE and xray
acromioclavicular joint sprain/dislocation management
depends on severity, RICE. 1-3 are typically nonsurgical. 4-6 are typically surgical.
clavicle fracture clinical presentation
direct trauma, swelling, deformity (shoulder sags frward and down), eccymosis, pain. crepitis, pt. unable to raise arm.
clavicle fracture workup
assess neurovascular function (even though it’s rare). you could do this w/ Adson test.
clavicle fracture managment
mild/proximal: rest, sling 3-4 weeks
comminuted mid/proximal w/ displacement: ORIF
lateral epicondylitis of the elbow workup
tennis elbow test (have pt. resist as you push down on the dorsal surface on the hand). xray is often normal. MRI if no improvement in 3 months
lateral/medial epicondylitis of the elbow managment
ice, stretching, counterforce elbow brace, NSAIDs, corticosteroid injections
medial epicondylitis of the elbow workup
golfer’s elbow test (have patient try to flex hand against resistance). xray is often normal. MRI if no improvement in 3 months.
clinical presentation of lateral epicondylitis of the elbow
tenderness of lateral epicondyle (tennis elbow), pain w/ arm and wrist extension.
clinical presentation of medial epicondylitis of the elbow
tenderness of the medial epicondyle (golfer’s elbow), pain w/ pronation and supination and hand flexion.
ulnar collateral ligament injury of the thumb (gamekeeper’s thumb) clinical presentation
partial or complete disruption of the ulnar collateral ligament. pain over ulnar border of the thumb. sometimes there is a lump (stener lesion).
ulnar collateral ligament injury of the thumb workup
xray can be used to ID avulsions. MRI to differentiate full from partial thickness.
ulnar collateral ligament injury of the thumb management
thumb spica cast for 6 weeks for partial tears or non-displaced avulsions. full-thickness tears require surgery.
mallet finger clinical presentation
loss of DIP extension w/ PROM. unopposed flexor digitorum profundus pulls the joint into flexion. soft tissue or boney mallet fingers look similar. DIP rests in flexion.
mallet finger workup
xray hand to find if Fx
mallet finger management
if joint is congruent splint in extension for 8 weeks
meniscal tears clinical presenation
joint line pain w/ deep squatting or duck walk. pain, clicking, locking, antalgic gait. effusion rarely sets in immediately.
meniscal tears workup
McMurray, modified McMurray, or Thessaly can be confirmatory. xray is usually normal, can show joint space narrowing. MRI is best (T2 weighted)
meniscal tears management
analgesics and PT. acute tears can be treated arthroscopically w/ meniscus repair or debridement.
anterior cruciate ligament injury of the knee clinical presentation
audible pop w/ buckling of knee. acute effusion. instability w/ lateral movement/going downstairs. after swelling resolves, pt. can walk w/ stiff knee gait.
