shoulder/elbow

Question 1

Common shoulder problems for young people:

Answer 1

instability, trauma

Question 2

common shoulder problems for middle age

Answer 2

rotator cuff, frozen shoulder

Question 3

common shoulder problems for elderly

Answer 3

arthritis, fx

Question 4

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

Answer 4

Trauma or not? Unidirectional vs multi-directional

Question 5

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

Answer 5

Cuff

Question 6

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

Answer 6

cervical spine

Question 7

What shoulder problems cause loss of ROM?

Answer 7

1) Adhesive capsulitis
2) OA
3) cuff tear

Question 8

What comorbidities are particularly relevant to MS issues?

Answer 8

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

Question 9

pop-eye deformity

Answer 9

Stephanie: biceps tear

Question 10

What problem most commonly causes muscle wasting?

Answer 10

compression neuropathy

Question 11

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

Answer 11

cuff tear

Question 12

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

Answer 12

OA, adhesive capsulitis

Question 13

SITS muscles

Answer 13

supraspinatous, infraspinatous, teres minor, subscapularis

Question 14

SITS muscle fxn

Answer 14

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

Question 15

What special test is checking internal rotation?

Answer 15

Gerber lift-off

Question 16

Gerber lift off is checking what muscle strength?

Answer 16

subscapularis

Question 17

What is the belly press test checking?

Answer 17

subscapularis

Question 18

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

Answer 18

Neer (arm raise) and Hawkin’s

Question 19

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

Answer 19

pain reproduced at AC joint

also can reproduce impingement pain

Question 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

Answer 20

Hornblower’s sign, teres minor

Question 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 ____________

Answer 21

external rotation, Lag test

Question 22

What are the signs of shoulder instability?

Answer 22

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

Question 23

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

Answer 23

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

Question 24

A sulcus sign is suggestive of __________________

Answer 24

ligament laxity = multidirectional instability

Question 25

How could you test posterior instability of shoulder?

Answer 25

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

Question 26

SLAP

Answer 26

superior labrum, anterior/posterior

Question 27

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

Answer 27

throwing

Question 28

What test can you do to check a SLAP tear?

Answer 28

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

Question 29

2 tests for biceps?

Answer 29

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

Question 30

Long thoracic nerve palsy is a/w ___________

Answer 30

medial winging of serratus anterior

Question 31

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

Answer 31

CN XI, trapezius

Question 32

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

Answer 32

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

Question 33

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

Answer 33

MRI with contrast

Question 34

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

Answer 34

Hill-Sach's, Bankart, Glenoid morphology

Question 35

90% of all shoulder dislocations are _______

Answer 35

anterior

Question 36

90% of first time anterior shoulder dislocations are _______________

Answer 36

Bankart Lesions

Question 37

What is actually the damaged structure in a bankart lesion?

Answer 37

anterior inferior glenoid labrum

Question 38

What complication is often a/w a bankart lesion?

Answer 38

Hill Sach's lesion/fx of the humeral head

Question 39

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

Answer 39

prominent humeral head with external rotation

Question 40

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

Answer 40

axillary nerve

Question 41

How do you tx anterior shoulder dislocation?

Answer 41

conscious sedation, reduction, sling, sx for repeaters

Question 42

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

Answer 42

violent muscle contractions in sz or electrocution

Question 43

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

Answer 43

internally rotated, unable to abduct

Question 44

What are you looking for on xray for posterior dislocation?

Answer 44

light bulb sign, empty glenoid

Question 45

how do you tx a posterior shoulder dislocation?

Answer 45

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

Question 46

How can you tx recurrent instability of shoulder?

Answer 46

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

Question 47

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

Answer 47

AC joint separation

Question 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

Answer 48

adhesive capsulitis

Question 49

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

Answer 49

endocrine (DM, thyroid)

Question 50

how do you tx this frozen shoulder?

Answer 50

PT, NSAIDS, CS inj, arthroscopy

Question 51

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

Answer 51

spectrum of severity.

Question 52

What imaging is used for rotator cuff tear eval?

Answer 52

MRI for uncertain dx or pre-sx

Question 53

Most common mgmt for cuff tear?

Answer 53

PT

Question 54

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

Answer 54

rotator cuff arthropathy

Question 55

What can be done for rotator cuff arthropathy?

Answer 55

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

Question 56

What does high-dose steroids increase the risk of?

Answer 56

AVN

Question 57

Tx of OA in shoulder

Answer 57

NSAIDS, Cox2, PT, CS inj

Question 58

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

Answer 58

ORIF with sling/immobilization long recovery, residual stiffness!!

Question 59

where is the most common location for a clavicular fx?

Answer 59

middle 3rd

Question 60

when do you repair a clavicle fx?

Answer 60

if > 2cm of shortening

Question 61

the trochlea articulates with the ________

Answer 61

coronoid process of the ulna

Question 62

The capitellum articulates with the __________

Answer 62

radial head fossa

Question 63

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

Answer 63

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

Question 64

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

Answer 64

cubital tunnel

Question 65

Where is the tenderness in tennis elbow?

Answer 65

lateral epicondyle/radial head/capitellum

Question 66

What is the milk test?

Answer 66

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

Question 67

MOI for UCL injury

Answer 67

land on palm, valgus stress from supination

Question 68

what is the most common problem of the elbow?

Answer 68

lateral epicondylitis

Question 69

What does lateral epicondylitis look like on PE?

Answer 69

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

Question 70

How do you tx epiconylitis?

Answer 70

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

Question 71

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

Answer 71

more of an overuse injury (especially pronation)

Question 72

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

Answer 72

ulnar

Question 73

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

Answer 73

pronation and wrist flexion

Question 74

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

Answer 74

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

Question 75

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

Answer 75

galeazzi fx (distal, radial fx)

Question 76

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

Answer 76

monteggia fx (proximal, ulna fx)