Ch.38 Upper Extremity Flashcards
(153 cards)
1
Q
What rehab should be done in the acute stage of injury?
A
RICE, cardio that doesn’t involved affected limb, gental ROM, stablization exercises
2
Q
What can be done for pain in acute injury?
A
Cryotherapy, E-stim, NSAIDs, tylenol, opiods, oral/injected steroids
3
Q
When can a patient advance to the recovery phase of rehab?
A
When pain is controlled and tissue healing occured
4
Q
What is the emphasis of recovery rehab?
A
Restoration of flexibility, strength and proprioception of injured limb
5
Q
Open kinetic chain exercises should be used for __.
A
Correcting strength imbalances
6
Q
Closed kinetic chain execises should be used for __.
A
provide joint stabilization throught muscle co-contraction
7
Q
When can a patient advance to the functional phase of rehab?
A
Injured limbe gained 80% of strength compared to normal limb and not flexibility imbalances
8
Q
What is addressed in functional rehab?
A
maladaptive movement patterns, muscle subsitution and full strength obtained
9
Q
2/3 of sternoclavicular joint dislocations are __.
A
Anterior
10
Q
Grade I Sternoclavicular Sprain
A
Tenderness to palpation w/o joint laxity
11
Q
Grade II Sternoclavicular Sprain
A
Tenderness to palpation w/ joint laxity w/ a good endpoint
12
Q
Grade III Sternoclavicular Sprain
A
Tenderness to palpation w/ significant joint laxity and no endpoint
13
Q
Tx of Grade I & II Sternoclavicular Sprain
A
nonoperative, sling immbolization for comfort in acute phase, rehab
14
Q
When can patient return to activity with sternoclavicular sprain?
A
Grade I: 1-2 weeks, Grade II: 4-6 weeks
15
Q
Tx of Grade III Sternoclavicular Sprain
A
Can be nonoperative but recuires surgery if unstable or for mediastinal compression
16
Q
80% of clavicle fractures occur __.
A
at middle 1/3 of clavicle
17
Q
Tx of clavicle fx in good alignment
A
immobilization in sling or figure of eigh bandage
18
Q
When should surgery be considered for clavicle fx?
A
15-20mm shortening, ope fx, neuovascular compromise or tenting of skin
19
Q
What are teh Rockwood classifications of AC joint sprains?
A
I: sprain AC ligaments
II: tear AC & sprain CC ligaments
III: tear both AC & CC ligaments IV: III plus posterior displacement of distal clavicle into trapezius V: IV plus rupture of deltotrapezial fascia VI: V plus displacement of clavicle below acromion or coracoid process
20
Q
Tx of type I & II AC joint sprains
A
nonoperative and rehab
21
Q
Tx of type III AC joint sprains
A
no-op unless persistent pain, comestic or heavy labors and athletes
22
Q
Tx of type IV-VI AC joint sprains
A
Surgery
23
Q
How does osteolysis of the distal clavicle develop?
A
repetive overloading: bech press or military press lifts
24
Q
What is the hx of osteolysis of the distal clavicle?
A
Gradual onset AC joint pain increased with overhead or bench presses, esp when bar lowered to chest
25
What are the pathologic changes on Xray for oteolysis?
distal clavicular subchondral bone loss and cystic changes
26
Tx of distal clavicle osteolysis
avoidance of aggraviting activities, rehab, steroid injection to AC joint, distal clavicle resection
27
What is does a loud grating scapulothoracic crepitus indicate?
Bursitis, fibrotic/atrophic muscle, anomal muscular insertions
28
What is does a loud snapping scapulothoracic crepitus indicate?
Boney pathology: osteophyte, rib/scapular osteochondroma/fx
29
What are the Neer classications of rotator cuff injury?
I: Inflammation & edema of cuffs II: Fibrosis & tendonitis of cuffs III: partial or complete tear of cuff
30
What are the Bigliani classifications of acromion shapes?
I: flat, II: curved, III: hooked
31
What augments rotator cuff contact to posteriorsuperior glenoid rim?
anterior glenohumeral head instability and posterior glenohumeral head capsular tightness
32
Rotator cuff impingement can be caused by:
hooked acromion, thick coracoacromial ligament, glenohumeral joint instability, scapulothoracic dyskinesis and instability
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What stage of throwing can cause microtrauma to rotator cuffs due to eccentric overload?
External rotators during decceleration phase
34
Rotator cuff muscle strengthening should begin with:
closed chain exercises to promote stability and proprioception
35
Open chain exercises should be used rotator cuff disorders to __.
Correct strength imbalance of shoulder ER relative to IR
36
Hx of long head biceps tendon ruputure
>40yo, hx of rotator cuff dz, "pop" at injury, during lifting or pulling
37
Best imaging for biceps tendon rupture
MRI or US
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Tx of biceps tendon rupture in >40yo or sedentary pt
Sling for compfort, strengthen shoudler girdle and rotator cuff muscles
39
Tx of biceps tendon rupture in young active pt
Surgery
40
MCC of pectoralis major strain
forceful shoulder adduction & IR (weight lifters & football players)
41
What muscle is important for anterior and posterior glenohumeral joint stability?
Subscapularis
42
What is the most frequent type of unidirectional glenohumeral joint instability?
Traumatic anterior instability
43
What is multidirectional glenohumeral joint instability due to?
Congenital capsular laxity (Marfans or EDS) or chronic repetitive microtrauma
44
What is a Bankhart lesion?
avulsion of anterior-inferior glenoid labrum w/ or w/o bone from glenoid rim
45
What's a SLAP lesion?
Superior labral anterior to posterior lesion
46
What is a Hill-Sachs defect?
compression fx of posterolateral aspec of humeral head from anterior humeral dislocation
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What is a reverse Bankhart lesion?
Tear of the posterior inferior glenoid labrum causing separation from the glenoid fossa rim
48
What are common sx of shoulder subluxation?
Burning or dead feeling in arm
49
How can an Hill-Sachs defect bee seen on X-ray?
AP view with shoulder IR and Stryker Notch view
50
What does the scapular Y view on xray show?
Assess glenohumeral joint alignment
51
What does the axillary lateral view show on xray?
Anterior or posterior subulxation or dislocation and fx of glenoid rim
52
What are the best views for Bankhar lesion on xray?
Garth view and West Point view
53
What patient has a high rate of redislocation after first time shoulder dislocation?
Young active patient, require surgery
54
When should shoulder immbolization be done after dislocation?
First 24 hrs, then 3 weeks with humer ER 30 deg. if not done in the first day benefits not significant
55
What conditions are associated with adhesive capsulitis?
DM, inflam arthritis, trauma, prolonged immobilization, thydroid dz, CVA, MI, autoimmune dz
56
Sx of adhesive capsulitis in Stage I
Painful and restricted ROM in first 1-3 mo
57
Sx of adhesive capsulitis in Stage II
Painful ROM, progressive loss of glenohumeral motion (3-9 mo)
58
Sx of adhesive capsulitis in Stage III
"Frozen stage": Reduced pain w/ shoulder movement, severely restricted glenohumeral ROM (9-15 mo)
59
Sx of adhesive capsulitis in Stage IV
"Thawing stage": Minimal pain, progressive normalization of ROM (15-24 mo)
60
Type 1 SLAP lesion
fraying of superior labrum w/o detached biceps tendon
61
Type 2 SLAP lesion
Bicep tendon detached from supraglenoid tubercle
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Type 3 SLAP lesion
Bucket handle tear of superior labrum w/o detachment of biceps tendon
63
Type 4 SLAP lesion
Tear of superior labrum extends to biceps tendon
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What exam finding can indicate SLAP lesion?
Postive O'Brien test
65
What is the gold standard for dx of SLAP lesion?
Arthroscopy
66
What imaging is used to dx SLAP lesion?
Gadolinium-enhanced MRI
67
Which tendon is MC involved in lateral epicondylosis?
Extensor carpi radialis brevis
68
What disorder can mimic lateral epicondylosis?
PIN syndrome
69
What exercise regimen should be used for tx of lateral epicondylosis?
Eccentric stengthening of wrist extensors
70
What are the MC involved tendons in medial epicondylosis?
Pronator teres and flexor carpi radialis
71
What can be seen on X-ray in Lateral/Medial epicondylosis?
punctuate calcifications at tendon origin
72
Exercises used for treatment of tendonopathy.
Eccentric stengthening
73
History of distal biceps tendonitis
Pain in antecubital fossa with repetive elbow bending & follow through phase of throwing
74
History of distal biceps tendon rupture
Male 30-50, dominant limb, heavy lifting with elbow at 90 deg flexion
75
History of triceps tendonitis
Aching and burning at distal triceps aggravated by throwing, using a hammer, wt lifting
76
How can tricep tendon rupture occur?
FOOSH injury, steroid use
77
Hx of snapping triceps tendon
snapping sensation over medial epicondyle with eblow flexion & extension
78
Hx of aseptic olecranon bursitis
direct blow or repetitive trauma to olecranon process develops small liquid pouch
79
Hx of septic olectranon bursitis
localized or systemic injection l/t infected joint
80
Tx of aseptic olecranon bursitis
Aspiration of bursa followed by compresive dressing and elbow pad
81
Tx of septic olecranon bursitis
Aspiration of bursa for CS and gram stain, followed by compresive dressing and Abx
82
Cause of ulnar collateral ligament strain
valgus stress to the elbow
83
What phases of throwing put stress on the UCL?
late cocking and acceleration phase of overhead throwing
84
PE of UCL strain
5 deg elbow flexion contracture, UCL tenderness and pain w/ or w/o laxity during UCL instability testing
85
Tx of UCL strain
no throwing for 3-6 wks, ROM, medial forearm muscle strengthening, interval throwing program once pain free ROM
86
Definition of valgus extension overload (VEO) disorder
impingement of posteromedial olecran against medial wall of olecranon fossa from valgus elbow stres w/ overhead throwing
87
PE of valgus extension overload (VEO) disorder
Pain over posterior medial tip of olecranon and pasive hyperextension w/ valgus load of elbow
88
What phase of throwing aggravates valgus extension overload (VEO) disorder
acceleration and follow through
89
Rehab of valgus extension overload (VEO) disorder
Scapula/core kinetics, medial forearm muscle strengthening
90
What disorders are referred to as Little Leaguer's elbow?
Medial epicondolitis, traction apophytiis, stress fx, throught medial epicondylar epiphyses and avulsion fx of medial epicondyle
91
What is Panner's disease?
osteochondrosis of capitellum that occurs in ages 7-10
92
PE of Panner's disease
Dull, aching lateral elbow pain aggravated by throwing, elbow effusion, ROM not restricted
93
Tx of Panner's disease
Stop throwing, posterior long arm splint for pain control
94
Hx of osteochondritis desicans of capitellum
throwing athletes 9-15yo, lateral elbow pain, 15 deg flexion contracture focal lesions to capitellum w/ loose body formation
95
Tx of osteochondritis desicans of capitellum
stop throwing for 6 wks, posterior long arm splint for pain control, surgery for loose bodies
96
MCC of elbow dislocation
FOOSh injury
97
MC direction of elbow dislocation
posterior lateral
98
Injuries associated w/ elbow dislocation
collateral ligament, flexor/pronator forearm muscle, brachial artery, median/ulnar/radial nerve disruptions
99
Hx of FCU tendonitis
volar wrist pain w/ wrist flexion & ulnar deviation (racquet sports, golf)
100
What can be associated with FCU tedonitis?
Pisotriquetral compression sydnrome as pisiform bone embedded in FCU tendon
101
Tx of FCU tendonitis
wrist hand orthoses in 25 deg flexion or surgery to resect pisiform bone w/or w/o Z-plasty lengthening of FCU tendon
102
Hx of FCR tendonitis
Lateral wrist pain w/ wrist flexion, radial deviation and grip
103
Tx of FCR tendonitis
wrist hand orthoses in 25 deg flexion
104
Tendons involved in de Quervain's syndrome
Abductor pollicis longus & extensor pollics brevis over radial styloid
105
Tx of de Quervain's syndrome
rest, thumb spica splint, first dorsal compartment steroid injection
106
What is Intersection syndrome?
Friction b/w abductor pollicis longus & extensor pollicis brevis tedongs 4-6 cm proximal to Lister's tubercle
107
Who is Intersection syndrome seen in?
Oarsmen, racquet sports, wt lifters
108
PE of Intersection syndrome
Dorsoradial distal forearm pain aggravated by wrist extension
109
Tx of Intersection syndrome
neutral wrist-hand orthosis, steroid injection to point at maximal tenderness, rarely surgery
110
Hx of extensor carpi ulnaris tendonitis
dorsoulnar wristpain w/ reptitive wrist extension & ulnar deviation in nondominant hand of tennis two-handed backhand
111
Hx of ECU subluxation
pop after forceful volar wrist flexion & ulnar deviation w/ pain
112
Tx of ECU tendonitis
neutral wrist-hand orthosis
113
What should be assessed for if pt w/ ECU tendonitis does not get better with conservative therapy?
Triangular fibrocartilage complex injury
114
Tx of ECU tendon subluxation
Acute: cast of wrist in pronated and dorsiflexion for 6 wk or surgery Chronic: sugrical reconstruction
115
What is the MC wrist ligament injury?
Scapholunate instability
116
Hx of scapholunate instability
Fall on hand in pronation, wrist extension & ulnar deviation
117
What is the dorsal intercalated segemental instability (DISI) pattern?
scaphoid into flexed position, lunate and triqetrum become extended
118
What test may indicate scapholunate instability?
Watson test
119
What can be seen on X-ray in DISI pattern?
scapholunate angle >60 deg on lateral view or gap >3 mm b/w scaphoid and lunate on AP view
120
Tx of scapholunate ligament injury
Surgery
121
What hand fx is prone to AVN or nonunion?
proximal or middle scaphoid fx d/t disrupted BS
122
Tx of middle or proximal scaphoid fx
6 wk in long arm thumb-spica cast w/ elbow 90 deg flexion & wrist in neutral w/ thumb in slight ext & ABD
123
Tx of distal 1/3 scaphoid fx
short arm thumb spica cast w/ wrist in neutral & thumb in slight ext & ABD
124
MC fx of the body
distal radius
125
What is the classification system for distal radius fx?
Frykman
126
MC distal radius fx
Frkyman type I or Colles fx
127
What is a Colles fx?
fx 2 cm proximal to distal radius w/ dorsal angulation of distal segment & radial shortening
128
Tx of Colles fx
Closed reduction & immobilization w/ sugar tong splint w/ wrist in slight flexion & ulnar deviation for 3 days then cast for 6 wks if non-displaced on xray
129
What is Kienbock's disease?
Progressive collapse of lunate d/t repetitive compressive forces to wrist
130
Hx of Keinbock's disease
Pain & stiffness of wrist
131
PE of Keinbock's disease
Pain to palpation over dorsum of lunate
132
Tx of Keinbock's disease
immobilization to allow revascularization, may need surgery to correct ulnar minus wrist
133
What is the trianular fibrocartilage complex (TFCC)?
Avascular central articular disc & vascular dorsal & palmar radioulnar ligaments
134
Hx of TFCC injury
Axial load to wrist w/ rotational stress l/t locking & catching
135
PE of TFCC injury
Pain at hollow b/w FCU & ECU tendon distal to ulnar styloid process
136
Tx of TFCC injury
Surgery
137
What can rupture of the central slip of extensor tendon at base of middle phalanx result in?
Boutonniere injury
138
What is a Boutonneire injury?
Inability to actively extend PIP joint
139
MOI of central slip extensor tedon rupture
Crush injury, forced flexion or lateral volar PIP dislocation
140
What causes a mallet finger?
Disruption of distal extensor tendon at insertion on dorsal proximal aspect of distal phalanx
141
What is the MOI of a mallet finger?
Hyperflexion force to an extended DIP joint
142
PE of a mallet finger
DIP joint in flexed position, pt unable to actively extend
143
Tx of a mallet finger
Splint DIP joint 24hr/day for 6-8 weeks
144
MOI of flexor digitorum profundus rupture (jersey finger)
Forced extension of flexed finger
145
Which finger is most likely to be effected by FDP tendon rupture?
Ring Finger
146
What is the MC dislocated joint in the hand?
PIP joint
147
What is the MC direction of PIP dislocation?
Dorsal
148
Tx of dorsal PIP dislocation
Reduction, Xrays, 45 deg extension block splint with 10 deg reduction in angle each week
149
What is a gameskeeper's thumb?
1st metacarpophalangeal jointUCL sprain
150
What is the MOI of a 1st MCP joint UCL sprain?
Radially directed force acrost 1st MCP joint
151
What is a Stener lesion?
Interposition of adductor pollicis aponeurosis b/w proximal phalanx and UCL ligament
152
Tx of 1st MCP joint UCL sprain
Partial: thumb spica splint; Rupture: surgery
153
What is a jammed finger?
Collateral ligament sprains of DIP or PIP joints
