upper extremity

Question 1

dupuytren contracture

affects what

causes what

tx

Answer 1

palmar aponeurosis, ring and little, middle fingers

causing painful nodules, pitting, and contractures

surgical release for metacarpal phalangeal joint greater than 30 degrees and for proximal phalangeal contractures of any degree, or nerve compression

Question 2

rotator cuff syndrome characteristics

Answer 2

eccentric loading; common cause is impingement of supraspinatus tendon as it passes beneath the subacromial arch

Question 3

sx of rotator cuff syndrome

Answer 3

dull pain

exacerbated by abduction of arm

pain interferes with sleep

Question 4

common method of shoulder dislocations

Answer 4

fall on outstretched arm in abduction and extension.

Question 5

PE shows loss of shoulder contour with elbow pointing outward

Answer 5

anterior should dislocation

Question 6

hill sachs lesion

Answer 6

humoral head deformities noted in recurrent dislocations

Question 7

bankart lesion

Answer 7

tear of the glenoid labrum picked up on MRI

Question 8

diagnostic imaging for shoulder

Answer 8

AP view as well as a transthoracic “Y” view.

Question 9

tx for shoulder dislocations

Answer 9

reduction, do films, check NV status, velpaeus sling. PT after 3 wks for people under 40 y/o and after 1 wk for pts older then 40

Question 10

common shoulder problem with pts with DM

Answer 10

adhesive capsulitis

Question 11

adhesive capsulitis comes from what? characteristics? DX and tx

Answer 11

inflammatory process that may follow injury. pain and restricted glenohumeral movement. arthrography may show decreased volume of joint capsule and capsular contraction. tx is NSAIDS, PROM.

Question 12

why is proximal portion displaced superiorly in a fracture clavicle

Answer 12

attachment of sternocleidomastoid muscle

Question 13

AC separation involves what and occurs how

Answer 13

tearing of the AC and/or coracoclavicular ligaments; caused by a fall on or impact to the tip of the shoulder

Question 14

AC separation PE, Xray, Tx

Answer 14

PE: apparent step off the the AC joint. AP xray both shoulders, maybe do stress/weighted films. tx; sling or sx

Question 15

what is carpel tunnel syndrome

Answer 15

compression of median nerve under the transverse carpel ligament

Question 16

thenar atrophy can be a sign of what

Answer 16

carpel tunnel syndrome late in the disease

Question 17

tennis elbow aka…

Answer 17

lateral epicondylitis

Question 18

golfers elbow aka

Answer 18

medial epicondylitits

Question 19

lateral epicondylitis, pt age, involves what structure

Answer 19

30s, tendinous insertion of extensor carpi radialis brevis

Question 20

lateral epicondylitis PE,, tx

Answer 20

pain with lifting(when arm is pronated). duplicate pain with elbow in extension and forearm pronated, extend fingers against resistance. tx: counterbalance braces, PT, OT, maybe NSAIDS, sx, inj

Question 21

medial epicondylitis affects what structures and how to reproduce the pain

Answer 21

flexor/pronator group; resisted pronation or flexion of wrist

Question 22

organism in olecranon bursitis

Answer 22

staph aureus. NSAIDS and warm compresses

Question 23

what is nursemaids elbow

Answer 23

longitudinal traction and the radial head slips anteriorly out of the annular ligament

Question 24

what is de Quervain’s disease and who does it occur in

Answer 24

stenosing tenosynovitis involving the abductor pollicis longus and extensor pollicis brevis; woman >30y/o and DM

Question 25

deQuervains PE and tx

Answer 25

pain at base of thumb, +Finklestein's test; NSAID, thumb spica splint, PT/OT, inj, sx decompression

Question 26

common shoulder dislocation

Answer 26

anterior 95%

Question 27

shoulder pain can be referred pain caused by

Answer 27

cervical spondylosis

Question 28

Supraspinatus Infraspinatus Teres minor Subscapularis

Answer 28

Supraspinatus – abducts the arm (This is the most commonly injured muscle) Infraspinatus – externally rotates the arm Teres minor – externally rotates the arm Subscapularis – internally rotates the arm

Question 29

carpel tunnel syndrome parathesias spares what finger

Answer 29

pinky

Question 30

anterior shoulder dislocation presentation

Answer 30

pt hold arm in slight abduction and ER elbow pointing outward

Question 31

post shoulder dislocation position

Answer 31

pt hold arm in adduction and IR

Question 32

shoulder dislocation risk for what

Answer 32

axillary nerve injury

Question 33

velpeau sling for what

Answer 33

shoulder dislocation and humeral head fx

Question 34

subacromial decompression for what

Answer 34

rotator cuff

Question 35

secondary to osteonecrosis, trauma, septic arthritis, endocrine, neuropathic d/o

Answer 35

can cause OA of humeral head

Question 36

humerus fracture from what nerve? may lead to what 2 things

Answer 36

from direct trauma radial nerve palsy may lead to wrist drop and loss of thumb EXTENSION

Question 37

humerus fx tx

Answer 37

coaptation sling/splint then hanging arm cast

Question 38

humeral head fx etio and age pain where signs? presentation

Answer 38

old pts with osteoporosis pain at greater tuberosity ecchymosis 24-48 hrs later hold extremity against chest wall

Question 39

humeral head fx dx tx

Answer 39

AP, lateral, y views "neer classification" ORIF, CRIF, pendulum, velpeau sling

Question 40

clavicle fx age 3% of what

Answer 40

kids live births due to trauma

Question 41

humeral head fx look for injuries to what

Answer 41

brachial plexus and axillary artery

Question 42

supracondylar humerus fx mechanism symptoms

Answer 42

fall on outstretched hand with hyperextension of elbow pain and MINIMAL swelling

Question 43

watch for what with supracondylar humeral fx

Answer 43

varus and valgus deformity from arrest of medial and lateral growth plate check for brachial artery injury volkman

Question 44

supracondylar humeral fx tx

Answer 44

kids: CRIF with post splint adults: ORIF

Question 45

clavicle fx presentation and tx

Answer 45

arm supported by other arm kids: figure 8 sling 4-6 weeks adults: sling 6 weeks

Question 46

clavicle fx description

Answer 46

proximal portion displaced superiorly due to attachment of sternocleidomastoid muscle

Question 47

night stick fx definition and tx

Answer 47

ULNAR shaft from direct trauma often from self defense with blunt object tx ORIF if bad displacement

Question 48

monteggia fracture description mechanism tx

Answer 48

DIAPHYSEAL fx of radius with dislocation of distal radio/ulnar joint from direct blow to radius ORIF radius and casting fx forearm in supination to reduce radioular joint

Question 49

colles fx description ages mechanism

Answer 49

distal radius elderly and kids fall on outstretched hand, leading to dorsally displaced dorsally angulated fx SILVER FORK DEFORMITY

Question 50

SILVER FORK DEFORMITY TX

Answer 50

CRIF then long arm cast, ORIF if fx is intra-articular

Question 51

boxers fx

Answer 51

metacarpal neck of 4th or 5th finger look for puncture wound 25-30 degrees angulation: ulnar splint, maybe pinning

Question 52

gamekeeper's thumb

Answer 52

UCL sprain/tear instability and weak pinch partial rupture: immobilize, thumb spica cast complete: surgical repair