Upper Extremity

Question 1

Rotator Cuff Characteristics

Answer 1

1. occurs with overhead overuse (throwing athletes)
2. underlying GH instability, poor muscle strength, training errors
3. common cause is impingement of the supraspinatous tendon as it passes beneath the subacromial arch

Question 2

Rotator Cuff Clinical Features

Answer 2

1. dull, aching shoulder
2. pain caused by inflammation, fibrosis, tears
3. pain exacerbated by ABD arm

Question 3

Rotator Cuff Diagnostic Studies

Answer 3

1. radiographs r/o calcific tendonitis

2. arthrography/MRI to r/o tears

Question 4

Rotator Cuff Treatment

Answer 4

1. Stop aggravating factors
2. NSAIDs (alleviate inflammation, pain)
3. cortisone injection
4. PT
5. arthroscopic subacromial decrompression
6. surgery

Question 5

Shoulder Dislocation Characteristics

Answer 5

1. fall on outstretched hand

2. dislocation most common

Question 6

Should Dislocation Clinical Features

Answer 6

1. loss of shoulder contour

2. careful neovascular assessment needed

Question 7

Shoulder Dislocation Diagnostic Studies

Answer 7

1. Xray (AP and Y view)
2. Hill-Sachs lesions (humeral head deformities)
3. MRI: Bankart Lesions (tear of glenoid labrum)

Question 8

Shoulder Dislocation Treatment

Answer 8

1. post-reduction films
2. immobilization with sling (velpeau sling)
3. therapy should being sooner for older patients (3 weeks for 40 and under, 1 week for over 40)

Question 9

Adhesive Capsulitis characteristics

Answer 9

1. Frozen Shoulder

2. inflammatory process following injury or spontaneous (increased risk with diabetes)

Question 10

Adhesive Capsulitis Diagnostic

Answer 10

Arthrography

Question 11

Adhesive Capsulitis Treatment

Answer 11

1. NSAIDs
2. passive ROM
3. manipulation under anesthesia

Question 12

Clavicle Fracture Characteristics

Answer 12

1. most common fracture in children and adolescents

2. fall on outstretched arm

Question 13

Clavicle Fracture Clinical Features

Answer 13

1. visible deformity

2. brachial plexus injuries? (pain, weak, reflex/sensory abnormalities)

Question 14

Clavicle Fracture Imaging

Answer 14

1. AP view xray

Question 15

Clavicle Fracture Treatment

Answer 15

1. Children: figure-8 sling 4-6 weeks

2. Adults: sling for 6 weeks

Question 16

AC Separation Characteristics

Answer 16

tearing of AC and/or coracoclavicular ligaments

Question 17

AC Separation Imaging Studies

Answer 17

1. Bilateral AP xray

Question 18

AC Separation Treatment

Answer 18

1. Conservative for mild-moderate (managed with sling and anesthesia)
2. Surgery for more severe

Question 19

Carpal Tunnel Syndrome Characteristics

Answer 19

Compression of median nerve

Question 20

Carpal Tunnel Syndrome Clinical Feature

Answer 20

1. night pain, numbness, paresthesias (sparing little finger), clumsiness, weakness
2. thenar atrophy
3. Tinel sign (tingling with percussion over volar aspect)
4. Phalen test (sxs with full flexion of test for >1 min)

Question 21

Carpal Tunnel Syndrome Diagnostic Studies

Answer 21

1. EMG

2. Nerve conduction

Question 22

Carpal Tunnel Treatment

Answer 22

1. activity modification
2. volar wrist splint
3. NSAIDs
4. steroid injection
5. surgery to decompress nerve

Question 23

Lateral Epicondylitis Characteristics

Answer 23

1. tennis elbow

2. tendinous insertion of extensor carpi radialis brevis

Question 24

Lateral Epicondylitis Clinical Features

Answer 24

pain when lifting objects (esp. in pronation)

Question 25

Lateral Epicondylitis Treatment

Answer 25

1. activity modification 2. counterbalance braces 3. pick up objects in supination 4. PT 5. steroid injections 6. NSAIDs 7. surgery for patients who fail 6 months of treatment

Question 26

Olecranon Bursitis Characteristics

Answer 26

1. acute injury or repetitive trauma to olecranon bursa | 2. can occur from infection from S. aureus

Question 27

Olecranon Bursitis Clinical Features

Answer 27

1. swelling overlying the olecranon process, usually painless 2. ROm preserved

Question 28

Olecranon Bursitis Treatment

Answer 28

1. ace wrap compression 2. aspiration of bursa if infected 3. NSAIDS, warm compresses 4. surgical removal

Question 29

Scaphoid Fracture Characteristics

Answer 29

most commonly fracture carpal bone

Question 30

Scaphoid Fracture Clinical Features

Answer 30

pain over anatomic snuffbox

Question 31

Scaphoid Fracture Imaging

Answer 31

1. long-arm thumb spica cast until bone scan/MRI

Question 32

de Quervain disease Characteristics

Answer 32

thumb extensor/abductor stenosing tenosynovitis

Question 33

de Quervain disease Clinical Features

Answer 33

1. pain/tenderness at wrist and base of thumb 2. swelling/thickening of tendon sheath 3. Finkelsteins test

Question 34

de Quervain Treatment

Answer 34

1. thumb spica splint 2. NSAIDs 3. PT 4. steroid injection 5. surgical decompression