Pathophysiology - UE Dysfunction Flashcards
test 2
1
Q
T or F?
The upper extremity consists of the shoulder complex, elbow and forearm complex, and wrist and hand.
A
True
2
Q
How many articulations are there in the shoulder complex?
A
4 - between the humerus, sternum, scapula, and clavicle
3
Q
What are the three synovial joints of the shoulder?
A
GH (ball and socket), SC (saddle), and AC (plane/gliding)
4
Q
Which joint is an articulation between the medial end of the clavicle, clavicular notch of manubrium of sternum, and cartilage of first rib?
A
sternoclavicular joint
5
Q
What movements does the SC joint have?
A
Elevation/depression
Protraction/retraction
Upward/downward rotation
Winging and tipping
6
Q
What kind of joint is AC joint?
A
Gliding or plane joint
7
Q
What serves as the main articulation that suspends the upper extremity from the trunk and is the joint about which the scapula moves?
A
AC Joint
8
Q
What are the motions of the AC joint?
A
Upward/downward rotation
Rotation in horizontal plane
Rotation in sagittal plane
9
Q
T or F?
GH joint is relatively stable and doesn’t rely on the muscles and structures (ligaments, labrum) around it.
A
FALSE - GH is unstable and relies on muscles, ligaments, and joint capsule around it
10
Q
How many bursae of GH joint?
A
12
11
Q
What is the scapulohumeral rhythm?
A
For every 2 degrees of shoulder abduction, scapula must upward rotate 1 degree
12
Q
What condition is an alteration in the normal position or motion of the scapula during scapulohumeral movements?
A
Scapular dyskinesis
13
Q
Scapular dyskinesia should be suspected in patients with what and is classified by what?
A
Scapular dyskinesis should be suspected in pts with a shoulder injury and can be identified and classified by specific physical exam
14
Q
What type of scapular dyskinesis is characterized by prominence of the inferior medial scapular border?
A
Type 1
15
Q
What type of scapular dyskinesis is characterized by the entire medial border protruding?
A
Type 2
16
Q
What type of scapular dyskinesis is characterized by superior translation of the entire scapula and prominence of the superior medial border?
A
Type 3
17
Q
What condition refers to pain and weakness most commonly experienced with movements of the shoulder ER and elevation as a consequence of excessive load on rotator cuff tissues and is commonly referred to as “subacromial impingement syndrome”?
A
Rotator cuff tendinopathy
18
Q
T or F?
In rotator cuff tendinopathy, acromial irritation may not be the primary cause of symptoms
A
True
19
Q
What are the 2 main conditions that can lead to rotator cuff tendinopathy?
A
Primary: intrinsic degenerative process when the top of the RC is compressed by the surrounding bone and soft tissue b/c decreased subacromial space
Secondary: results from GH instability and/or tensile overload of the RC resulting in poor control of the humeral head during overheard activities (pts here are usually under 35 yo and have traumatic instability, posterior defect of humeral head, and damage to glenoid labrum)
20
Q
What is the cause of internal glenoid impingement?
A
Caused by impingement of the posterior edge of the supraspinatus and anterior edge of the infraspinatus against the posterior-superior glenoid and glenoid labrum
21
Q
What is the mechanism of injury for internal glenoid impingement?
A
Extension, abduction, and ER
22
Q
What condition is a common cause of posterior shoulder pain in throwing or overheard athletes and is commonly misdiagnosed as rotator cuff tendinopathy?
A
Internal glenoid impingement
23
Q
What is internal glenoid impingement also called?
A
Posterior-superior glenoid impingement or posterior impingement
24
Q
What are some factors in rotator cuff tendinopathy?
A
Position of arm during activities, age capsular tightness, condition of the AC joint, correct function of dynamic stabilizers, amount of vascularization to the cuff, and poor endurance of scapular pivots (sustained or repetitive overhead activities)
25
What is the primary intervention for rotator cuff tendinopathy?
Active exercise therapy to relieve pain, reduce mm spasm, promote tendon healing, restore normal shoulder movement, and improve function
26
T or F?
Conservative care is implemented first before surgical options of RC tendinopathy
True
27
What is occurring in tradition open rotator cuff repair?
Vertical incision over anterior shoulder, deltoid is divided to allow access to RC and subacromial space, and an anterior and inferior acromioplasty is done to reduce acromion
28
During what surgical option for RC repair is an anterior and posterior acromioplasty performed?
Traditional open RC repair
29
What is occurring in a mini open surgical repair of RC?
Arthroscopic subacromial decompression with deltoid splitting
30
What are benefits of doing and arthroscopic procedure for RC repair over surgery?
smaller incision, get to inspect GH joint, can treat intra-articular lesions, you avoid detaching the deltoid, less soft tissue dissection, and less pain
31
T or F?
Regardless if during an open arthroscopic procedure to fix RC tendinopathy, post surgical rehab is the same because the TENDON TO BONE HEALING stays the same?
True. Speed of progression of healing depends on the status of the deltoid muscle, size of tear, and ability to move shoulder without injuring tissues
32
For a small tear in the RC, how long do you have to wear a sling?
1-3 weeks
33
For a medium tear in the RC, how long do you have to wear a sling?
3-6 weeks
34
For a large/massive tear in the RC, how long do you have to wear a sling?
6-8 weeks
35
ER beyond neutral is restricted for the first ___ weeks after a fix of a RC tear?
4 weeks
36
T or F?
Some patients may require an abduction orthosis if the tension through the repair site is minimal or not with the arm in 20-40 degrees of abduction
True
37
What is the term for abnormal symptomatic motion of the GH joint that affects normal joint kinematics and results in pain, subluxation, or dislocation of the shoulder?
Glenohumeral instability
38
T or F?
The more unstable the GH joint, the less use, and therefore the more shoulder dysfunction
True
39
What are some causes of GH joint instability? (3)
1. Genetics
2. Biochemical (collagen)
3. Biomechanical factors
40
What is the characteristic complaint of glenohumeral instability?
Shoulder slipping or popping out during overheard activities
41
What is the most common direction of GH instability?
Anterior instability
42
How does anterior GH instability occur?
When the abducted shoulder is repeatedly place in anterior position of ER and horizontal abduction.
43
Pts with anterior GH instability may have pain with what movements?
Overhead movements due to inability to control their laxity using their muscles.
44
What can occur unilaterally from acute traumatic events that cause secondary lesions such as Bankart (avulsion of anteroinferior labrum from glenoid rim and requires surgery) and Hill-Sachs lesions (depression fracture on posterior humeral head at site where humeral head impacted the inferior glenoid rim)?
Anterior GH instability
45
T or F?
Chronic, recurrent dislocations of the shoulder is not something that can lead to degenerative arthritis
FALSE - chronic, recurrent dislocations of the shoulder can lead to degenerative arthritis
46
Who is most likely to have a RC tear with a GH dislocation?
An older person
47
T or F?
Recurrent subluxations can cause dysfunction and GH instability
True
48
What is the typical method of injury resulting in GH instability?
FOOSH (fall on outstretched hand) this forces into abduction, extension, and ER
49
What type of GH instability is rare?
Posterior instability
50
What type of GH instability is often associated with a seizure, electric shock, MVA, or diving into a shallow pool?
Posterior GH instability
51
Pts with posterior GH instability have sx's with the arm in what position?
Forward flexed and adducted
52
What are the three classifications of posterior GH instability?
Subacromial, subglenoid, and subspinouse (most common)
53
What is the classic sign of posterior GH instability?
A loud clunk as shoulder is moved from flexion to abduction and ER
54
What type of GH instability is uncommon?
Inferior GH Instability
55
How can inferior GH instability occur?
From carrying heavy objects at your side or hyperABDuction forces that cause levering of the humeral neck against the acromion
56
T or F?
Inferior sublux is common in pts with inferior GH instability after CNS injury secondary to weakness of shoulder girdle and scapular stabilizers
True - RC mms do not have strength to hold humeral head in labrum, so inferior sublux occurrs
57
What is the term for symptomatic GH instability in more than one direction where rehab is the primary intervention to restore GH stability?
Multidirectional GH instability
58
What does SLAP lesion mean?
Superior Labral lesions that are both Anterior and Posterior
59
What condition is occurring when people performing overhead movement may develop a "dead arm" with a painful shoulder?
SLAP lesions
60
What is the MOI of a SLAP lesion?
FOOSH, sudden deceleration or traction forces (catching a heavy falling obj), MVA, chronic anterior and posterior instability
61
SLAP lesions - which is fraying and degeneration of edge of superior labrum and the pt loses ability to horizontally abduct and ER with forearm pronated w/o pain?
Type 1
62
SLAP lesions - which is a vertical tear of the labrum similar to a bucket handle tear of meniscus?
Type 3
63
SLAP lesions - which is a pathologic detachment of the labrum and biceps tendon anchor resulting in loss of stabilizing of labrum and biceps?
Type 2
64
SLAP lesions - which is an extension of the bucket handle tear into the biceps tendon, and portions of the labral flap and biceps tendon displaceable into GH joint?
Type 4
65
What is the conservative approach to heal SLAP lesions?
avoid positions that make dislocation, scapular stability exercise, closed-chain exercises, and exercises to rehab scapulohumeral rhythm
66
What are surgical interventions for SLAP lesions?
Bankart (reattachment of torn capsule)
capsulorrhapy (tightening of capsule)
electrothermally assisted capsulorraphy
SLAP lesion repair
67
What condition is a chronic inflammatory process in pts with a painful, stiff shoulder?
Underlying pathologic changes are synovial inflammation w/subsequent reactive capsular fibrosis
Frozen shoulder/adhesive capsulitis
68
T or F?
Frozen shoulder is an inflammatory and fibrosing condition, depending on the stage of disease
True
69
What are characteristics of primary frozen shoulder?
* Provoking chronic inflamm. in musculotendinous or synovial tissues like RC, biceps tendon, or jt capsule
* occurs between 40-60 yo
* characterized by progressive and painful loss of AROM and PROM in shoulder
* inflamm. and pain causing mm guarding w/o true fixed contracture of jt capsule
* disuse, leading to loss of shoulder mobility and continued disuse can lead to impingement
70
T or F?
With time, there is resolution of pain with a stiff shoulder with severe limitation of function in primary frozen sholder.
True
71
What is a secondary frozen shoulder characterized by?
Significant restriction of both active and passive shoulder motion that occurs in absence of a known intrinsic shoulder disorder
72
What are the stages of adhesive capsulitis/frozen shoulder?
1. Freezing - intense pain even at rest, loss of ER and ABD, lasting 10-36 wks
2. Frozen - pain only w movement, and resolves but leave a pain-free stiff shoulder
3. Thawing - slow, steady recovery of some of the lost ROM resulting from capsular remodeling; minor improvements
73
What condition is an injury to the nerves and soft tissues of the UE and cervical spine that occurs during birth, specifically at upper C5-C6 trunk of the brachial plexus?
Erb's palsy
74
In Erb's palsy, how is the arm usually situated?
Adducted and medially rotated, elbow is extended, and forearm is pronated
75
How can a SC joint sprain occur?
From MVA and sports
76
SC joint sprain types
Type 1: sprain of SC ligament
Type 2: sublux, partial tear of ligaments
Type 2 A/B: anterior (most common) and posterior sublux
Type 3 A/B: anterior and posterior dislocation
Type 4: habitual dislocation (rare)
77
Is pain localized or diffused in an SC joint sprain?
Localized
78
What movements create pain with an SC joint sprain?
Shoulder elevation, horizontal abb/abd, and you have hypo/hypermobility
79
Who are AC joint sprains most commonly seen in?
Athletes
80
How does and AC joint sprain occur?
Falling on to shoulder with arm adducted to side
81
How many types of injuries of AC joint sprains are there based on direction and amount of displacement?
6 - see Dutton p. 497
82
In an AC joint sprain, is pain localized or diffused?
Localized
83
In an AC joint sprain, what movements cause pain?
Pain with shoulder elevation, horizontal add/abd, and you have hyp/hypermobility
84
What do clavicle fractures typically result from?
FOOSH or less commonly, from direct blow
85
T or F?
With a clavicle fracture, you have a hard time elevating the arm above 60 degrees
True
86
What movement causes pain when you have a clavicle fracture?
Pain with horizontal adduction
87
T or F?
Clavicular fractures typically involve a clavicular deformity and tenderness with palpation
True
88
What is the most common fracture of the humerus and typically results from a direct blow to the anterior, lateral, or posterolateral part of the humerus or FOOSH injury?
Proximal humeral fracture
89
Displaced or nondisplaced proximal humeral fracture?
Majority are stable w/no significant displacement of the feature
nondisplaced
90
What are common complaints/features of proximal humeral fractures?
Pain and loss of function of the arm, swelling, and discoloration of the shoulder and upper arm
91
What is the intervention for a non displaced proximal humeral fracture?
Conservatively, control distal edema and stiffness and early motion. Use a sling until pain is gone (2 weeks)
92
What is the intervention for a displaced proximal humeral fracture?
Surgery including closed reduction, ORIF, proximal humeral head replacement, or long period of immobilization
93
What is the term for a shoulder replacement?
Total shoulder arthroplasty
94
T or F?
A total shoulder arthroplasty is a surgical option for old people with shoulder arthopathy
True
95
T or F?
Shoulder arthopathy occurs as a result of superior translation of the humerus in the shoulder due to deficient RC
True
96
What are some other diagnoses that require a total shoulder arthroplasty?
Bone tumors, RA, Paget's disease, avascular necrosis of humeral head, fx dislocations, recurrent dislocations
97
What is a reverse arthroplasty?
The ball and socket are reversed
98
What serves as the intersection of the humerus, radius, and ulna?
Elbow
99
What are the 3 articulations of the elbow?
humeroulnar (olecranon of ulna and trochlea of humerus)
humeroradial (concave radial had with convex capitulum of humerus)
radioulnar joint (where pronation and supination occur)
100
What are the 3 ligaments of the elbow?
Medial (ulnar) collateral ligament (protects against valves stress)
Lateral (radial) collateral ligament (provides stability to lateral part of elbow)
annular ligament (maintain relationship between head of radius on humerus and ulna)
101
What is the ER of the arm when the elbow is flexed to 90 due to?
ER of the trochlea
102
T or F?
Trochlea is usually tiled, giving the carrying angle of 10 for men and 13 or women.
True
103
What condition occurs either at the musculotendinous junction or radial tuberosity being avulsed partially or completely but majority at the shoulder?
Biceps tendon rupture
104
Does biceps tendon rupture at elbow occur mostly in males or females?
Males
105
What are sx's of a biceps tendon rupture?
Sharp, tearing-type pain with an acute injury or swelling and activity related pains in the antecubital fossa from chronic injury
106
T or F?
Triceps tendon ruptures occur usually with a deceleration force during extension to uncoordinated contraction of triceps against flexing elbow
True
107
What is the treatment for biceps and triceps tendon ruptures?
Surgery
108
What results from repetitive hyperextension of the elbow with pronation OR repetitive flexion combined with stressful pronation/supination
Bicipital tendinopathy
109
Bicipital tendinopathy is common in who?
Weightlifters, bowlers, gymnasts
110
What are the complaints of bicipital tendinopathy?
Pain at anterior part of distal arm
111
What motions created pain with someone with bicipital tendinopathy?
Pain with resisted elbow flexion and supination + pain with passive shoulder and elbow extension
112
What does triceps tendinopathy result from?
Repetitive extension
113
What are sx's/complaints of triceps tendinopathy?
Tenderness local to the triceps insertion at elbow and worsened by resisted elbow extension
114
T or F?
Brachialis strain is pretty rare but can occur from overuse activities like heavy lifting
True
115
T or F?
Brachialis strain indicated by a painless, enlarging mass which is a RED FLAG and pain in anterior part of distal arm
True
116
Is a brachialis strain prone to myositis ossificans (pathologic bone formation) b/c it is likely to hemorrhage when injured?
Yes
117
What are the two types of epicondylitis and where are they?
Tennis elbow - lateral epicondyle
Golfer's elbow - medial condyle
These are overuse injuries
118
What condition is characterized by being at the origin of extensor muscles, often degenerative and not inflammatory, pain on lateral part of a elbow, is from overuse, and as sx's of ashiness and morning stiffness?
Palpation is tender over the Extensor Carpi Radialis Longus Brevis
Tennis elbow - epicondylitis
119
What is the intervention for tennis elbow and golfers elbow?
Manual therapy, braces, resistance exercises, and surgery if absolutely needed after 6 months
120
What condition is characterized by involving the origin of the flexor carpi radialis and pronator teres?
Begins as micro tearing and there is repeated stress involving flexor-pronator tissues. People like pitchers can get this.
Golfer's elbow
121
What is a medial (ulnar) collateral ligament sprain caused by?
Chronic valgus and external rotation forces or a FOOSH
122
What condition is characterized by being from chronic valgus and ER forces (pitching), a FOOSH, from a surgery for cubital tunnel syndrome, can irritate the ulnar nerve, and causes medial elbow pain?
Medial (ulnar) collateral ligament sprain
123
What is the intervention for a medial (ulnar) collateral ligament sprain?
Rest, strengthening, supervised throwing, and maybe surgery via Tommy John surgery (reconstruction of ligament by resorting of anterior oblique band of UCL)
124
What is the term for a pathologic bone formation that is formation of mature lamellar bone in nonosseous tissues?
Heterotopic ossification
125
What is the term for heterotypic ossification that forms in inflammatory muscle?
Myositis ossificans
126
What can ossification result from?
Direct elbow trauma and aggressive PROM after the trauma
127
What condition is characterized by:
- Swelling over olecranon process
- Pain and swelling that is acute or gradual
- Bruising over olecranon from trauma or irritation by repetitive weight bearing
Olecranon bursitis (students elbow)
128
What fracture of the arm is caused by direct trauma to the arm or shoulder or by axial loading through the elbow and is above the condyles of the humerus?
Supracondylar fracture
129
What fx of the arm is of the distal end of the humerus and is difficult to manage, from a high-energy injury?
Intracondylar fractures
130
With elbow dislocation, is posterior less common than anterior?
No, posterior is more common than anterior. The ulna is placed posteriorly in relation to the distal humerus
131
T or F?
Elbow dislocation can lead to compartment syndrome, myositis ossificans, and UCL involvement
True
132
What are the three main joints of the distal forearm and hand?
Distal radioulnar joint
Radiocarpal joint
Mid-carpal joint
133
What general condition is characterized by:
- being common in hand and wrist and presents w no major motor or sensory issues
- can be accompanied by a hx of pain or vague sensory disturbances
- needs surgery or just PT depending on severity
Peripheral nerve entrapment
134
Compression of what nerve in the forearm causes chronic wrist pain and functional impairment of the hand? It is the moat common compression neuropathy and between 40-60 yo
Median nerve entrapment - subset of peripheral nerve entrapment. Also called carpal tunnel syndrome.
135
What are some things that can cause carpal tunnel syndrome of the median nerve?
Pregnancy b/c fluid retention, RA, OA, trauma, collagen disorders, etc
136
What is the treatment for carpal tunnel syndrome?
Splints, joint immobilization, modify activities, exercise, and possibly surgery to release entrapment of nerve
137
What condition is characterized by:
- can occur at Guyon's canal
- clinically presents as claw hand b/y unopposed action of extensor digitorum in 4th and 5th fingers
- can't extend 2nd and distal phalanges of any fingers
- cannot adduct or abduct or oppose fingers
- cannot adduct thumb
- loss of sensation on ulnar side of hand, ring finger, and over entire little finger
- all of this can also happen at the elbow
Ulnas nerve entrapment
138
What is the term for inflammation of the tendon or tendon-muscle attachment?
Tendinitis
139
What is the term for inflammation of the tendon sheath?
Tenosynovitis
140
What tendinopathy condition is characterized by:
- Progressive tenosynovitis affecting tendon sheaths of Dorsal side of wrist resulting in thickening of extensor retinaculum, and compression of tendons esp during radial deviation
- Characterized by degeneration and thickening of tendon sheath
De Quervain's Disease
141
What are some predisposing factors to De Quervain's disease?
Overuse, repetitive tasks involving overexertion of thumb or radial/ulnar deviation of wrist, and arthritis
142
What test is used to determine De Quervain's disease?
Finkelstein test - grab thumb in fist and ulnar deviate
143
What condition is characterized by:
- active cellular process in fascia of hand, characterized by development of nodules in palmar and digital fascia
- contractures at MCP, PiP, and sometimes DiP joint
- has a higher incidence in alcoholics, diabetic, and epileptics
Palmar Fasciitis or Dupuytren Contracture
144
T or F?
Conservative treatment for Palmar fasciitis is clinically useful
False - it is not useful
145
What can happen if an extensor tendon ruptures?
Mallet finger forms at DiP joint
146
What tendon rupture is rupture of the flexor pollicis profundus at its insertion and is caused by a forceful passive extension while FDP is contracting?
(like when a finger is caught in a jersey while tackling in football)
Rupture of the terminal phalangeal flexor (Jersey Finger)
147
What fracture of the distal radius is a complete fracture with posterior displacement of the distal fragment?
Colle's Fracture
148
What fracture of the distal radius is a complete fracture with palmar displacement of the distal fragment?
Smith's fracture
149
What fx of the distal radius is a posterior or molar articular fracture resulting in wrist subluxation?
Barton's fracture
150
What fracture of the distal radius is incomplete and undisplaced and commonly seen in children?
Buckle fracture
151
Fx of what bone in the hand is commonly missed but is caused be a FOOSH, has poor blood supply leading to delayed healing or nonunion, and there is pain over the anatomic snuffbox?
Scaphoid in hand
152
An ulnar collateral ligament sprain (aka gamekeeper's thumb, skier's thumb, breakdancer's thumb) of the thumb is an injury to the UCL of the MCP joint of thumb and is commonly caused by what?
A hard abducting force on the thumb
153
What condition, formerly known as reflex sympathetic dystrophy, refers to a disorder that can occur even after minor injury to a limb?
Complex regional pain syndrome
154
What are symptoms of CRPS (complex regional pain syndrome)?
Pain and increased pain sensitivity, change in skin color or texture, swelling, change in skin temp, decreased function, and rapid or no hair/nail growth
155
What are things that may worsen complex regional pain syndrome?
Immobilization and over protecting the limb
