Disorders of the UE

Question 1

What are the muscles of the RTC

Answer 1

SITS
supraspinatus
infraspinatus
teres minor
subscapularis

Question 2

what is the insertion and MOA for supraspinatus

Answer 2

Greater tuberosity (GT)
ABduction

Question 3

what is the insertion and MOA for Infraspinatus

Answer 3

GT
ER

Question 4

what is the insertion and MOA for Teres Minor

Answer 4

GT
ER

Question 5

what is the insertion and MOA for Subscapularis

Answer 5

Lower Tuberosity (LT)
IR

Question 6

what is the most common muscle inflamed in the RTC

Answer 6

supraspinatus

Question 7

what type of injury causes RTC tendonitis

Answer 7

overuse injury
repetitive overhead activity, lifting, athletes with repetitive shoulder movement

Question 8

What is the presentation for RTC tendonitis

Answer 8

unknown onset of shoulder pain - commonly anterior and lateral and pain with physical activity

Question 9

what is present on the physical exam for RTC tendonitis

Answer 9

point tenderness over supraspinatus/GT, reduced ROM, esp ABduction, weakness

Question 10

What special tests are used for assessing the supraspinatus

Answer 10

Hawkins-Kennedy, Neer and Empty Can test

all positive for pain and or weakness

Question 11

What is the treatment of RTC tendonitis

Answer 11

activity modification and rest, NSAIDs, subacromial injection, PT for strengthening and stretching

Question 12

What is the number one cause of shoulder pain

Answer 12

subacromial impingement

Question 13

What is important with the presentation of subacromial impingement

Answer 13

night time pain otherwise presents with shoulder pain, pain with overhead activities

Question 14

what special tests are positive with subacromial impingement

Answer 14

Neer and Hawkins- Kennedy test with tenderness over the greater tuberosity

Question 15

What is the treatment for subacromial impingement

Answer 15

first line is conservative treatment and if failure, operative for subacromial decompression

Question 16

what is the least likely muscle to tear in a RTCT

Answer 16

subscapularis

Question 17

what is the presentation of RTCT

Answer 17

similar to tendonitis and impingement with night pain and +/- weakness and/or loss of ROM

Question 18

What special tests are positive for RTCT

Answer 18

empty can, Drop arm, Infraspinatus and lift off test all positive with RTCT

Question 19

What is the treatment for RTCT

Answer 19

first line is conservative
partial tears with subacromial impingement - subacromial decompression
complete and/or significant symptomatic tears - RTCR, tendon transfers and Reverse TSA

Question 20

What special tests are used for biceps tendonitis

Answer 20

speeds test and yergasons test

Question 21

what is the MOI for bicep tendon rupture

Answer 21

sudden or prolonged bicep contraction against resistance

Question 22

what injury is commonly seen with the “pop eye” deformity

Answer 22

biceps tendon rupture

Question 23

What is the MOI for AC joint injuries

Answer 23

direct blow to the shoulder, fall onto shoulder, FOOSH

Question 24

treatment of AC joint injury

Answer 24

most treated non-op (type 1-3) with conservative management, operative at type 4-6 or failed non-op

Question 25

What is the MOI for SC joint dislocation

Answer 25

MVC or sports injury (direct blow)

Question 26

what is essential to be assessed for SC joint dislocation

Answer 26

neurovascular status - brachial plexus and major vascular structures nearby

Question 27

what are the complications wtih SC joint dislocation

Answer 27

pneumothorax, SVC injury, Esophageal injury, compression of subclavian artery or carotid artery, voice changes and venous congestion

Question 28

what is the best test to assess for SC joint dislocation

Answer 28

CT Scan is the best

Question 29

what is the treatment of SC joint dislocation

Answer 29

closed or ORIF - often thoracic surgeon/cardiology

Question 30

What special tests are used for dislocation patients

Answer 30

apprehension test and sulcus sign

Question 31

what is something to be aware of with a clavicle fracture

Answer 31

risk for pneumothorax from fracture fragment - diminished breath sounds on affected side

Question 32

when os operative treatment necessary for clavicle fracutres

Answer 32

open fracture, pending open fractures (skin tenting), associated neurovascular injury, significant displacement

Question 33

What does the axillary nerve innervate

Answer 33

deltoid

Question 34

What is important to check with a humerus fracture

Answer 34

neurovascular assessment for median, radial and ulnar nerve function

Question 35

What is lateral epicondylitis

Answer 35

tennis elbow - inflammation of the extensor tendon insertion

Question 36

what is medial epicondylitis

Answer 36

golfers elbow - inflammation of the flexor tendon insertion site (medial epicondyle)

Question 37

when is Nursemaids elbow most common

Answer 37

kids 6 months to 6 years - peak incidence ages 2-3

Question 38

what is the MOI for Nursemaids elbow

Answer 38

longitudinal traction to extended elbow

Question 39

What type direction is most common for elbow dislocations

Answer 39

posterior dislocation is 80-90%

Question 40

what are the three points of articulation in the elbow

Answer 40

ulnotrochlear radiocapitellar proximal radioulnar

Question 41

what is the common MOI for elbow dislocation

Answer 41

FOOSH is the most common

Question 42

When do you need to assess neurovascular status for elbow dislocations

Answer 42

pre-reduction and post-reduction

Question 43

when is operative treatment necessary for elbow dislocations

Answer 43

if neurovascular deficit, associated fracture or unstable

Question 44

What are the common MOI for radial and ulnar shaft fractures

Answer 44

MVC including motorcycle sports injuries night stick injury falls from height

Question 45

what do you need to assess for with radial and ulnar shaft fractures

Answer 45

neurovascular status and compartment syndrome

Question 46

what tool can you use to assess ganglion cysts

Answer 46

transilluminates with light

Question 47

what part of the hand does the median nerve affect

Answer 47

thumb through to the medial aspect of the ring finger

Question 48

special tests for CTS

Answer 48

Tinels and Phalens test

Question 49

what ligament is cut during CTR

Answer 49

transverse carpal ligament

Question 50

What is a colles frature

Answer 50

dorsal displacement

Question 51

what is a smiths frature

Answer 51

volar displacement

Question 52

what is another name for navicular fracture

Answer 52

scaphoid fracture

Question 53

DeQuervains is inflammation of what tendon sheath

Answer 53

1st MCP joint

Question 54

What test is used for the diagnosis of DeQuervains

Answer 54

Finkelsteins