Shoulder, Elbow, Wrist and Hand

Question 1

Joint that stabilizes the shoulder in the AP plane

Answer 1

Acromioclavicular

Question 2

Joint that helps prevent vertical dislocation of humerus

Answer 2

Corcao-acromial

Question 3

Function of the supraspinatus muscle

Answer 3

Initiation of arm abduction/elevation

Depression and centering of the humeral head on the glenoid

Question 4

Function of the Infraspinatus and teres minor muscles

Answer 4

External rotation of the humerus

Question 5

Function of the subscapularis muscle

Answer 5

Internal rotation of the humerus

Question 6

Pathology that results from a loss of innervation/function of the periscapular muscles of the shoulder (scapulothoracic joint)

Answer 6

Loss of 2:1 motion of scapula to humerus
Potential for subacromial impingement
Potential for winged scapula

Question 7

Periscapular muscles

Answer 7

Trapezius
Rhomboid
Levator scapulae
Serratus
Latissimus

Question 8

Function of the coraco-acromial arch

Answer 8

Prevents vertical displacement of the humerus

Question 9

Role of the coracoacromial ligament/arch in shoulder impingement

Answer 9

Previous injury to the CoAc joint can cause calcinosis of the ligament, increasing the risk for subacromial impingement

Question 10

Ligaments most commonly involved in subacromial impingement

Answer 10

Supraspinatus and long head of the biceps

Question 11

Spectrum of disease seen in rotator cuff tears (based on age)

Answer 11

YOUNG: Most commonly overruse pain with activity only
MIDDLE: Most commonly impingement or overruse, pain occurs with activity and can awaken at night
OLD: Most commonly a true rotator cuff tear or bony impingement. Pain is chronic even at rest.

Question 12

PE tests that can be performed to detect impingement

Answer 12

Neer, Hawkins

Question 13

Mechanism by which supraspinatus weakness can cause impingement

Answer 13

Supraspinatus typically depresses humeral head

With weakness, humerus can rise and pinch the supraspinatus tendon beneath the acromion

Question 14

Shoulder position in an anterior dislocation

Answer 14

ABducted

EXternally rotated

Question 15

Shoulder position in a posterior dislocation

Answer 15

ADDucted

INternally rotated

Question 16

Burkhart’s lesions

Answer 16

Tear of the anterior-inferior labrum in an anterior shoulder dislocation

Question 17

Hill-Sach’s Lesions

Answer 17

Denting of the humerus in shoulder dislocation

Question 18

Common causes of posterior humeral dislocation (uncommon)

Answer 18

Trauma
Electrocution
seizures

Question 19

Multidirectional Humeral Instability

Answer 19

Can develop as a result of multiple dislocations or laxity of the rotator cuff
Patients often experience multiple subluxation events and show hesitance on exam

A frank dislocation event is rare

Question 20

Treatment options in shoulder dislocations

Answer 20

Patients should get XR to evaluate for fracture and then reduced
XR should be repeated in 3-10 days to ensure no fracture

Question 21

Indications for a surgical reduction of a shoulder dislocation

Answer 21

If repeated instability and subluxation is not corrected in PT

Question 22

Patient has anatomical snuffbox pain

Answer 22

Immobilize ALWAYS, may be an occult scaphoid fracture

Question 23

Bennett’s Fracture

Answer 23

Fracture of the 1st metacarpal due to an axial force against a flexed thumb (bad punching form)

Fracture is very unstable as AbPL pulls fracture proximally and AdPL adducts fracture

Question 24

Boxer’s fracture

Answer 24

Angular fracture of the 5th metacarpal

Heals well

Question 25

Distal radial fracture

Answer 25

Common fracture in adults FOOSH (may also occur with an ulnar styloid fracture) Heals well

Question 26

Phalangeal fracture (Skiier's Thumb)

Answer 26

Avulsion fracture of the ulnar collateral ligament of the 1st digit DIP joint.

Question 27

Mallet Finger (fracture)

Answer 27

Similar to Skiier's thumb, but an avulsion fracture of the DIP of fingers due to the lateral extensor tendons of the DIP joint Soft tissue mallet is the same without fracture

Question 28

Muscle implicated in tennis elbow

Answer 28

Extensor carpi radialis brevis

Question 29

Defromity in mallet finger

Answer 29

PIP Extension is lost, PIP joint remains flexed on extension

Question 30

Boutinnier Deformity

Answer 30

Rupture of the central extensor slip (DIP) | Leads to inability to extend DIP joint, but PIP joint remains intact

Question 31

Symptoms of an RA extensor tendon ruputre

Answer 31

inability to extend thumb due to rupture of the EPL | Ulnar deviation of the fingers

Question 32

Tendon most often involved in RA mediated tendon rupture

Answer 32

EPL

Question 33

Amount of force needed in repaired tendons to function

Answer 33

40N

Question 34

Muscles supplied by the median nerve

Answer 34

All Flexors except FDP and FCU | Thenar muscles

Question 35

Radial nerve innervation

Answer 35

Forearm and wrist extensors | Sensation to dorsal thumb and pointer finger

Question 36

Primary abnormality seen in radial nerve damage

Answer 36

wrist drop

Question 37

Deficits seen in Carpal tunnel syndrome

Answer 37

Loss of sensation to the thumb, pointer and middle finger finger Atrophy of thenar muscles Loss of grip strength Weakness in ab/adduction of thumb and pointer

Question 38

Deficits seen in cubital tunnel syndrome

Answer 38

Loss of sensation to ring and pinky fingers Loss of ab/adduction of fingers Weakness in wrist flexion (opposite wrist drop seen in carpal tunnel) Claw hand on extension of fingers