Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Medicine II > UE ortho > Flashcards

UE ortho Flashcards

1
Q

broad categories for shoulder pain

A

arthritic picture
impingement
rotator cuff injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are we worried about with impingement

A

i. Subacromial bursitis
ii. Rotator cuff tendonitis
iii. Biceps tendonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

suction cup that holds the rotator cuff and the capsule attaches to

A

the labrum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

impingement pain would be described as

A 
pain with reach for a seat belt
hooking a bra
throwing a ball 
inability to sleep on shoulder 
pain that radiates from the top of the shoulder to the bicept

upper neck and back pain
loss of strength and motion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

with frank weakness in the shoulder

A

we worry about a tear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

with difficulty because of pain

A

worry about impingement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

physical exam

A 
look for TTTP around sub-acromial area
looking at passive or active 
strength testing (out of 5)

” Inspect for any visible deformity
“ Palpate for any point tenderness over biciptal groove, AC joint, posterior subacromial area
“ Passive and active ROM
“ Strength testing
“ Special tests: Jobe (empty can), Neer, Hawkins, Speeds, Cross-body Adduction, Drop Arm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

joeb or empty can

A

abduction against resistance with internal rotation
rotating the humeral head will allow for better understanding of impingement

positive test tells you
rotator cuff

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Neer

A

internal rotation thumb down
examiner supports the scapula while lifting the arm (passive)
looking to see if it ellicits pain

also looking for impingement rotator cuff

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Hawkins

A

internal rotation with flextion 90 degree angle robot wave

examiner hands on bicept and forearm (rotator cuff)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Speeds

A

for bicepts tendon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Cross-body Adduction

A

mostly used for AC joint

palpate AC joint and cross arm with 90 degree angle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

no joint space at glenohumeral

A

OA

also visualized with bone spurs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

impingement tx

A

course of anti inflammatories
cortisol injection if no relief with oral NSAIDs in 4-6 weeks
can take 2-3 for cortisone to work
if continued need to rule out a cuff tear with an MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what population would you want to avoid cortisone with

A

DM population-A1C over 9 absolutely, reconsider over 8

high risk for bacterial infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

orthopedic managment of anterior

A

a. Anterior dislocation: conservative management
b. Short period of immobilization
c. Gradual advance to passive rom, then active rom, then advance to strengthening
d. Can be a long 3-5 month process
e. If continued instability 6 months plus after injury than refer to surgeon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

orthopedic management of posterior

A

a. Not as common, I always review these with surgeon on first visit and defer to their treatment plan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what do you need with a gleno-humeral dislocation

A

XRAy of shoulder to rule out fracture of glenoid humeral head
post reduction films are needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

a compression fracture of the posterolateral articular surface of the humeral head

A

Hill Sachs lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

acromioclavicular MOA

A

a. Typically caused by direct downward blow to the tip of the shoulder
b. Severity of injury dependent on structures that are compromised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

CM of acromioclaviuclar injury

A

” Focal pain and swelling over AC joint

“ Pain with attempt at overhead motion of arm or cross-body adduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

PE with acromioclaviuclar injury

A

” Inspect for deformity over AC joint
“ Focalized tenderness over AC joint
“ With mild injuries can access AC joint with cross body abduction (may be too painful for grade II or higher)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

dx of acromioclavicualr injury

A

Diagnostics

  1. Xrays: AP, lateral and axillary
  2. AP of both shoulders helpful if displacement or widening of joint not obvious
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

tx of acromioclavicular injury

A

” Non operative (grade I-III)
“ Brief period of immobilization, followed by passive range of motion of shoulder and gradually progress to active range of motion with focus on strengthening surrounding structures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
what is thoracic outlet syndrome
temperature changes and skin color changes might go down this route
26
big cause of olecranon bursitis
GOUT spider bites banging the elbow
27
olecranon bursitis what is our red falg
you need to know | NO FEVER NO CHILLS to rule our your seotic arthritis with this
28
CM of olecranon bursitis
" Patients note limited ROM of elbow due to swelling and discomfort " Not always point tender " Make sure to ask about fever, chills, nausea, vomiting
29
PE for olecranon bursitis
" Visible large mass over tip of elbow | " Redness or erythema to skin not uncommon
30
Tx for olecranon bursitis
" If mass is small: compression, NSAIDs, ice and limited use of elbow " If mass is large: aspiration " Cloudy fluid or suspect infection: send aspirate for cell count, cultures, gram stain and crystals
31
dx tests for olecranon bursitis
joint aspiration if it looks like cottage cheese it's gout crystals gram stain cell count
32
tennis elbow aka
a. Lateral Epicondylitis
33
where does Lateral Epicondylitis and what is it usually due to
Occurs at site of origin of the extensor carpi radialis brevis sometimes it's just over the tendon and sometimes it moves down into the actual musculature Due to tissue degeneration with fibroblast and microvascular hyperplasia
34
b. Medial Epicondylitis muscles involved
ii. Occurs in common tendinous origin of flexor/pronator muscles just distal to medial epicondyle iii. Less common than lateral epicondylitis
35
pain with wrist extension and/or forearm supination
lateral epicondylitis
36
: pain with wrist flexion and/or forearm pronation is suggestive of
medial epicondylitis
37
what would you find in a PE of a pt with condylitis
" Point tender over or just distal to origination of affected musculature " Pain with resisted wrist and/or forearm action lateral can see pain with middle finger flexion
38
Treatment for condylitis
NSAIDs Ice, massage, topical creams Activity modification Bracing: elbow strap and or wrist brace will srtop action at brace and allow for rest Cortisone injection: locate point of maximal tenderness for target spot to inject Surgery: debridement and possible release of tendon
39
Cubital Tunnel Syndrome
Compression of the ULNAR nerve at the cubital tunnel along the medial aspect of the elbow
40
b. Second most common compression neuropathy in upper extremity
Cubital Tunnel Syndrome secondary to carpal tunnel
41
when do you typically see cubital tunnel syndrome
Exacerbated by prolonged flexion of elbow | pts at night
42
CM of cubital tunnel syndrome
" Parasthesia and numbness of ring and small fingers | " Nighttime pain
43
VII. Cubital Tunnel Syndrome PE
" Inspect for atrophy of muscles innervated by ulnar nerve " Palpate nerve to see if it is mobile within the tunnel " Tinel sign, Elbow flexion test
44
Cubital Tunnel Syndrome dx
nerve conduction study
45
VII. Cubital Tunnel Syndrome TX
" Elbow pad to protect nerve " Splint for nighttime comfort w elbow in 45 deg flexion " NSAIDs " Surgical treatment: decompression (release) or ulnar nerve transposition
46
ulnar nerve respon
pinky and ring
47
compression of the median nerve
a. Compression of the median nerve within the carpal tunnel VIII. Carpal Tunnel Syndrome thumb index middle and half of the ring
48
what populations do you typically see carpal tunnel in
Commonly affects middle aged or pregnant women Often idiopathic but is associated with pregnancy, flexor tenosynovitis, overuse, inflammatory conditions, trauma to the wrist, endocrine disorders and tumors
49
CM of carpal tunnel
" Numbness in thumb, index and middle fingers " Pain awakens them at nighttime " Aching pain radiates up arm or into thenar area " Inability to open jars or clumsiness with holding objects " Pain with driving or keyboarding
50
durken carpal compression
" Inspect for thenar atrophy " Phalen maneuver and Tinel sign " Durkan carpal compression test
51
dx study for carpal tunnel
i. Nerve conduction study
52
carpal tunnel tx
``` " Bracing (esp nighttime, driving) " NSAIDs " Ergonomic modifictions " Cortisone injection " Surgical release of fibrous surrounding : open or endoscopi ```
53
ganglion cysts arise from
a. Arises from the capsule of a joint or a tendon synovial sheath
54
Cyst contain
b. Cyst contains thick, clear, mucinous fluid
55
Most common soft tissue tumors of the hand and wrist
cysts
56
cysts differentiate form cancer
because they are mobile and loose
57
CM of cysts
" Visible mass or lump that may fluctuate in size | " May be painful with range of motion at the affected joint or point tender to pressure
58
PE of cyst
" Soft, mobile mass | " May be multilobulated
59
why does cysts come back
because they have their own lining
60
cysts treatment
" If it is not painful than I tell patients to leave it alone " If it is causing pain or discomfort can attempt aspiration of cyst (mindful of volar wrist area) " Surgical excision also an option if aspiration unsuccessful
61
Swelling of sheath that surrounds abductor pollicus longus and extensor pollicis brevis at radial styloid area
X. De Quervain Tenosynovitis
62
De Quervain Tenosynovitis affects what muscles
abductor pollicus longus and extensor pollicis brevis at radial styloid area the muscles that deviate the wrist and abduct the arm baby picking up
63
where do we see CM of pain
" Pain, swelling and tenderness over radial styloid | " Pain with thumb flexion, abduction w wrist ulnarly deviated
64
Physical Exam of pts with suspected De Quervain Tenosynovitis
" Finkelstein test: provocative test to produce symptoms. Flex thumb into palm and ulnar deviate the wrist Usually positive with De Quervains diagnosis
65
De Quervain Tenosynovitis
" NSAIDs, immobilization, physical therapy, activity modification " Cortisone injection " Surgery
66
Trigger Finger is inflammation of
Inflammation of flexor tendon or first annular pulley finger when you try to straighten it catches
67
what SE do you want to warn pts of with cortisone
lightening of the skin | hypopigmentation
68
CM of trigger finger
" Pain, catching or locking when attempt finger flexion | " Painful nodule in the distal palm
69
PE with trigger finger
" Painful palpable nodule at distal palmar crease | " Palpable hitching along flexor tendon as passively flex finger
70
tx of trigger finger
" Cortisone injection into flexor sheath " Surgical release of A1 pulley if symptoms refractory to injection Injection technique " Idea is to bathe tissue with anti inflammatory liquid " Use 1ml syringe with small needle " Do not inject fluid directly into tendon

Medicine II (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions