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Flashcards in Upper Extremity Deck (14)
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1
Q

Glenohumeral Joint Dislocation/ Subluxation

Anterior?
Posterior?

Hx:

PE?

Imaging?

Tx?

Specific lesions?

A

Anterior (95%)- Forced abduction + external rotation
Posterior (5%)- Forced addiction + internal rotation

Hx: Pain, deformity, loss of function, arm held in “position of protection”

PE: Access axillary nerve

X-rays: AP, Y-view, or axillary view

  • Anterior leads to ligament damage:
    1) Bankart lesion: anterior labrum detaches from the glenoid rim
    2) Hill-Sachs lesion: humeral head is abraded by the anterior rim of the glenoid. Affects the posterolateral humeral head.

Tx: Immediate reduction of joint, sling/swathe, analgesics, protected ROM and isometric exercises, avoiding recurrence, surgery for recurrent dislocations.

2
Q

Acromioclavicular Joint Sprain

Grades I, II, III?

PE findings?

Imaging?

Tx?

A

Injury due to the result of a direct blow to the tip of the shoulder, or by an upward force exerted on the long axis of the humerus.

Grade 1: Joint intact. Mild stretching of acromioclavicular ligaments.
Grade 2: Disruption of superior and inferior AC ligaments. Instability with stree testing
Grade 3: Disruption of inferior AC ligaments AND the corococlavicular ligaments. Deformity with prominence of clavicular head.

Exam: Point tenderness + Can lift arm above shoulder with pain

Imaging: Weighted X-rays

Tx: Sling, analgesics, ROM and strengthening exercises over 2-4 weeks (Grade 2 need 4-6 weeks for fibrous healing)

3
Q

Rotator Cuff Injuries

PE?

Imaging/Tests?

Tx?

A

> 40 y.o.: Cuff tear (most commonly supraspinatus)
<40 y.o.: Impingement or tendinitis

Impingement Syndrome: Pain originating from the compression of tissues between the humeral head and corachromial arch.

PE: Inability to actively abduct arm above the horizontal plane. Passive ROM normal and painless. (Drop arm test, empty can test, ne’er impingement test)

Imaging/Dx Tests:
MRI (gold standard for diagnosis), Plane Radiographs, Arthrogram.

Tx: Conservative! Avoid aggravating, NSAIDS, PT, Rest

4
Q

Infant Brachial Plexus Injury/ Erb’s Palsy “Waiter’s tip”

Hx?

Types of nerve damage?

Tx?

A

Injury to the brachial plexus during a difficult vaginal delivery as the neck is stretched.

If the upper brachial plexus (C5-C6) is mainly involved, it’s called erb’s palsy.

Hx: Infant does not move one arm or shoulder (older children: weakness in one arm, loss of feeling, partial or total paralysis of the arm)

Types:
Neurapraxia: Does not tear the nerve.
Neuroma: Damages some of the nerve fibers.
Rupture: Nerve is torn/ruptured.
Avulsion:Nerve is torn from the spinal cord.

Tx: Passive shoulder ROM, after 3-6 months nerve grafting or muscle transfer.

5
Q
Lateral epicondylitis (tennis elbow)
&amp; 
Medial Epicondylitis (golfer/little league elbow)

PE?
Tx?

A

Lateral: Overuse injury to the tendinitis origin of the extensor supinator muscle group (LES)
Medial: Overuse injury to the tendinous origin of the flexor pronator muscle group (MFP)

PE:
Point tenderness over elbow epicondyle.
Lateral- Reproduce pain w/ resistance to wrist extension supination
Medial- Reproduce pain with resistance to wrist/pronation

Tx: Avoidance, NSAIDS, elbow strap

6
Q

Olecranon Bursitis

Imaging, Tx?

A

Usually painless inflammation of the bursa.

Develops gradual = chronic
Develops suddenly = infection or trauma

Imaging/Test: X-ray, Aspirate and culture

Tx: R.I.C.E., Elbow pad, corticosteroid injection (if no infection)

7
Q

Nursemaid’s Elbow

Hx, PE, Tx?

A

Subluxation of the radial head caused by rapid extension and pronation of the arm. Could be because the annular ligament is not developed.

Hx: Grabbing arm and pulling a child or swinging child by arms.

PE: Pain and inability to use arm.

Tx: Firm supination and flexion of arm. Ice and use of sling.

8
Q

Carpal Tunnel Syndrome

PE?

Imaging/Tests?

Tx?

A

Median nerve is compressed in the carpal tunnel.

PE: Pain, numbness, tingling, decreased grip, strength, thenar wasting

Imaging/Tests: X-ray hand/wrist, electrodiagnostic studies, lab studies to rule out DM, gout, renal and thyroid disorders.

Tx: Conservative 1st- wrist splints, NSAIDS, ergonomic adjustments, PT, steroid injections. Then, surgery.

9
Q

DeQuervain’s Tenosynovitis
(Gamer’s thumb, Texting thumb)

PE, Tx?

A

Stenosing tenosynovitis of 1st dorsal compartment of wrist. (Contains the EPB & APL -abductor tendons)

PE: Radial side of wrist pain, burning, swelling, and grip weakness

Tx: Thumb spica cast/splint immobilization, rest, NSAIDS, PT

10
Q

Jersey Finger

Tx?

A

Commonly occurs when finger caught in competitor’s jersey. DIP joint is forced into extension, unable to flex.
* Ring finger most common

IMPT: 10-14 days before tendon shrinks. Must treat quickly!
Tx: Surgical repair, splint for 6 weeks

11
Q

Mallet Finger Treatment

Tx?

A

Inability to actively extend DIP joint caused by axial compression load. Axial compression load ruptures the thin extensor tendon.

Tx: STAX extension splint for 6-8 weeks. Surgery if joint surfaces subluxed or large fracture fragment.

12
Q

Swan Neck Deformity

Tx?

A

Fingers. Hyperextension of PIP joint with flexion of DIP joint. Volta plate attenuation at PIP.

Tx: Extension splinting PIP joint (Tripoint splint) or surgery

13
Q

Subungal Hematomas & Tuft Fractures

PE, Imaging, Tx?

A

PE: Pain, throbbing distal pharynx secondary to trauma.

Imaging: X-ray

Tx: Evacuation of blood, repair nail plate, splinting

14
Q

Gamekeeper’s Thumb (Skier’s Thumb)

Tx?

A

Injury to the ulnar collateral ligament of the thumb at the MCP joint resulting in instability of the MCP joint and decreased thumb grip strength.

Tx: Thumb spica cast/splint immobilization for 4-6 weeks. Surgery to repair avulsed ligament.