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MM1 Leesy > B6.085 - Common Pathologic Conditions of Upper Extremity > Flashcards

B6.085 - Common Pathologic Conditions of Upper Extremity Flashcards

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1
Q

Dupuytrens contracture

A

relatively common disorder characterized by progressive fibrosis of palmar fascia with an unknown etiology

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2
Q

associations with dupuytrens contracture

A

northern european genetics smoking drinking DM thyroid disease >50 yo M>F repetitive palmar trauma w vibration

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3
Q

clinical dx of dupuytrens contracture

A

gradual onset begins as one or more smaller tender lumps on palm pain resolves w time, nodules thicken and contract tough bands of tissue may form may result in loss of full extension 4th and 5th fingers commonly affected

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4
Q
A

dupuytrens contracture

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5
Q

tx for dupuytrens contracture

A

mild - padding, steroid injection

progressive - surgical removal of fibrotic adhesions, steroid injection

injection of clostridia histolyticum collagenased <50 degrees

minimal surgical lysis of adhesions has also been done

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6
Q

mallet finger deformity

A

injury frequentyl acquired when attempting to catch a ball and impact causes sudden flexion of DIP of an extended finger

most common closed tendon injury of finger

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7
Q

mechanically what is mallet finger

A

traumatic disruptio of terminal slip of extensor tendon at distal interphalangeal (DIP) joint

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8
Q

treatment of mallet finger

A

splinting 6-8 weeks if uncomplicated, immobilization with slight hyperextension 5-15 degrees

comlicated injuries require referral and likely surgical repair

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9
Q
A

mallet finger

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10
Q

jammed finger

A

prolonged swelling of proximal interphalangeal joint after an axial loading force

diagnosis of exlusion

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11
Q

signs of more serious injury than jammed finger

A

deformity

significant swelling

significant bruising

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12
Q

treatment of jammed finger

A

conservative management, early ROM important

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13
Q

trigger finger

A

the flexor tendon catches in what is called the first annular (A1) pully of the MCP causing a snapping, catching or locking when flexing finger

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14
Q

features of trigger finger

A

pain in palm at entrance to flexor tendon sheath

usually worse in AM improving throughout day

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15
Q

risk factors of trigger finger

A

DM, age, female

dx is clinical

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16
Q

treatment for trigger finger

A

conservative - splinting, NSAIDs, modify repetitive activity

Injection of steroids

surgery if conservative fails, release of A1 pully

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17
Q
A

trigger finger

flexor tendon catches on what is called A1 first annular MCP

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18
Q

gamekeepers thumb

A

forced abduction of the thumb can result in rupture of ulnar collateral ligament

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19
Q

exam for gamekeepers thumb

A

tenderness overlying the ulnar aspect of the MCP joint of the thumb

swelling

laxity of 30-40 degrees more than the uninjured thumb measured in neutral and 30 degrees of flexion are strongly suggestive of a complete ulnar collateral ligament tear

no end point in radial deviation of the phalanx

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20
Q

test for gamekeepers thumb

A

stressing ulnar collateral ligament of MCP joint

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21
Q

treatment of gamekeepers thumb

A

thumb spika cast or splint

may need surgical referral if there is avulsion fracture

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22
Q

carpal tunnel syndrome

A

nocturnal parasthesia worsened by gripping activities like holidng a phone, gripping steering wheel, writing

weakness of grip

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23
Q

risk factors for carpal tunnel

A

female

pregnancy

DM

obesity

RA

hypothyroid

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24
Q

what type of neuropathy is carpal tunnel

A

median nerve neuropathy

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25
describe carpal tunnel as it relates to anatomy
unique anatomy of the median nerve as it passes through the "carpal tunnel", increased pressure in this confined area can lead to nerve compression and subsequent neuropathy overuse syndromes seem to cause edema and lead to compression
26
testing for carpal tunnel
tinel test (TAP) , phalen test (FLAP)
27
what is the tinel test
test for carpal tunnel examiner taps over the wrist at the point where the median nerve passes through tapping creates electric or sharp pain and tingling in hand, 50% sn 77% sp
28
what is the phalen test
patient flexes wrists with the elbows raised and the backs of the hands pressed together for 1 minute positive is pain or tingling in median nerve distribution sn 68% 73%sp
29
confrimatory testing for carpal tunnel
electromyography or nerve conduction studies not absolutely needed until surgery is a consideration imaging is generally not useful in providing additional information
30
treatment for carepal tunnel
conservative Night bracing ice rest NSAIDs steroid injections surgical release sono guided techniques, open surgical
31
ulnar neuropathy at the wrist
compression of ular nerve at wrist clasically seen in cyclists due to pressure from handlebars
32
treatment for ulnar nerve neuropathy
padding, gloves or handlebars NSAIDs Ice
33
scaphoid fracture
scaphoid most commonly fractured bone in wrist
34
avascular necrosis of proximal scaphoid
complication of even the smallest amount of displacement in scaphoid fracture blood supply from scaphoid comes from radial artery, feeding the bone on the dorsal surface near tubercle and scaphoid waist. Because the proximal portion has no direct blood supply, nonunion caused by poor blood supply is an important complication of scaphoid fracture
35
treatment and dx of avascular necrosis of proximal scaphoid
surgical treatment recommended can be difficult to diagnose, snuffbox tenderness most sensitive (90%) scaphoid tubercle tenderness 87% sn, 57% sp high index of suspicion with tenderness and negative x ray
36
avascular necrosis of proximal scaphoid
37
scaphoid fracture
38
nursemaids elbow
radial head dislocation usually due to pulling small childs arm history is key child with arm held limp and partially flexed
39
exam for nursemaids elbow
apprehensive inspection frequently unremarkable palpation shows tenderness over lateral aspect (radial head) ROM - wait until x rays
40
nursemaids elbow reduction
apply pressure at radial head grasp wrist and apply slight traction supinate wrist while flexing elbow to 90 degrees
41
medial epicondylitis and lateral epicondylitis
repetitive motion with either extension (lateral) or flexion (medial)
42
predisposing factors to epicondylitis
age 45-50 smoking obesity
43
what is the difference between tendititis and tendinosis
tendinitis is inflammation of the tendon and results from micro tears and tendinosis is a degenration of the tendons collagen in response to chronic overuse
44
presentation of epicondylitis
pain with tenderness at insertion of tensions on epicondyle
45
presentation of lateral epicondylitis
pain with resisted extension at wrist, supination of hand
46
presentation of medial epicondylitis
pain with resisted flexion of wrist and pronation of hand
47
treatment for epicondylitis
conservative splinting, activity modification, counterforce bracing, NSAIDs, physical therapy, surgery last resort
48
49
describe examination of the shoulder
inspect symmetry palpate Acromion, AC joint, coracoid, major bones ROM
50
anatomy of rotator cuff
SItS Supraspinatus Infraspinatus teres minor Subscapularis
51
what does the supraspinatus do
inn by suprascapular n abducts arm initially before action of deltoid most common rotator cuff injury empty can test
52
what does infraspinatus do
inn by suprascapular n externally rotates arm pitching injury
53
what does teres minor do
inn by axillary n adducts and externally rotates arm
54
what does subscapularis do
inn by upper and lower subscapular nerves internally rotates and adducts arm push away test
55
special tests for supraspinatus
empty can test active painful arc test - moving arm through abduction, + if pain past 90 degrees drop arm test - lowering arm from full abduction not smooth and coordinated
56
special tests for infraspinatus/ teres minor
external rotation - isometric ER, patient presses against examiners hand
57
special test for subscapularis
internal rotation - assessed using the push off test painand weakness is positive
58
empty can test
supraspinatus test arm held at 90 degrees of abduction and 30 degrees forward flexion. Then internally rotating completely with thumb pointing down pain without weakness indicates tendinopathy pain with weakness indicates tear
59
AC separation
common injury in sports resulting in player hitting shoulder while arm is adducted wiht downard force AC joint injuries are about 10% of shoulder injuries
60
treatment fro AC separation
Type 1-2 managed conservtively 3 judgement call 4-6 need surgical reduction and repair
61
grading AC separation
type 1 AC separation - ligament sprain, joint intact 2 - AC ligament torn, CC intact 3 - Both AC and CC torn, joint dislocated 4 - 6 - above plus displacement of distal clavicle
62
subacromial bursitis
can be from trauma, overuse, inflammatory, infection need to differentiate infection, aspirate bursa, imaging usually not needed
63
management of subacromial bursitis
infection - hospitalization conservatively
64
adhesive capsulitis
frozen shoulder condition causing pain and limited ROM of shoulder causes largely unknown spontaneous resolution usually risk fx - \>40, F, DM
65
3 stages and presentation of adhesive capsulitis
painful, adhesive, recovery gradually increasing pain and stiffness without cause, initial phase can last 3-9 months. exam may have muslce spasms and decreased ROM without focal tenderness tx - supportive and conservative
66
calcific tendinopathy
calcific tendinitis of the shoulder as an acute or chronic painful condition due to the presence of calcific deposits inside or around the tendons of the rotator cuff; more specifically, it s caused by depositon of calcium hydroxyapatite crystals commonly within the supraspinatus and infraspinatus tendons
67
exam for calcific tendinopathy
pain with active abduction, passive has minimal tenderness. Impingement less frequently positive imaging is confirmatory
68
tx for calcific tendinopathy
supportive, conservative steroid injection ESWT can help break up calcifications surgery for refractory causes
69
impingment
hawkins kennedy test is used to test for it as well as passive painful arc test
70
hawkins kennedy test
clinician stabilizes shoulder with one hand and the patients elbow flexed at 90 degrees then passiveley internally rotates the shoulder using the other hand. Pain is positive
71
passive painful arc test
passively raising arm in flexion while holding the shoulder from shrugging. pain is positive
72
rotator cuff tear dx and tx
may need imaging for dx (MRI) trial of conservative treatment (rest, PT, NSAIDs, injection) ortho referral for refractory cases immediate ortho if acute traumatic injury with full thickness tears
73
rotator cuff exercises
once daily start with light weights (1-2 lbs) work up to 30 reps, warm up, ice after
74
supraspinatus rotator cuff tear signs
tender to palpation of subacromion tegion supraspinatus test (empty can)
75
tx for rotator cuff injury
PT, steroid injection, surgery

MM1 Leesy (6 decks)

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