Ortho Block II

Question 1

Upper extremity shoulder rupture is common in what pts

Answer 1

Older with RTC Dz or young weight lifters/ throwers

( young more uncommon)

Question 2

Popeye deformity is a sign of

Answer 2

Proximal biceps tendon rupture

Question 3

PE findings in a proximal bicep rupture

Answer 3

• palpable deformity proximally
• Tenderness in the bicipital groove
• resisted bicep flexion worsens the deformity

Question 4

Tx approach to Proximal biceps tendon rupture

Answer 4

Non op: ROM/ Strengthening

Op for young athletes/ young worker

Question 5

Referral criteria for Proximal Biceps Tendon rupture

Answer 5

Young athletes
Young laborers
Concominant rotator cuff tear

Question 6

What is the most common position for shoulder dislocation

Answer 6

Anterior DC is the most common

Question 7

What is a TUBS instability

Answer 7

Traumatic, unilateral, Bankart, surgical

Question 8

What is a AMBRI shoulder dislocation

Answer 8

Atraumatic, multi directional, bilateral, rehabilitate, inferior capsule

Question 9

What are the 2 most common causes of Posterior shoulder Dislocation

Answer 9

Seizures and Electric shock

Question 10

What are the ADE of shoulder dislocations

Answer 10

Axillary nerve injury
Chronic Instability
Glenohumeral OA

Question 11

Posterior Dislocations present in what position

Answer 11

Adducted and internally rotated

Question 12

What 3 test are used to evaluate shoulder instability/ dislocation

Answer 12

Sulcus sign (inferior) 
 apprehension (anterior) 
 jerk Test ( posterior)

Question 13

What is the best MRI to order for shoulder instability

Answer 13

MRI with arthogram

Shows the Capsule, the laboral and the RTC

Question 14

TX approach to Shoulder instability

Answer 14

NON op: acute reduction with sedation

AMBRI- rehab
TUBS- surgical op

Question 15

Red flag referral foo shoulder instability

Answer 15

Irreducible

TUBS

Question 16

What is a slap tear

Answer 16

Superior labrum anterior to posterior tear of the shoulder

The “slap” anchors the long head of the biceps

Question 17

What is the best test to evaluate for a SLAP tear

Answer 17

O’Brien test

Question 18

What is the gold standard to evaluate for a SLAP tear

Answer 18

MRI with arthrogram

Question 19

What is the TX approach to slap tears

Answer 19

NSAIDS rehab, limit aggravation

Rehab failure= surgical repair

Question 20

What are two uncommon bone formations that can lead to thoracic outlet syndrome

Answer 20

Cervical rib at C7 or long transverse process of C7

Question 21

What are the clinical S/s of thoracic outlet syndrome

Answer 21

Neurologic:

• Diffuse, non-specific complaints of the entire UE
• Ulnar neuropathy

Vascular:

• Swelling and discoloration
• Fatigue and weakness
• Worse when arm overhead

Question 22

What is the ADE of thoracic outlet syndrome

Answer 22

Chronic HEadache

Or loss of overhead ROM

Question 23

What is the PE approach to Thoracic outlet syndrome

Answer 23

Check for a Bruit or MAss 
Evaluate distal pulses bilaterally 
Check Distal nerve function 
(Ulnar nerve) 
Roos Test- Aka Elevated arm stress test

Question 24

When should you order an EMG in thoracic outlet syndrome

Answer 24

TO r/o ulnar nerve entrapment

Question 25

What is the TX approach to Thoracic outlet syndrome

Answer 25

Non op: 3-6 months pt Op: to remove variant bone formation or tumor

Question 26

What are the ADE of Tx for thoracic outlet syndrome

Answer 26

Complex regional pain syndrome (use gabapentin) Intercostal neuroma, frozen shoulder Brachial plexus injury PTX

Question 27

A brachial plexus injury at birth manifests as what disorder

Answer 27

Neonatal Brachial plexus palsy

Question 28

What is the most common palsy’s in neonatal brachial plexus palsy

Answer 28

``` Most common is erbs ( C5-6) Lumped palsy ( C8-T1) ```

Question 29

What are the clinical S/s of neonatal brachial plexus palsy

Answer 29

Psuedo paralysis | Increased irritability associated with a clavicle/ numerous Fx

Question 30

A baby with no spontaneous movement with decreased reflexes suspect?/

Answer 30

Neonatal brachial plexus palsy

Question 31

Waiters tip position in a baby is a sign of.. ?

Answer 31

Erbs palsy ( neonatal brachial plexus palsy ) Shoulder adducted and IR, elbow extended, forearm pronated, wrist flexed

Question 32

What is horners syndrome

Answer 32

A sign of poor palsy prognosis in a baby - loss of sweating on the face - Ptosis - miosis

Question 33

What is the Tx approach to neonatal brachial plexus palsy?

Answer 33

Non-operative- Monitor nerve function Prevent contractures/deformities Physical therapy Operative- Surgical to address imbalance

Question 34

What is Torticollis

Answer 34

Congenital- Unilateral sternocliomasiod contracture at birth (Most common) Acquired- eyes (nystagmus, superior oblique palsy), spine (atlantoaxial rotatory displacement), trauma, infection, neoplasms

Question 35

How does AARD present in torticollis

Answer 35

Atlantic axial rotary displacement Tilt will be the same as torticollis with a spasm on the unaffected side

Question 36

What is the referral criteria for Torticollis

Answer 36

All pts with acquired and CMT for PhyTx

Question 37

Tx approach to Torticollis

Answer 37

Non-operative- Congenital= stretching Acquired= treat reason