Orthopaedic Examination, Diagnosis and Treatment Flashcards Preview

Rheum/Musculoskeletal/Derm Week 1 > Orthopaedic Examination, Diagnosis and Treatment > Flashcards

Flashcards in Orthopaedic Examination, Diagnosis and Treatment Deck (58):
1

What is trigger finger?

“Locking” of ROM during finger flexion from adhesions

in flexor tendon sheaths that presents with pain on the volar side of the MCP joint.

 

Tendon “release” often presents as an audible “snap” as finger moves into flexion

2

Q image thumb

Trigger Finger

In this, an inflamed nodule of tendon gets trapped behind/underneath tendon sheath, and finger becomes stuck in flexed position and may be swollen initially 

Treated: NSAIDs, corticosteroid injections (successful usually), and then surgical release 

3

How do finger sprains present?

Commonly presents with localized tenderness/swelling, may see echymosis on the volar aspect with swelling of the digit

-Volar plate should be intact

-Treat with splint for 4-6 weeks (only immobilize joint of interest) 

4

What is Mallet Finger?

Avulsion of extensor tendon from distal phalanx, inability to

actively extend DIP joint (passive OK), commonly occurs if

fingertip hits ball

5

Q image thumb

Mallet finger 

cant extend DIP of the involved finger 

6

What is Jersey Finger?

Avulsion of profundus tendon from distal phalanx, inability to

actively flex DIP joint if PIP joint stabilized, commonly occurs

when grabbing jersey and joint forcefully extended against

active motion

7

What are these?

Q image thumb

Finger Dislocations

Reduce, then splint normally

8

What is DeQuervain’s Syndrome?

Tenosynovitis of extensor pollicis brevis and abductor pollicis longus tendons from repetitive stress (radial deviation).

9

How does DeQuervian's Syndrome present?

 Presents with pain/swelling to proximal thumb/ distal radius, pain with radial/ulnar wrist deviation and thumb extension and abduction.

Treatment: immobilization, NSAIDs

10

Q image thumb

Extensor Pollicus Brevis- injured in DeQuervian's Syndrome

11

What are the most common fractures of the wrist?

-Colles fracture (distal radius) and Smith fracture (distal radius)

-Scaphoid fracture

 

12

Q image thumb

Bones of the Hand

13

Q image thumb

Wrist Bones 

14

One of the most common causes of wrist fracture is falling on an outstretched hand. What are some risk fatcors that make a fall more likely to result in fratcure?

Older individuals:

osteoporosis, smoking, calcium and/or vitamin D deficiency

15

Q image thumb

Common Wrist Fractures

16

Immediate swelling after injury suggest what?

Either blood enters the joint or a ligament tare

Late swelling suggests a MCL or cartilage structure without good blood supply

17

What is this test designed to diagnose?

Q image thumb

Finkelstein's Test- pull the thumb into the palm, thendeviate 

DeQuervian's Syndrome 

18

When is a CT scan indicated for a musculoskeltal injury?

When injuries to soft tissue, blood vessels, fracture alignment, or articular invovlement are suspected

19

When is an MRI indicated for a musculoskeltal injury?

when ligament injuries or injuries to small bones in the wrist (e.g. scaphoid fracture) are suspected

20

What are some potential complications of unaddressed distal radial fractures?

-arthritis/arthrosis

-loss of motion

-osteomyelitis

-Nerve compression/neuritis

etc. 

21

What is Carpal Tunnel Syndrome?

Compression of the median nerve at the wrist in carpal tunnel where thickening from irritate tendons or other swelling narrows the tunnel and entrapment neuropathy is seen 

22

What forms the top of the carpal tunnel?

The transverse carpal ligament 

23

Where is median nerve entrapment from carpal tunnel felt?

burning, tingling in the radial aspect of palmar surface skin, index and middle finger, half the ring ringer, and the nail bed of these fingers 

and symptoms are worse at night due to the wrist being flexed during sleep 

some patients might feel like the wrsit is swollen even though it is not 

24

Q image thumb

Distribution of the Median Nerve in the Hand 

25

What are some possible causes of Carpal Tunnel Syndrome?

-Congenital predisposition

-Wrist trauma

-Pituitry gland overactive

-Hypothyroidism

-Rheumatoid Arthritis

 

26

What are some other risk factors for Carpal Tunnel?

Female sex: women are 3 times more likely than men to

develop carpal tunnel syndrome (smaller tunnel?)

Dominant hand usually affected first and more severely.

Diabetes or other metabolic disorders that affect nerves

 

27

What occupations predispose to Carpal Tunnel?

3 times more common in assembly-line workers than in

data-entry workers

28

What are some physical exam tests for carpal tunnel?

Tinel Exam- tapping or pressing on median nerve results in shock-like sensation

Phalen Exam- patient holds hands upright with fingers down and backs of hand together for 30-60 seconds –reproduces symptoms

 

Ultrasound and nerve conduction studies or electromyography are also useful

29

How is Carpal Tunnel treated?

Drugs- NSAIDs, Oral cortisone (prednisone), Cortisone/lidocaine injection. And then get the nerve conduction study (goal standard). If positive, think carpal tunnel release 

 

Not likely to recur but can get fibrous scar tissue and recurrent tenosynovitis (or can have incomplete ligament release)

30

What is the main stabilizing ligment of the elbow? What is the primary structure of the elbow invovled in throwing?

stabilizing ligament- ulnar collateral ligament (Tommy John)

throwing- anterior bundle 

A image thumb
31

85% of throwers with medial elbow instability (UCL injury) complain of pain in the _______ phase of throwing 

acceleration phase (deceleration typically = shoulder problems)

32

How does a UCL injury present?

Acute medial pain

- Onset during throwing, inadequate warmup

- “Pop” heard or felt

- Can be one pitch or can be insidious

33

What is this?

Q image thumb

Complete UCL tear on MRI (need an MRI because hard to test stability of the joint)- look for ecchymoses

 

 

34

Lateral Epicondylitis is common in what sport?

Tennis 

A image thumb
35

Describe Lateral Epicondylitis. Muscle most commonly invovled?

-More common (9:1) than medial epidcondylitis

-Degenerative process: “tendinosis”

- Extensor Carpi Radialis Brevis (ECRB) most commonly involved

36

How does lateral epicondylitis present?

You might be able to palpate a mobile wad while resisting active wrist extension

-pain at lateral epicondyle or over muscle mass usually present

-no neurologic symptoms and sensation normal

 

37

How is lateral epicondylitis treated?

Up to 90% of epicondylitis resolves spontaneously. If not, Rehab focus on stretching wrist extensors, eccentric wrist extensors, NSAIDs, and eventually surgery if needed. 

38

Medial Epicondylitis is common what sport?

Golf and some baseball 

39

How does medial epicondylitis present?

you may see pain with resisted wrist flexion or PRONATION. Tenderness may be within the muscle belly or directly over the medial epicondyle 

40

What is Panner's Disease?

Osteocondrosis of the capitellum of the elbow. (elbow's version of Legg'Calve-Perthes Disease). Presents with later elbow pain and perhaps stiffnes in a sports-active youngster (think young baseball pitcher, gymnast, cheerleader)

A image thumb
41

Patient population for Panner's Disease?

Usually seen in children under 10 

42

What is this?

Q image thumb

Panner's Disease- fracture of the capitulum of te elbow 

43

What is this?

Q image thumb

Olecranon Bursitis - typically due to direct trauma. Treat with rest, compression and NSAIDs. If persists, aspirate. 

44

Elbow dislocations are often the result of what?

-hyperextension

-trochlea levered over the coronoid process

45

What direction are most elbow dislocations?

The vast majority are posterior (most common posterolateral)

usually injure adjacent ligaments and potential for neurovascular involvment 

A image thumb
46

What is this?

Q image thumb

Supracondylar fracture 

47

What is this?

Q image thumb

Supracondylar fratcure with posterior elbo dislocation

48

What is this? Treatment?

Q image thumb

Olecranon process fracture. If stable/nondisplacedm short immobilization period (45-90 degree of flexion). If displaced, ORIF surgery with longer immobilization period and early ROM if tolerated 

49

What is this?

Q image thumb

Radial fractures

Most treated non-operatively 

50

What is Tinnel's Test?

Gentle percussion of the ulnar nerve above or within the cubital tunnel should not elicit pain in the normal elbow- pain or paresthesias into the ring and small fingers with tapping over the ulnar nerve in the cubital tunnel is considered a positive test 

51

Q image thumb

Normal Shoulder Anatomy 

52

Q image thumb

Bony Anatomy of the Scapula 

53

What are the structures of the subacromial space?

A image thumb
54

Identify the Muscles of the rotator cuff (posterior view)

Q image thumb

Top: Supraspinatus (abduction)

Left (small arrow): Teres minor (external rotation)

Right (long arrow): Infraspinatus (external rotation)

55

Identify muscle (anterior view)

Q image thumb

Subscapularis (internal rotation and adduction)

56

How could you test the integrity of the infraspinatus/Teres minor?

Have the patient flex the elbows to 90 degress and fully adduct to the side and ask them to attempt external rotation against your resistance 

A image thumb
57

How could you test the subscapularis muscle?

Lift-Off Test

58