MSK - Upper Extremity

Question 1

What is the most unstable position for the shoulder?

Answer 1

Abducted, ER, Flexed to 90 degrees

Question 2

Describe the difference between the anatomical neck and surgical neck of the humerus?

Answer 2

Anatomical neck - more superior, above lesser tuberosity, where cartilage ends
Surgical neck - inferior to anatomical neck, between tubercles

Question 3

What portion of elevation is due to scapulothoracic motion? Glenohumeral?

Answer 3

Scapulothoracic - 1/3

Glenohumeral - 2/3

Question 4

What muscles are typically thought of when needing full shoulder ROM?

Answer 4

Rotator cuff + deltoid

Question 5

If the rotator cuff was torn, what active motion could still be seen at the shoulder?

Answer 5

Elevation (due to deltoid)

Question 6

What would a cyst over the suprascapular notch cause? Over the spinoglenoid notch?

Answer 6

Suprascaular notch - reduce innervation to supra and infra, reducing ER and abduction
Spinoglenoid notch - reduce innervation to infra only, reducing ER

Question 7

Which muscles are stronger in the shoulder, internal or external rotators?

Answer 7

Internal rotators

Question 8

What causes lateral scapular translation winging deformity? Why?

Answer 8

Injury to spinal accessory nerve

Causes unopposed pull of serratus anterior

Question 9

What causes medial scapular translation (winging)?

Answer 9

Injury to long thoracic nerve

Question 10

How will the pt presentation differ between an anterior and posterior shoulder dislocation?

Answer 10

Anterior - slightly abducted, ER

Posterior - slightly adducted, IR

Question 11

What is a Bankart lesion?

Answer 11

Anterior labrum tear as a result of anterior dislocation

Question 12

What would potentially be injured if a patient complained of deep, front to back shoulder pain?

Answer 12

Labrum tear

Question 13

What does the Empty can test isolate?

Answer 13

Supraspinatus

Question 14

What does ER of the shoulder test?

Answer 14

Infraspinatus and teres mminor

Question 15

What does Belly Press test?

Answer 15

Subscapularis strength

Question 16

What is the Hawkin’s test position? What does it evaluate?

Answer 16

Flex elbow, raise shoulder, IR. Dr impinge greater tubercle on acromion
Evaluates potential impingement of supraspinatus

Question 17

What is Speed’s test? What does it evaluate?

Answer 17

Dr. resists pts shoudler elevation while hand monitors biceps tendon
Positive if pain/feel biceps tendon popping out at shoulder

Question 18

What is Yergason’s test? What does it evaluate?

Answer 18

Dr. resists patients supination while elbow flexed

Tests biceps

Question 19

What is a positive O’brien’s test? What does it evaluation

Answer 19

Pt extends arm, thumb down, adduction. This causes pain. Pain relieved when thumb points up
Isolated labrum tears

Question 20

What is the apprehension test? What is positive?

Answer 20

Pt supine, shoulder abducted and ER. Positive if patient becomes very nervous and feels like shoulder is coming out of place

Question 21

What is initial treatment for atraumatic shoulder instability?

Answer 21

Supervised rehabilitation

Question 22

What dislocation is most likely in a person who falls on an outstretched arm or has a seizure/is electrocuted?

Answer 22

Traumatic posterior dislocation (instability)

Question 23

What is a SLAP tear? What typically causes these? What is the most specific diagnostic tool?

Answer 23

Superior labrum anterior to posterior tear
Fall/jerking motion
MRI arthrogram

Question 24

How does the treatment differ for an acute SLAP tear vs. a degenerative SLAP tear?

Answer 24

Acute - arthroscopic fixation

Degenerative - arthroscopic debridement

Question 25

What is the most likely diagnosis for a person without remarkable shoulder history, whole slowly looses ROM, maintains strength, and has severely decreased active and passive ROM? What is initial treatment? Secondary?

Answer 25

Adhesive capsulitis (frozen shoulder) Initial: Injections, PT, steriords Secondary: Manipulation under anesthesia

Question 26

What are the three phases of adhesive capsulitis?

Answer 26

Inflammatory - first 6 months Plateua - tight, little/no pain Thawing - spontaneously resolves

Question 27

What is initial treatment for shoulder arthritis?

Answer 27

Non-op

Question 28

What treatment is appropriate for a person with rotator cuff impingment pain and no predictors for a tear?

Answer 28

NSAIDs, PT, injection

Question 29

What treatment is appropriate for a person with rotator cuff impingement pain and minor weakness lasting longer than 6 weeks?

Answer 29

MRI

Question 30

What type of shoulder replacement is done on someone with chronic rotator cuff arthropathy?

Answer 30

Reverse total shoulder

Question 31

What is the treatment for Type I and II AC joint separation? IV, V, VI? III?

Answer 31

I and II - conservative IV, V, VI - surgery III - controversial

Question 32

What is the initial treatment for a clivical fx? Scapula fx? Proximal humerus in youger pts? Older?

Answer 32

Clavicle - ORIF Scapula - non-op Proximal humerus younger - ORIF Proximal humerus older - Hemi/Reverse total shoulder

Question 33

What is function ROM for the elbow? (Flexion, extension, pronation, supination) What is normal?

Answer 33

Functional: 30-130, 50 pronation and supination Normal: 0-150, 90 pronation and supination

Question 34

What are the three medial collateral ligaments? Which is most important for resisting valgus stress?

Answer 34

Anterior - most important for resisting valgus stress Posterior Transverse

Question 35

What clinically can be seen with a distal biceps rupture? What are treatment options for low demand pt vs. young/healthy patient?

Answer 35

Weak supination Low demand pt - non-op Young/health - Surgery

Question 36

What tendon is most often affected in lateral epicondylitis?

Answer 36

Extensor carpi radialis brevis

Question 37

What is osteochondritis dissecans? What are the 3 types? What is treatment for each? How does treatment differ for Panner's Disease?

Answer 37

``` Separation of articular cartilage of capitellum in elbow Type 1 - intact, stable - non-op Type 2 - collapse - op Type 3 - loose body - op Panner's disease - DO NOT OP ```

Question 38

What is nurse maid's elbow? What age group is it most common in? How is it reduced?

Answer 38

Subluxation of radial head 1-3 years old Flex and supinate elbow

Question 39

At what point are radial head fractures in adults treated with ORIF?

Answer 39

>1/3 radial head, displaced/comminuted

Question 40

What degree of angulation is acceptable in pediatric radial head fractures?

Answer 40

<30 degrees

Question 41

How are non-displaced olecranon fractures treated? Displaced?

Answer 41

Non-displaced - immobilization | Displaced - ORIF

Question 42

What does the Phalen maneuver diagnose if postive? How is it set up?

Answer 42

Patient's arms extended, wrists flexed | Tests for median nerve compression in flexor retinaculum

Question 43

After clinical findings suggestive of carpal tunnel, what test should be ordered?

Answer 43

NCV - nerve conduction velocity test

Question 44

How is carpal tunnel syndrome treated?

Answer 44

Initial - non-op, conservative, NSAIDs, injection, night braces Secondary - surgery

Question 45

What finger most commonly gets Dupuytren's contracture? What is it a thickening of? What is the treatment?

Answer 45

Ring finger Palmar fascia Collagenase injections or percutaneous aponeurotomy (surgery is difficult)

Question 46

What is the treatment for trigger finger?

Answer 46

Rest, NSAIDs, ice, injection, surgery to cut A1 pulley

Question 47

What is the Finklesteins test? What is treatment for the condition?

Answer 47

Adduct thumb in fist, Dr. resists patients radial deviation of wrist DeQuervains's tenosynovitis Spica splint, injection, NSAIDs, Surgical release

Question 48

What is Jersey finger? What tendon is injured in Zone 1? Zone 2? Treatment?

Answer 48

Avulsion of tendon on distal surface of phalynx (flexor tendon injury) Zone 1 - FDP Zone 2 - FDS and FDP Surgery within 1 week of injury

Question 49

What is mallet finger? How is it treated?

Answer 49

Extensor tendon injury Continuous splinting for 6 weeks Surgery only if compliance is an issue

Question 50

What is a Galeazzi Fracture?

Answer 50

Radial fracture with dislocation of distal radioulnar joint

Question 51

What is a Monteggia fracture

Answer 51

Ulnar fracture with dislocation of proximal radiocapitellar joint

Question 52

What is the treatment for a scaphoid fracture?

Answer 52

Surgical screw

Question 53

What degree of angulation is acceptable in a Boxer's fracture?

Answer 53

10-15 degrees