Upper extremities + Peds Fx Flashcards

Question

De Quervain Syndrome | *what is it

Answer 1

Stenosing inflammation of tendons (entrapment tendonitis) of the first dorsal compartment - ->APL (abductor pollicis lungus) - -->EPB (extensor pollicis brevis) MOA: excessive thumb use with repetitive action-- thumb abduction and extension CM * pain along radial aspect of wirst + base of thumb---rad to forearm esp with thumb extension or fripping * pain and tenderness at the radial styloid * swelling and thickness over the tendon sheath DX *Finklestein test: (+) means-->first dorsal compartment pain with ulnar deviation while the thumb is flexed in the palm or pain with thumb extension TX * thumb spica splint initial tx * NSAID * PT * corticosteroid injection if initial tx is unsuccessful

Answer 2

*median nerve entrapment and compression at the carpal tunnel RFs * women * DM * preg * occupations w/ repetitive extension and flexion of wrists CM * paresthesias or pain of the palmar aspects of the first 3 (&radial half of the fourth) digits esp at night * thenar muscle wasting in advanced cases DX * tinel test=pos if percussion of median nerve produces s/s * Phalen tests: pos if flexion of both wrists for 30-60 seconds reproduces s/s TX * initial/conservative=volar splint, NSAIDS * corticosteroid injecs * surgery in refractory cases

Answer 3

*progressive fibrosis of palmar fascia--leads to contractures as result of nodules or longitudinal bands (cords) in the palm RF * men >40 * ETOH * DM * smoking CM * visible or palpable nodules over the distal palmar crease of proximal phalanx along the course of the flexor tendons * fixed flexion deformity at the MCP joint with limited extension of MCP or PIP TX * intralesional collagenase and/or corticoid injection * surgical correction for adv or refrac cases

Answer 4

fx thru fifth metacarpal neck MOA: direct trauma to a closed first against a hard surface CM * pain along the dorsum of 5th metacarpal of hand with swelling * ecchymosis DX -XR TX * initial=ulnar gutter splint * ORIF * check for bite wounds----- if punched in the teeth/face - ->put them on Augmentin

Answer 5

Nursemaid's elbow *radial head is wedged into stretched annular ligament MC in kids 2-5YO *MCC by lifting, swinging, or pulling a child while the forearm is pronated and extended PE *arm slightly flexed and child refuses to use the arm Diagnosis=clinical XR usually normal TX *closed reduction----pressure on radial head with supination of elbow, followed by flexion of elbow

Answer 6

MC fx bone in kids, adolescents and newborns during brith Males>>>females typically occurs with mid-high energy impact to the area or fall on an outstretched hand if no h/x of trauma--- suspect malignanyc, rickets or abuse (ESP if <2yO) PE * pain with ROM * deformity at site * holds arm against chest Comps * pneumo * hemo * coracoclavicular ligament disruption (distal) * brachial plexus injuries CLASSIFICATION 1. group 1= MC, midshaft, middle 2. group 2=lateral (distal) third 3. group 3= proximal *medial* third TX * group 1= sling immobilization (with sling or fgure 8 splint) * if lateral or proximal, get an ortho consult *surgery is typcally indicated for any open fx, displaced fx, etc

Answer 7

* cortex broken one side, bent/bowed on the other | * peds

Answer 8

MOA=mc after blow to an abducted, externally rotated and extended extremity others: FOOSH, or posterior humeral force MC type=anterior PE: arm will be held in abducted and external rotation (elbow pointing out) -sqaured off shoulder-- humeral head is palpable with loss of deltoid contour SUBTYPES `1. Hill Sach Lesion: groove fx of humerus... corticol depression in posterolateral head of humerus MOA=forceful impaction of humeral head against anterioinferior felnoid rim when shoulder is dislocated anteriorly 2. Bankart Lesion: glenoid rim fx--stripping of glenoid labrum and periosteum from anterior-inferior surface of glenoid * occurs in lower part of labrum

Answer 9

ANTERIOR= abducted, external rotation, FOOSH | POST=adducted, internal rotation, seizures, electric shock

Answer 10

ANT: abduction + external rotation, humeral head palpable--squared off POST: adducted and internally rotated--shoulder appears flat with prominent humeral head

Answer 11

``` ANT= axillary and Y view *helps disting b/w ant and post POST= light bulb sign ```

Answer 12

ANT=reduction and immobilization MUST CHECK AXILLARY NERVE for injury b4 AND after reductio. POST=reduction and immobilization

Answer 13

AKA AC separation * clavicle sep from the scapula * MCC is falling directly on shoulder---direct blow to adducted shoulder CM * pain with lifting arm, unable to lift arm at the shoulder * can be +/- dtep off at AC joint TYPES 1, 2 and 3 MC 4 5 6 usually require surgical repair type 1= AC ligament stretched or partially torn type 2=AC ligament is totally torn and joint is slightly displaced type 3=AC ligament AND coracoclavicular ligmanet torn--- joint is completely displcaed-------clavicle no longer attached DX *xray with weights to help see dispalcement TX * types 1-3: conservative (ice, brief sling immobilization and rest). early rehab for ROM preservation * types 4-6: surgical reattachement of ligaments

Answer 14

* when tendons of the rotator cuff and subacrominal bursa are pinched in the narrow space beneath the acromion * causes tendons and bursa to become inflammed and swollen---"PINCHING" * worse when arm is adducted THREE GRADES I: inflammaiton of bursa and tendons II: progressive thickening and scarring of bursa III: rotator cuff degeneration and tears TX= conserv + PT

Answer 15

Frozen Shoulder *stiffness due to inflammation MC in 40-60s, DM, hypothyroidism CM * shoulder pain. stiffness * decr ROM--esp with external rotation * pain usually worse at night PE *resistance on passive ROM only on affected side *gradual return to normal ROM-- can take up to 18-24 mo TX * rehab= mainstay. * anti-inflamms * intraarticular steorid inj * heat

Answer 16

*MOA: chronic erosion, trauma MCC=repetitive overhead movements OTHER: older age, smoking INJURIES INCLUDE BOTH: 1. tendonitis--inflamma usually assoc with subacromial bursitis 2. tear Supraspinatus is MC injured CM * Anterolateral shoulder pain--deltoid pain---with decr ROM * decr ROM esp with overhead activities, external rotation or abduction---ex reaching for wallet * passive ROM > active * continuous pain and weeakness PE * Impingement tests= pain= (+) tear 1. Hawkins 2. Drop arm test 3. Neer test *supraspinatus strength test aka empty can test-->most specific for supraspinatus involvement

Answer 17

HAWKINS= elbow/shoulder flexed at 90 degrees with sharp anterior shoulder pain with internal rotation DROP ARM: pain with inability to lift arm above the shoulder level or hold it or severe pain when slowly lowering the arm after shoulder is abducted 90 degrees NEER: arm fully pronated (thumbs down) with pain during forward flexion (shoulder is held down to prevent shrugging)

Answer 18

``` MOA=FOOSH, direct blow PE *arm held in adduction *decr ROM *pain *swelling *ecchymosis MUST R/O BRACHIAL PLEXUS INJURY---- test deltoid sensation ``` TX Sling immobilization, analgesics & physical therapy

Answer 19

MOA=FOOSH, direct trauma PE=pain swelling to arm, ecchymosis, decr ROM MUST RULE OUT RADIAL NERVE INJURY--- (+) injury=wrist drop TX Coaptation splint or sling with prompt ortho follow up Surgical if open fracture, vascular or brachial plexus injuries

Upper extremities + Peds Fx Flashcards

(43 cards)