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Flashcards in shoulder/elbow Deck (76):
1

Common shoulder problems for young people:

instability, trauma

2

common shoulder problems for middle age

rotator cuff, frozen shoulder

3

common shoulder problems for elderly

arthritis, fx

4

What's the first classification you want to make when working with a shoulder dislocation?

Trauma or not? Unidirectional vs multi-directional

5

Patient c/o lateral pain from deltoid down to elbow. Where is this typically coming from?

Cuff

6

Patient c/o shoulder pain that radiates to hand, where is this typically coming from?

cervical spine

7

What shoulder problems cause loss of ROM?

1) Adhesive capsulitis
2) OA
3) cuff tear

8

What comorbidities are particularly relevant to MS issues?

DM, thyroid, smoking and any serious med problem that would r/o candidacy for sx

9

pop-eye deformity

Stephanie: biceps tear

10

What problem most commonly causes muscle wasting?

compression neuropathy

11

If you can get more ROM from the shoulder passively than actively, what are you thinking first?

cuff tear

12

If you have lost passive ROM in the shoulder, what are you thinking first?

OA, adhesive capsulitis

13

SITS muscles

supraspinatous, infraspinatous, teres minor, subscapularis

14

SITS muscle fxn

1) supraspinatous--abduction
2) infraspinatous--external rotation
3) teres minor--multidirection accessory
4) subscapularis--internal rotation

15

What special test is checking internal rotation?

Gerber lift-off

16

Gerber lift off is checking what muscle strength?

subscapularis

17

What is the belly press test checking?

subscapularis

18

Which PE tests are looking for impingement of the rotator cuff?

Neer (arm raise) and Hawkin's

19

If you passively moved the arm in adduction across the body, what would you be checking for?

pain reproduced at AC joint

(also can reproduce impingement pain)

20

The _________ sign shows a tear in the _________ and is concerning b/c it limits the ability for patients to perform ADL's like brushing teeth/hair, feeding

Hornblower's sign, teres minor

21

Infraspinatous is responsible for ______ rotation. If a patient's arms are passively placed in jazz hand position, but they cannot maintain it, this is a positive ____________

external rotation, Lag test

22

What are the signs of shoulder instability?

A) Apprehension, humerus feels like it will pop out anteriorly
B) Jobe relocation, feels better if you push posteriorly on proximal humerus
C) Augmentation--feels worse if you pull anteriorly
D) Release--Release of JOBE feels bad

23

What are the grades of the load and shift test for shoulder stability?

0--no movement
1--humeral head to the glenoid labrum
2--humeral head over glenoid rim
3--dislocation

24

A sulcus sign is suggestive of __________________

ligament laxity = multidirectional instability

25

How could you test posterior instability of shoulder?

Jerk test: arms out like linebacker, push posteriorly and listen/feel for jerk/clunk

26

SLAP

superior labrum, anterior/posterior

27

What is a common cause for young people to get a SLAP tear?

throwing

28

What test can you do to check a SLAP tear?

O-brien's test/empty can test. Arm is horizontal, 10 degrees adducted. Pain worse with thumb down

29

2 tests for biceps?

speed test (wolverine) and yergason test (elbow flexion).

30

Long thoracic nerve palsy is a/w ___________

medial winging of serratus anterior

31

Lateral winging is caused by __________ nerve palsy, and is a/w what muscle?

CN XI, trapezius

32

How can you tell the difference b/t medial and lateral winging?

Medial--wall push up produces vertical wing.
Lateral--external rotation produces oblique wing

33

What type of imaging is best for the rotator cuff/SLAP region?

MRI with contrast

34

What type of shoulder problems are mostly bony and should be evaluated with a CT?

Hill-Sach's, Bankart, Glenoid morphology

35

90% of all shoulder dislocations are _______

anterior

36

90% of first time anterior shoulder dislocations are _______________

Bankart Lesions

37

What is actually the damaged structure in a bankart lesion?

anterior inferior glenoid labrum

38

What complication is often a/w a bankart lesion?

Hill Sach's lesion/fx of the humeral head

39

What will a patient's arm look like if there is an anterior shoulder dislocation?

prominent humeral head with external rotation

40

What must you check in the event of an anterior shoulder dislocation?

axillary nerve

41

How do you tx anterior shoulder dislocation?

conscious sedation, reduction, sling, sx for repeaters

42

What can cause a posterior dislocation aside from posterior directed force?

violent muscle contractions in sz or electrocution

43

What will the arm look like in a pt with a posterior shoulder dislocation?

internally rotated, unable to abduct

44

What are you looking for on xray for posterior dislocation?

light bulb sign, empty glenoid

45

how do you tx a posterior shoulder dislocation?

sedation, reduction by external rotation and push humeral head anteriorly, then immobilize x 6 weeks

46

How can you tx recurrent instability of shoulder?

PT, sx to repair labral tear, reconstruction of bone loss

47

A fall onto the shoulder or catching a backwards fall with your elbows is likely to cause __________

AC joint separation

48

This is an idiopathic condition characterized by pain and stiffness of the shoulder at rest. Pain increases at extremes of ROM. Ability to perform AROM is equal to PROM

adhesive capsulitis

49

adhesive capsulitis is thought to be related to what systemic conditions?

endocrine (DM, thyroid)

50

how do you tx this frozen shoulder?

PT, NSAIDS, CS inj, arthroscopy

51

What's the difference b/t a subacromial impingement and a rotator cuff tear?

spectrum of severity.

52

What imaging is used for rotator cuff tear eval?

MRI for uncertain dx or pre-sx

53

Most common mgmt for cuff tear?

PT

54

Term for when the rotator cuff cant contain the humeral head withing the glenoid

rotator cuff arthropathy

55

What can be done for rotator cuff arthropathy?

Reverse TSA (total shoulder arthroplasty) for pts with no rotator cuff fxn (fossa becomes ball, humerus becomes socket)

56

What does high-dose steroids increase the risk of?

AVN

57

Tx of OA in shoulder

NSAIDS, Cox2, PT, CS inj

58

how are non-displaced proximal humerus fx's treated?

ORIF with sling/immobilization

long recovery, residual stiffness!!

59

where is the most common location for a clavicular fx?

middle 3rd

60

when do you repair a clavicle fx?

if > 2cm of shortening

61

the trochlea articulates with the ________

coronoid process of the ulna

62

The capitellum articulates with the __________

radial head fossa

63

what are you thinking if there is ttp over the medial epicondyle of the elbow?

1) medial epicondylitis
2) MCL injury
3) medial epicondyle avulsion

64

A positive Tinel's sign in ulnar nerve distribution indicates _________

cubital tunnel

65

Where is the tenderness in tennis elbow?

lateral epicondyle/radial head/capitellum

66

What is the milk test?

like your doing a delt stretch and you milk the thumb, which creates valgus stress and reproduces pain in problem with the ulnar collateral ligament

67

MOI for UCL injury

land on palm, valgus stress from supination

68

what is the most common problem of the elbow?

lateral epicondylitis

69

What does lateral epicondylitis look like on PE?

tenderness is anterior and distal to lateral epicondyle, wrist extension exacerbates

70

How do you tx epiconylitis?

NSAIDS, CS inj, orthotics, PT, LASERS, sx

71

Lateral epicondylitis is an inflammatory disorder, what about medial epi?

more of an overuse injury (especially pronation)

72

Which nerve is a/w neuropathy in 50% of medial epicondylitis cases?

ulnar

73

Medial epicondylitis is a/w with increased pain during what movements?

pronation and wrist flexion

74

What are the 3 tx's for radial head fx?

1) Conservative--non-displaced
2) ORIF for young or displaced >2mm
3) replacement--older, severely comminuted

75

The _______ is a fracture of the distal radius with dislocation of the distal radioulnar joint

galeazzi fx (distal, radial fx)

76

The ___________is a fracture of the proximal third of the ulna with dislocation of the head of the radius

monteggia fx (proximal, ulna fx)