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Flashcards in Upper Extremity Deck (110):
1

PE exams for Impingement Syndrome

Neer and Hawkins, Apley Scratch for ROM

2

Impingement Syndrome Dx

Xray (to r/o OA, trauma, calcific tendinitis)--> if normal then do MRI
U/S can be used to r/o tears

3

Impingement Syndrome Tx

NSAIDs, rest, ice, activity modification
PT
Subacromial injections (lido + methylprednisolone)

4

Complications of Impingement Syndrome if left untreated

Rotator Cuff Tear

5

"shoulder pain" in Impingement Syndrome

worse w/ overhead activity, superior and lateral aspect of shoulder over deltoid
+/- acute and burning (bursitis) or intermittent and dull (tendinopathy)

6

Pathophys of Impingment Syndrome

Reduction in space below coracoacromial arch

Supraspinatus and infraspinatus tendons compressed under acromion--> tendinopathy
Subacromial bursa compressed--> bursitis

7

MC affected in rotator cuff tear

Supraspinatus

8

MOA of rotator cuff tear

chronic repetitive injury of overhead movement
chronic dislocations
acute trauma

9

Rotator Cuff Pain

anterior lateral shoulder w/ radiation distally
shoulder weakness
*night pain*

10

Rotator Cuff tendon-specific tests

Drop Arm, Empty Can, Lift Off, external rotation, external rotation lag sign

11

Lift off test is for what muscle

Subscapularis

12

External rotation test is for what muscle

infraspinatus/teres minor

13

SITS of rotator cuff

supraspinatus, infraspinatus, teres minor, subscapularis

14

Xray views for suspected rotator cuff tear

AP, axillary outlet

15

Rotator Cuff diagnostic imaging criteria

1. number of involved tendons
2. size of tear
3. amount of tendon retraction
4. degree of fatty atrophy of rotator muscles

16

Tx of 75% rotator cuff tear

Surgery; >50% likely requires surgery based on degree of pain dysfunction and severity

17

Tx of 45% rotator cuff tear

NSAIDs, subacromial steroid injections, PT (<50% this is tx)

18

when do pts w/ rotator cuff tears regain total function

6-12 months if post-op

19

Which is more common primary or secondary bicep tendonitis

Secondary

20

What is secondary bicep tendonitis

inflam of proximal bicep tendon in intertubercular groove dt change of surrounding structure

21

Bicep Tendonitis Pain

Anterior shoulder pain w/ radiation down w/ tenderness over bicep groove

22

T/F impingement signs are negative with biceps tendonitis

F. Neer and Hawkins are often +

23

Special Tests for Biceps Tendonitis

Speed's, Yergason's

24

Frozen Shoulder Syndrome

Adhesive Capsulitis

25

Primary etiology Adhesive Capsulitis

unknown but believed autoimmune; F>M, diabetics

26

Adhesive Capsulitis Pain

PM, rest, w/ A and P ROM and worse at end of motion

27

Adhesive Capsulitis Test

ROM assessed while stabilizing capsula

28

Adhesive Capsulitis Tx

Conservative: ice, NSAIDs, steroid injections, **PT**

29

Surgery for adhesive capsulitis releases what ligament

Middle glenohumeral

30

Glenohumoral OA Pain

slow progressive vague, *present at rest but worse w/ activity

31

AP Xray of shoulder shows joint space narrowing, osteophyte and cyst formation and subchondral sclerosis....dx?

Glenohumeral OA

32

Surgical option for Glenohumeral OA

Joint arthroplasty (total or hemi)

33

Medical therapy for Glenohumeral OA

NSAIDs, ROm exercises, modificaiton of activity, +/- steroids

34

Why are steroids not advised in Glenohumeral OA

may delay labral healing

35

Tennis elbow

Lateral Epicondylitis

36

Is tennis elbow MC in professional or non-competitive athletes and why

Non-competitive bc technique

37

Muscle involved in lateral epicondylitis

Extensor muscle tendons of forearm

38

Lateral epicongylitis special tests

Cozen's and Mill's both +

39

T/F lateral epicondylitis pain is worse after activity involving repeated wrist flexion and pronation against resistance

FALSE--> repeated wrist extension and supination against resistance
ex: painting, tennis, turning screwdriver

40

T/F ROM will be fully intact with tennis elbow

True

41

Is imaging needed in tennis elbow

no

42

Lateral epicondylitis Tx

rest and NSAIDS 1st line and successful
PT--> friction massage, ice

43

Do steroid injections provide long-term relief for lateral epicondylitis

no

44

Golfer's Elbow

Medial Epicondylitis

45

Repetitive motion leading to medial epicondylitis

Wrist flexion and pronation

46

Medial Epicondylitis Pain

over medial epicondyle w/ radiation down anteromedial forearm

47

How long should someone modify activity when treating medial epicondylitis

1 month

48

Olecranon Bursitis presentation

inflamed elbow, boggy swelling,
if infected: erythema, warmth, pain

49

Cause of olecranon bursitis

usu traumatic event

50

2 ways to dx bursitis

imaging (recommended) +/- aspiration if suspected infection

51

Mommy thumb

De Quervain Tenosynovitis

52

Structures involved in De Quervain

Abductor pollicis longus and extensor pollicis brevis on dorsal radial aspect of wrist

53

Special tests for De Quervain

Finkelstein's +

54

T/F imaging is necessary for De Quervain

False

55

Tx of De Quervain

activity modification, Ice, NSAIDs, Thumb spica splint, injections along tendon sheath, surgical decompression of tendon

56

What is Dupuytren's Contracture

Fibroproliferative disease of palmar fascia

57

Environmental RF for Dupuytren's

handling tasks of vibration, DM, cigarette smoking, alcohol consumption, antiepileptic drugs

58

tx of persistent Dupuytren's

intralesional steroids, surgical repair w/ open fasciotomy

59

Why is the glenohumeral joint predisposed to instability

shallow--> increased ROM

60

Dynamic stabilizers of glenohumeral joint

rotator cuff, long head of biceps, deltoid

61

Static stabilizers of glenohumeral joint

glenoid fossa, labrum, joint capsule, ligaments

62

Least stable position of shoulder

Abduction w/ external rotation

63

Hill-Sachs lesion

injury to posterolateral aspect of humeral head seen w/ shoulder dislocation
if >30% of articular surface--> may cause recurrent dislocations/instability

64

Bankart lesion

Avulsion of anterior capsule-labral complex below midline of glenoid

65

Anterior shoulder instability special test

apprehension test (shoulder abducted and externally rotated, forward pressure to posterior humeral head--> pain)

66

Labral tear tests

load and shift tests (move proximal humeral head anteriorly posterior and inferior--> excessive translation or sensation of subluxation is +), crank test

67

Crank test

Shoulder abducted and internally rotated w/ axial load--> pain, catching or grinding all + for labral tear

68

Imaging for anterior shoulder instability

Xray first w/ shoulder in AP neutral rotation, internal and an axillary view w/ external rotation
CT good for bony lesions but unnecessary
MRI for labral lesions and Bankart

69

Length of sling for shoulder dislocation

1-6 weeks

70

2 ligaments involved in AC joint

AC ligaments and joint capsule provide anterior stability
CC ligaments provide vertical stability

71

MC cause of AC joint injury

fall or blow to shoulder with arm adducted

72

AC joint injury MOA

acromion pushed downward and medially, first injuring AC ligaments and then CC

73

Type 2 AC injury

rupture of AC ligaments, sprain/partial tear of CC

74

Type 5 AC injury

rupture of AC and CC, more than 100% displacement of distal clavicle

75

Type 4 AC injury

rupture of AC and CC, posterior displacement of clavicle

76

Patient presentation of Type 3

usu arm held adducted at side, obvious deformity at AC joint, pain w/ shoulder ROM esp. w/ abduction

77

Patient presentation of Type 3 AC injury

usu arm held adducted at side, obvious deformity at AC joint, pain w/ shoulder ROM esp. w/ abduction

78

Pt presentation of Type 5 AC injury

Severe deformity, clavicle not manually reducible dt penetration of deltotrapezial fascia

79

Imaging views for AC injury

AP, Axillary, outlet
cross-arm adduction view to eval instability

80

AC injury tx

MC w/out surgery , w/ sling and NSAIDs

81

AC injuries that need surgery

Type 4-6 and done early to reconstruct CC

82

Time away from activity for type 3 AC

up to 6 weeks

83

AC injury tx for overhead throwers

Early surgery even for type 3

84

MC part of bicep involved in rupture

proximal long head of biceps tendon

85

RF for bicep tendon rupture

inflammatory process from subacromial impingement or trauma

86

"popeye" muscle appearance

Bicep tendon rupture

87

Important hx features of bicep tendon rupture

"pop" w/ acute injury, pain w/ overhead activities

88

Special tests for bicep tendon rupture

Ludington's test(both hands behind head and flex)
Speed's test
Yergason's test

89

Imaging for bicep tendon rupture

AP and axillary xray views typically -
MRI for young athletes and persistent pain

90

tx for proximal bicep tendon rupture

rest +/- immobilization, NSAIDs, ice
PT helpful to restore ROM and strength
surgery ONLY for special populations (professional athlete manual laborers)
Tenotomy for geriatric pt

91

Trigger finger

Stenosing tenosynovitis

92

structures involved in trigger finger

Flexor digitorum superficialis and flexor digitorum profundus tendons
A1 pulley over metacarpal head

93

Digits effected by trigger finger

thumb>middle>ring>index>small

94

RF to trigger finger

DM, RA, collagen vascular d/o, dupuytren's disease, gout, renal disease

95

Grade 3 trigger finger

passive: digit becomes locked and passive extension necessary to unlock

96

Grade 4 trigger finger

most severe; fixed flexion contracture at PIP
may be persistent

97

PE of trigger finger

palpable nodule in flexor digitorum superficialis
popping sensation over A1 pulley

98

Trigger finger Tx

NSAIDs, splinting in extension +/- steroid injection later
surgery for actively triggering fingers

99

Grade 2 trigger finger

patient can actively extend digit; reproducible locking or catching

100

Notta's node

nodule at A1 pulley in children

101

Drop finger or Baseball finger

Mallet finger--> finger droops at tip dt injury to terminal extensor

102

Joint effected by Mallet finger

DIP; extensor lag

103

Swan neck deformity

as extensor mechanism no longer goes to DIP, PIP becomes hyperextended --> swan neck compensatory measure

104

T/F flexor function is effected in Mallet finger

F

105

Imaging for Mallet finger

posteroanterior, lateral and oblique views on xray
**lateral most likely to reveal dorsal fractures

106

Mallet finger tx

splinting DIP in slight hyperextension for 6 weeks followed by only at night for 2 weeks

Surgery if mallet finger dt laceration of tendon, fractures

107

Primary functions of fingernail

protection, tactile sensation, regulation of peripheral circulation, assist in picking up objects

108

Nail injury

MC due to crush or pinching mechanism

109

Subungual hematoma

extremely painful, tx w. trephination (hole)

110

Open nail bed injury

nail partially or completely avulsed from nail bed