MSK ramey and ferrill

Question 1

rotator cuff (RC) injuries

Answer 1

• Dx specific to tendinous attachments of mm
• usually d/t chronic repetitive microtrauma, acute macrotrauma, or combo
• MC sports related injury

Question 2

subscap

Answer 2

major inferior attachment of RC

internal rotation of humerus and downward rotation of head in GH joint

Question 3

supraspinatus

Answer 3

• superior attachment of RC
• major mm affected in impingement syndrome bc under coracoacromial lig
• elevation and abduction of humerus and upward traction of head in GH

Question 4

infraspinatus

Answer 4

post-sup attachment of RC

external rotation of humerus and downward traction of head in GH

Question 5

teres minor

Answer 5

post inf attachment of RC

external rotation of humerus in concert w/infraspinatus and downward traction of head in GH

Question 6

what is the major mm involved w/impingement syndrome?

Answer 6

supraspinatus

Question 7

impingement interval

Answer 7

space btwn undersurface of acromion and superior aspect of humeral head
maximally narrowed when arm ABducted

Question 8

primary impingment

Answer 8

most common
impingement of RC mm/tendons from anatomical restriction and repetitive motion (especially elevation and internal rotation)

Question 9

secondary impingement

Answer 9

• may result from pain which causes reflex inhibition and weakness of RC mm -> fail in fnx to center humeral head
• subsequent superior translation adds to impingement

Question 10

symptoms of impingement syndrome

Answer 10

• varies from minimal pain w/activity to marked tendinitis, significant pain and decreased ROM
• if pain and decreased ROM severe think tear

Question 11

PE impingement syndrome

Answer 11

-observe scapulothoracic motion while pt abducts shoulder
-firing of upper traps and weak scapula stabilizing mm -> slight winging
-painful at 90-120 degrees of abduction
+ neers and hawkins

Question 12

neers

Answer 12

internally rotate arm and passively bring into flexion -> pain

Question 13

hawkins

Answer 13

arm and elbow flexed at 90 and passively internally rotated -> pain

Question 14

x-ray for subacromial space

Answer 14

scapular Y view

AP view good for GH and sclerosis of greater tuberosity

Question 15

what are MRI and US good for

Answer 15

grade II lesions

Question 16

who needs surgery

Answer 16

younger pts w/full thickness tears

Question 17

conservative therapy

Answer 17

strengthening
Ice-after use
heat and massage- before use
meds-NSAIDs 
steroid injection 
rest

Question 18

biceps tendinitis

Answer 18

inflammation of biceps tendon secondary to repetitive use or sudden violent extension of elbow

Question 19

biceps tendinitis PE

Answer 19

-tenderness on palpation of groove, sometimes crepitus or snapping w/flexion
+speeds test
+yergasons test

Question 20

yergasons test

Answer 20

pain w/elbow extension and internal rotation of shoulder

Question 21

Tx of biceps tendonitis

Answer 21

limit activity 
NSAIDs, US, EMS, and ROM exercises
once pain free strength train
check for impingement syndrome 
corticosteroid injection is discouraged

Question 22

lateral epicondylitis

Answer 22

aka tennis elbow
pain and tenderness over lat epicondyle and extensor tendon
pain w/resistance to wrist and 3rd digit extension
grip strength test -> pain

Question 23

Tx of lat epicondylitis

Answer 23

PT mainstay

NSAIDs, steroid injection

Question 24

medial epicondylitis

Answer 24

aka golfer elbow
symtoms similar to flexor-pronator mm strain
tender to palpation
pain elicited with resisting pronation, wrist flexion and grip strength test

Question 25

Tx of medial epicondylitis

Answer 25

PT mainstay | NSAIDs, steroid injection

Question 26

tendonosis

Answer 26

chronic changes assocaited w/epicondylitis -> angiofibroblastic proliferation

Question 27

why is it important to Tx upper thoracics w/UE pain/SD

Answer 27

sympathetics innervating UE arise here and are interconnectd w/superior, middle, and inferior cervical ganglion also need to Tx clavicle and upper ribs

Question 28

if pt is slow or unresponsive to Tx for UE issue should check for what

Answer 28

systemic disease like DM or hypothyroidism

Question 29

set up for chin pivot HVLA

Answer 29

used for T1-3 SB into barrier R into EASE thrust is ant, lat, and caudal

Question 30

supraspinatus TP

Answer 30

supraspinatus mm sup to spine of scap

Question 31

Tx of supraspinatus TP

Answer 31

supine | flexion, abduction to 45 degrees, external rot of humerus

Question 32

subscap TP

Answer 32

ant and lat surface of scap

Question 33

Tx of subscap TP

Answer 33

supine | extension, slight ABduction, internal rotation of humerus

Question 34

biceps brachii TP

Answer 34

long head of tendon in bicipital groove

Question 35

Tx of biceps brachii TP

Answer 35

supine or seated | flexion of elbow, minor flexion of arm, adduction, and internal rotation of arm

Question 36

radial head TP

Answer 36

lat surface of radial head

Question 37

Tx of radial head TP

Answer 37

supine or seated | full extension of elbow, supination of wrist and fine tune w/ab/adduction

Question 38

mm involved in Tx of radial head TP

Answer 38

supinator

Question 39

med epicondyle TP

Answer 39

medial epi at common flexor tendon and attachment of pronator teres

Question 40

Tx of med epicondyle TP

Answer 40

supine or seated | flex elbow to 90, pronate wrist, fine tune w/internal/external rotation

Question 41

mm involved in Tx of med epicondyle TP

Answer 41

forearm flexors | pronator teres

Question 42

spencers

Answer 42

``` extension flexion compression w/circumduction traction w/circumduction adduction w/external rotation abduction internal rotation traction w/inferior glide (joint pump) ```

Question 43

nursemaids elbow

Answer 43

- subluxation of annular ligament d/t longitudinal traction of extended elbow - usually w/forearm pronation - annular lig is weak in kids and oval shape of radius allows for slippage

Question 44

nursemaids elbow PE

Answer 44

- anxious child protective of arm - forearm is usually flexed 15-20 degrees partially pronated and supported w/other hand - signs of trauma absent - usually 2-3yrs, rare >7

Question 45

fat pad sign

Answer 45

on x-ray | indicated joint effusion and occult fracture

Question 46

neurovascular exam w/nursemaids elbow

Answer 46

must be assessed and documented before and after manipulation status of brachial a, median, and ulnar nn

Question 47

closed reduction for nursemaids elbow

Answer 47

- child seated in parents lap - place thumb over radial head and maximally supinate forearm - apply axial compression at wrist - forearm maximally flexed while supinated

Question 48

Humerus BLT

Answer 48

-seated w/hand of SD side on shoulder and w/Dr on side of SD -reach around humerus as superior as possible leverage placed w/humerus pulling lat -pt moves uninvolved shoulder posterior, drawing hand with it to disengage involved humeral head -BLT established w/internal/external rotation and slight sup motion

Question 49

scapulothoracic BLT

Answer 49

- assesses position of scap on thorax -> hypertonic serratus ant will cause elevation and lat displacement of scap - stand on side of SD - place pad of thumb on ribs at MAL as sup as possible - slide thumb post along ribs until under scap - pt leans forward - other hand on top of scap - inf traction on scap - balance