Wells - UE Flashcards
what is the soc dx for rotator cuff tear
MRI
what is the 1st line surgical tx for rotator cuff tear
arthroscopy
what is the last muscle movement to return after rotator cuff repair
internal rotation → tucking in shirt
a person is only allowed __ rotator cuff repairs in their lifetime
2
what is the non operative tx for rotator cuff injuries
- PT bid x 2 weeks
- NSAIDs → make sure no contraindications!!
what UE injury might a dry waller have who complains of a painful arc
impingement syndrome
what are the tests for impingement syndrome
neers
hawkins
steroid + lidocaine injections can be __ for impingement syndrome
diagnostic
for impingement syndrome, should you image or treat first
treat first
what surgery may be required or severe/acromial hook impingement syndrome
acromioplasty
what is the tx for a grade I-III AC separation
conservative
what is the test for biceps tendonitis
speeds
which type of instability is way more common in a shoulder dislocation
anterior
what is the test for shoulder dislocation
apprehension test
+/- sulcus sign
what must you do when reducing a shoulder dislocation
pre and post reduction films
what might you suspect if you see hill sachs lesion, bankhart lesion, and axillary nerve injury
complications of shoulder dislocation
what is an axillary n lesion
complication of humeral neck fx
what 2 muscles are paralyzed in an axillary n lesion
deltoid
teres minor
what does this injury make you think
axillary n lesion → delta atrophies rapidly
what is a hill sach’s lesion/fx
complication of shoulder dislocation → cortical depression in posterolateral head of humerus
what is this xray showing
hill-sachs lesion
what is a bankhart lesion
complication of shoulder dislocation → injury of anterior (inferior) labrun of shoulder
what is this xray showing
bankhart lesion
→ can have bony (glenoid) and/or soft tissue (labrum) trauma
what is a SLAP lesion
superior labral anterior posterior
what might you think when a pt complains of “painful catching or clicking” in the shoulder
SLAP lesion
what is the gold standard if you suspect a labral tear (ex SLAP lesion)
MRI arthrogram
what type of imaging is this and what is it showing
MRI arthrogram → causes tear to glow
SLAP lesion/torn labrum
what injury might you suspect if a pt complains of acute pain w. lifting/bench pressing and you see bruising and declivity in the muscle
pectoralis major rupture
4 key points for fractures
- when in doubt → xray and refer!
- peds: low threshold for referral
- pain, pallor, pulselessness → emergent surgery required
- delayed healing in smokers, DM, high altitude
humerus fx are usually caused by __;
think what pt population
fall
osteoporotic women
what is this called, and what injury does it make you think of
bicep muscle/tendon rupture
what is the tx for bicep muscle/tendon rupture
surgery per ortho
which recovery takes longer, RC tear or SLAP lesion
SLAP lesion
what education would you give a pt about recovery for lateral epicondylitis (tennis elbow)
hard to treat
long time to heal
for lateral epicondylitis, cortisone injxns and surgery are
a last resort
medial epicondylitis (golfers elbow) is caused by what type of injury
pronation injury
what are symptoms of ulnar n subluxation
chronic pain
paresthesias
electric shock
weakness
what injury does tommy john surgery treat
cubital tunnel syndrome (ulnar n subluxation)
what is the mc location for olecranon bursitis
radial head
what do the fat pad and sail signs make you think of
joint effusion → olecranon bursitis
have a low threshold for xray if there is
a traumatic event
what is the tx for elbow fx
splint and sling vs ORIF
what is the mc pediatric fx
supracondylar
what is the main concern with peds supracondylar fx
growth plate/vessel/nerve damage → must ensure proper healing
what injury is characterized by entrapment of the anular ligament
nursemaid’s elbow
what is the mc FOOSH injury
distal radius fx
what does “dinner fork deformity” make you think of
distal radius fracture
what xray is best to see the carpal bones
oblique
what is the tx for distal radial fx’s
- splint
- recheck
- cast
- sugar tong x 6 weeks
- short cast
what position functions should you test after casting a radial fx
hold a can of soda
avoid extreme flexion/extension/radial/ulnar deviation positioning
what must you test after radius fx casting (besides position fxn)
neurovascular fxn at finger tips
what injury do you think of when a pt c.o pain over the anatomic snuff box
scaphoid fx
what xray should you order for a scaphoid fx
scaphoid view → ulnar deviation of wrist
what injury is this
scaphoid fx
what is the tx for a scaphoid fx
- xray
- even if negative xray → thumb spica splint
- re-xray in 1 week
what is a major complication of a scaphoid fx
avascular necrosis dt backwards vasculature
what injury is associated w. the terry thomas sign
wrist ligamentous injury
in a wrist ligamentous injury, if the xray is negative but the pt has pain over the carpal ligaments/cartilage, what test should you order
MRI arthrogram
what imaging is good to show soft tissue injury
MRI arthrogram
what test would show nerve compression w. a ganglion cyst
allen test
which n is compressed in carpal tunnel syndrome
median n
what injury would you suspect if a pt c.o pain in the front of the wrist and numbness or tingling into the thumb, index, middle, and ½ of ring finger
carpal tunne syndrome
what imaging should you order if a pt’s hx is consistent w. CTS and their symptoms are not improving w. conservative tx
EMG/NCVS
what is a major concern w. CTS
atrophy or nerve death
what injury is very common in new moms
De Quarvain’s tenosynovitis
what test would you use if you suspect deQuarvain’s tenosynovitis
Finkelstein
which type of tendon injury is more concerning
flexor → needed for grip
what is the tx for mallet finger
must tx w. stack spint x 6 weeks for 24 hr/day
what happens if the pt w. mallet finger removes a stack splint too early and the finger tip drops
must start all over again (6 weeks, 24 hr/day)
what is the mc location for duputreyn’s contracture
4th and 5th fingers
what is the tx for trigger finger injury
hand surgeon for tendon sheath release
what is the moi of a butonniere deformity
jam injury
in a butonniere deformity, the PIP is __
and the DIP is __
flexed
extended
what is the tx for a boutonniere deformity
figure 8 splint
in a swan injury, the PIP is __
and the DIP is __
hyperextended
flexed
what is no man’s land
the palm of the hand
what is the tx for a palm laceration
local block
clean it out
refer to hand surgeon immediately!!
Bouchard’s nodes are in the
PIP
heberdons nodes are in the
DIP
what is the mc location for early OA
thumb: basilar joint/CMCJ
what is the tx for CMCJ OA
- conservative tx
- if conservative tx fails → LRTI (ligament reconstruction and tendon interposition)
what injury occurs in skiers thumb
stretch or lateral tear of the ulnar collateral ligament
what are 5 important considerations for non surgical fx recovery
- intraarticular is always a more complicated recovery
- early intervention w. PT/OT is vital
- threaten pt’s to stop smoking so they can heal
- splint fx for 1st 1-3 days → THEN cast when swelling has gone down
- RICE is your friend
proximal blocks are done by
anesthesia
we will use __ blocks regularly
digital
radiculopathy from an impinged n root can mimic
joint pain
nerve pain can cause
weakness
cervical spine pain can mimic
shoulder pain
