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Course 2 - Orthopedics > Shoulder, Elbow, Hand & Wrist > Flashcards

Shoulder, Elbow, Hand & Wrist Flashcards

(100 cards)

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1
Q

what are the four articulations of the shoulder?

A

sternoclavicular joint
scapulothoracic articulation
acromioclavicular joint
glenohumeral joint

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2
Q

what are the capsule, ligaments, cartilage, and bone associated with the sternoclavicular joint?

A

Capsule, ligaments: sternoclavicular ligaments
Cartilage: hyaline, articular disc
Bone: clavicle, sternum

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3
Q

what are the capsule, ligaments, cartilage, and bone associated with the acromioclavicular joint?

A

Capsule, ligaments: AC ligaments, CC ligaments
Cartilage: hyaline, meniscus
Bone: clavicle, scapula

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4
Q

what are the muscle, tendon, bursa, capsule and ligaments, cartilage, and bone associated with the glenohumeral joint?

A

Muscle, tendon, bursa:
o Superficial: deltoid, pec, trap
o Deep: rotator cuff, long head biceps
o Subacromial space

Capsule, ligaments: capsule, GH ligaments

Cartilage: hyaline, labrum

Bone: humerus, scapula

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5
Q

what are the muscles and bone associated with the scapulothoracic articulation?

A

Muscles, tendons, bursa: trapezius, serratus, rhomboids, levator, assorted bursas

Bone: scapula, ribs

(no cartilage and ligaments bc not a synovial joint)

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6
Q

patterns of disease for instability

A

mostly young/active people
not much pain
stiffness less common
apprehension

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7
Q

patterns of disease for rotator cuff syndrome

A

middle age/older
pain with reaching and at night
stiffness less common
weakness when loss of tendon attachment

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8
Q

patterns of disease for fractures

A

young/active, and elderly/frail
acute and constant pain
stiffness is potential sequela
less common weakness

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9
Q

describe clavicle fractures

A

MOA: direct blow or FOOSH
features: rarely open, rarely NV compromise, can have thoracic cage injury

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10
Q

describe Tx for clavicle fractures

A

all: sling, RICE initially
non op: if closed, shorted <2cm, medically infirm, not wanting surgery
op: open, severe shortening/displacement, combined injuries, pt preference, painful non-unions

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11
Q

describe AC joint separation

A

MOA: direct blow to shoulder (contact sports)
AC ligaments injured, CC ligaments injured
Rockwood classification of ligament injuries

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12
Q

describe Tx for AC joint separation

A

AC: sling, rice, PT

CC & AC: sling, periscapular muscle rehab, reconstruct torn ligaments for heavy labourers

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13
Q

describe GH joint dislocation

A

common, shoulder dislocation, reduction, can become recurrent

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14
Q

describe anterior GH joint dislocation

A

MOA: arm outstretched, force applied
most common type
shoulder looks squared, NV exam needed
need emergency reduction

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15
Q

what is bankart dislocation

A

avulsion (tearing) of anterior (inferior) labrum (cup-shaped cartilage that reinforces the shoulder joint)

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16
Q

what is Hill-Sachs

A

impaction of post-humerus on anterior glenoid

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17
Q

what is bony bankart?

A

rim fracture of ant-inf glenoid

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18
Q

describe posterior dislocation

A

arms flexed, adducted, internal rotation (seizures, football, electrocution)
same possible dislocations as anterior but with ‘reverse’
associated with humeral head fracture

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19
Q

what are static stabilizers of shoulders

A

bony shapes, concavity, joint capsule, labrum, glenohumeral ligaments, inherent negative pressure

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20
Q

what are dynamic stabilizers of the shoulder

A

rotator cuff muscles, long head of the biceps tendon, scapulothoracic motion, and other shoulder girdle muscles such as the pectoralis major, latissimus dorsi, and serratus anterior

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21
Q

how to radiologically distinguish ant vs post dislocation of shoulder

A

humerus is dislocated in same direction as coracoid: ant dislocation
humerus displaced away from coracoid: post dislocation

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22
Q

what is the mercedes benz sign?

A

3 points at acromion, coracoid, sacular body

if head of humerus is at center, normal

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23
Q

which of the following is not a synovial joint?

  • Glenohumeral joint
  • Sternoclavicular joint
  • Scapulothoracic joint
  • Acromioclavicular joint
A

Scapulothoracic joint

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24
Q

Which of the following muscles do not help operate the scapulothoracic joint?

  • Serratus anterior
  • Infraspinatus
  • Trapezius
  • Levator scapulae
  • Rhomboids
A

Infraspinatus

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25
Select the best pairing of diagnostic features - Adhesive capsulitis and apprehension - Glenohumeral arthritis and young/active person - Seizure disorder and anterior glenohumeral dislocation - Elderly and acromioclavicular joint separation
Seizure disorder and anterior glenohumeral dislocation
26
What is true about AC joint separations - Result from a direct blow to the AC joint - Often require ligament repair - Can lead to AC arthritis in future - Options 1 and 3
Options 1 and 3
27
what makes up the rotator cuff?
``` 4 tendons arising from scapula infraspinatous supraspinatous subscapularis teres minor keeps humerus on glenoid, resist upward pull of deltoid ```
28
suprascapular nerve innervates
infra/supra spinatus
29
upper/lower subscapular nerves innervate the
subscapularis
30
axillary nerve innervates
teres minor
31
what is the most common rotator cuff tear
supraspinatous
32
describe the continuum of tendinopathy
bursitis --> partial thickness tear --> full thickness tear --> arthropathy
33
describe pathophysiology of AC joint arthritis
degenerative OA, post-traumatic arthritis
34
presenting complaint of AC joint arthritis?
pain on ant-lat shoulder, focal > diffuse
35
physical findings of AC joint arthritis?
tenderness over ACJ, pain with adduction, prominent joint
36
radiography of AC joint arthritis?
degenerative changes on XR
37
Tx of AC joint arthritis?
``` Rest, ice/heat, activity mod, OTC meds Topicals, NSAIDs, exercise Corticosteroid Rx (injection of joint) Surgery and chronic management ```
38
pathophysiology of long head of biceps (LHB) tendinopathy
Degeneration of tendon in bicipital groove
39
presenting complaint of LHB tendinopathy
ant shoulder pain, pain w resisted biceps activity
40
physical findings of LHB tendinopathy
Tender over LHB, pain w resisted flexion/supination
41
radiographs of LHB tendinopathy
thickening, tearing, fluids in tendon sheath on US/MRI rupture does not require surgery size of tear and symptoms do not correlate
42
pathohysiology of rotator cuff tears
degeneration of rendon related to vascularity, repeat use, chronic injury
43
presenting complaint of rotator cuff tears
pain w overhead reach, pain at night, weakness overhead
44
physical findings of rotator cuff tears
discomfort w strength test and impingement | AROM
45
radiographs of rotator cuff tears
x-ray: normal or rounding/sclerosis of greater tuberosity, prox migration of humeral head US: good for full thickness SS, IS tears, not for partial or SSc tears MRI not routinely required
46
Tx for rotator cuff tears
stepwise Tx plan, subacromial injection in bursa, surgical repair, supervised active rehab
47
what is scapular dyskinesis?
abnormal movement of the scapula movement
48
what is the region in cervical spine most associated with shoulder diseases?
C5-6
49
MOA of corticosteroids
inhibit prostaglandins and leukotienes, reduce inflammation/pain
50
advantages and pitfalls for corticosteroid use
prognostic/diagnostic use | can lead to hyperglycemia in diabetics, using it without rehab is useless
51
long-head bicep ruptures does not/do require surgery
does not
52
T/F: size of tear and symptoms are correlated
F
53
describe the elbow joint
3 articulations in same capsule and synovial fluid space, hinge joint radial notch of ulna + radial head (proximal radioulnar) trochlea + radius (humeroradial) trochlea + ulna (humeroulnar)
54
describe humeral shaft fracture
fracture anywhere along the shaft of the humerus not common FOOSH close to radial nerve
55
describe deficiency in radial nerve
wrist drop, inability to extend fingers, numbness along forearm supplies triceps, extensor in forearm
56
Tx for humeral shaft fracture
straight cast, plate and screws
57
describe distal humerus fracture
not common unless elderly (osteoporosis) FOOSH, sometimes open close to ulna
58
describe deficiency in ulnar nerve
supplies hand intrinsic muscles, some flexors, 1.5 digits
59
describe Tx for distal humerus fracture
always surgery, sometimes elbow replacement
60
describe radial head fractures
common, more F than M | FOOSH, direct axial load or rotation force
61
Tx for radial head fractures
wrist exam and radiograph sling & icepack, sometimes screw, sometimes replacement DONT IMMOBILIZE; stiff elbows are hard to deal with
62
describe olecranon fractures
can be common direct blow to elbow or FOOSH can be open range from simple --> smashed
63
static stabilizers of the elbow
``` ulnohumeral joint (coronoid) medial (ulnar) collateral ligament (MCL) lateral collateral ligament complex (LCL) radiocapitellar joint surgical reconstruction ```
64
dynamic stabilizers of elbow
``` anconeus brachialis triceps biceps active focused rehab ```
65
pathophysiology of elbow dislocations
posteolateral most common axial loading supination/external rotation valgus posteolateral force
66
what is the terrible triad?
radial head fracture, coronoid fracture, ulnar collateral ligament injury
67
Tx for elbow dislocations
non-op: closed reduction, splinting @ 90 degrees op: LCL, MCL repair fix ulnar, radial should resolve
68
describe pathophysiology of distal biceps rupture
excessive eccentric tension as the arm is forced from a flexed to an extended position
69
symptoms of distal biceps rupture
palpable defect, muscle rolled up
70
Epicondylitis is defined as
inflammation of epicondyle lateral is tennis elbow medial is golfer's pain and inflammation around elbow
71
pathophysiology of epicondylitis
repetitive micro-trauma leading to changes in collagen and vascularity and finally structural incompetence
72
clinical features of lateral (tennis elbow)
pain with passive flexion and resisted extension
73
clinical features of medial (golfer's elbow)
pain with passive extension and resisted flexion
74
Select the best combination of named bony bits and where to find them ``` Olecranon and proximal humerus Coracoid and anterior scapula Medial epicondyle and proximal ulna Sternoclavicular joint and distal clavicle Coronoid and anterior scapula ```
Coracoid and anterior scapula
75
Which of the following is true about rotator cuff problems? Physiotherapy is unlikely to produce satisfactory symptom resolution The size of the tear is predictable by symptoms You should get an MRI to try to get them in to the surgeon faster There is commonly no clear injury that triggers symptoms
There is commonly no clear injury that triggers symptoms
76
Which of the following is not a static stabilizer of the elbow joint? ``` Bony shape of the ulnohumeral joint Biceps Lateral ulnar collateral ligament Medial collateral ligament Joint capsule ```
Biceps
77
# Choose the best combination of clinical features Lateral epicondylitis and pain with resisted wrist extension Medial epicondyltitis and pain with resisted wrist extension Olecranon fracture and radial nerve injury Distal humerus fracture and non-operative treatment
Lateral epicondylitis and pain with resisted wrist extension
78
describe carpal tunnel syndrome
compression of median nerve due to increased pressure in carpal tunnel
79
presentation of carpal tunnel syndrome
nocturnal pain, numbness/tingling, in thumb and index and long fingers, symptoms get better with shaking out hands, thenar wasting
80
investigations for carpal tunnel syndrome
tinel's sign phalen's reverse phalen's durkan's
81
Tx of carpal tunnel
non-op: night time splinting, corticosteroid injections | op: carpal tunnel release
82
describe flexor tenosynovitis
acute bacterial infection in the flexor tendon sheath
83
investigations for flexor tenosynovitis? 4 things for Kanavals signs
fusiform swelling, pain with palpation, flexed posture, pain with passive stretch
84
Tx for flexor tenosynovitis
surgery to remove pus + ABx + irrigation high incidence of post op stiffness aggressive rehab after surgery
85
describe scaphoid fracture
largest carpal bone, 80% surface is articular FOOSH force to wrist in hyperextension (>90 degrees)
86
what does the scaphoid articulate with
Articulates w radius, lunate, capitate, trapezoid, trapezium
87
presentation of scaphoid fracture
wrist swelling, pain in snuff box, pain with ulnar deviation
88
complications of scaphoid fracture
avascular necrosis and non-union (retrograde blood supply) | can lead to SNAC (scaphoid nonunion advanced collapse)
89
investigation for scaphoid fracture
``` not always on XR, bone scan or CT compression test (push 1st MC into scaphoid) ```
90
Tx for scaphoid fracture
splint, CT if abnormal, surgery if displaced smaller piece = higher chance of not healing higher risk if delay in Tx
91
describe ulnar nerve compression
compression of ulnar nerve @ elbow | cubital tunnel at elbow close to medial epicondyle
92
presentation of ulnar nerve compression
numbness in D4, D5 - worse with elbow flexion hypothenar and interosseous wasting weakness in muscles innervated by ulnar nerve
93
investigation for ulnar nerve compression
Froment sign Wartenburg sign Duschenne’s sign
94
Tx for ulnar nerve compression
non-op: splint at night (straight), activity modification (avoid leaning on flexed elbow) op: decompression, transposition
95
describe ulnar collateral ligament injury (skier's thumb)
``` tear of ulnar collateral ligament hyperflexibility, laxity in thumb need US to visualize non-surgical for partial tears, splinting/immobilization surgical for full tear ```
96
describe Dupuytren’s contracture
nodules in palm, progress to hard cords, thickening in palm, finger doesn’t straighten all the way (D4&5 affected most) genetic, European descent
97
describe mallet finger
``` injury to the extensor digitorum tendon at DIP cannot extend DIP, pain, numbness blunt force (ball) splint for Tx ```
98
what is high ankle sprain
MOI: external rotation and dorsiflexion | anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL) torn, inferior tib-fib also torn
99
TX for sprains
NSAID protective bracing PT surgical reconstruction for high grade
100
define plantar fasciitis
inflammation of thick connective tissue that support arch of foot focal pain, morning pain/stiffness

Course 2 - Orthopedics (7 decks)

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