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Upper Extremity Disorders Flashcards

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1
Q

Most dislocations occur in ____ direction

A

Anterior-inferior

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2
Q

What motion causes an anterior-inferior dislocation

A

ER

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3
Q

What tears with anterior dislocation?

A

Inferior GH ligament
Anterior Capsule
Occasionally Glenoid Labrum

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4
Q

What motion causes a posterior dislocation?

A

Horizontal adduction and IR of glenohumeral joint

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5
Q

Hill-Sachs Lesion

A

Fx of posterior humeral head due to anterior subluxation

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6
Q

SLAP Lesion

A

Tearing of Superior Labrum, Anterior to Posterior

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7
Q

Bankart Lesion

A

Avulsion of anteroinferior capsule and ligaments associated with glenoid rim
Requires Surgery

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8
Q

What nerve can you bruise with a shoulder dislocatino?

A

Axillary Nerve

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9
Q

Following surgical repair for dislocation/chronic subluxation, patients should avoid:

A

Apprehension Position (Flexion to 90*, Horizontal abd to 90 and ER to 80)

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10
Q

Do Bankart Lesions Require Surgery?

A

Yes

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11
Q

If unstable shld has sx, how long kept in sling?

A

3-4 weeks

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12
Q

What Tendon is involved in a SLAP lesion?

A

Biceps Tendon

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13
Q

Location of pain in a labral tear

A

Cannot be localized to a certain point

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14
Q

What activities make labral tears worse?

A

Overhead activities or if arm held behind back

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15
Q

Pain with what movement with Labral Tears?

A

Resisted flexion of biceps

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16
Q

Where is it tender with a labral tear?

A

Front of shoulder

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17
Q

Gold standard of identifying labral tear?

A

Arthroscopic sx of shld

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18
Q

What is compressed in TOS?

A

Neurovascular Bundle

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19
Q

What is in the neurovascular bundle?

A

Bracial Plexus
Subclavian artery/vein
Vagus and Phrenic Nerves
Sympathetic Trunk

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20
Q

Common areas of TOS compression (4)

A
  1. Superior thoracic outlet
  2. Scalene Triangle
  3. Between Clavicle and 1st Rib
  4. Between pec minor and thoracic wall
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21
Q

Mechanism of injury for AC injury

A

Fall onto shoulder with UE adducted

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22
Q

Why are tendons of RC susceptible to tendonitis

A

Relatively poor blood supply near insertion of muscles

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23
Q

After surgical repair of shoulder impingement, what should you limit?

A

Shoulder elevation > 90*

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24
Q

Posterior/Internal Impingement is between what?

A

Rotator Cuff and greater tuberosity
OR
Posterior Glenoid and Labrum

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25
Where is inflmaation typically in bicipial tendonsis?
Long head of biceps
26
Where is the impingement in Bicipital tendonosis
Proximal tendon between anterior acromion and bicipital groove
27
Surgical comments about Proxial Humerus Fx?
Generally does not require immobilization or sx because it is a fiarly stable fx
28
Important part of tx in proximal humerus fx? Why?
Early PROM to prevent capsular adhesions
29
Capsular Pattern ofAdhesive Capsulitis
Loss of ER --> Abduction --> Flexion | Least restricted IR
30
What disease is most commonly seen in Adhesive Capsulitis?
DM
31
Elbow Capsular Pattern
Loss of Flexion greater than Loss of Extension
32
Reason for loss of motion in elbow that doesnt follow capsular pattern?
Loose body in joint Ligamentous Sprain CRPS
33
Pattern of loss of motion for an elbow contracture
Capsular Pattern
34
What muscle is affected in Lateral Epicondylosis?
Extensor Carpi Radialis Brevis (ECRB)
35
Motion that causes Lateral epicondylosis
Repetitive wrist extension or strong grip with wrist extended
36
What must you rule out with lateral epicondylosis?
Cervical involvement
37
What type of bracing is used with Lateral Epicondylosis?
Counterforce bracing to reduce forces along ECRB
38
Muscles involved with Medial Epicondylosis
Pronator Teres | Flexor Carpi Trandialis
39
Motion that causes Medial Epicondylosis
Strong hand grip and excessive pronation of forearm
40
What type of distal humerus fx must be examined quickly for neurovascular status? Why?
Supracondylar Fx | High number of neurological (radilal nerve) and vascular structures
41
What does poor neurovascular status post distal humerus fx lead to?
Volkmann's Ischemia
42
Distal humeral fxs have a high rate of ____
Malunion
43
Where is osterochondrosis in elbow typically found?
Central and/or Lateral aspect of Capitellum | Radial Head
44
What causes osteochondrosis of humeral capitellum?
Repetitive compressive forces between radial head and humeral capitellum
45
Most common age for Osteochondrosis of humeral capitellum
Children < 10
46
What causes Ulnar Collateral Ligament injuries?
Repetitive Valgus stresses with overhead throwing
47
Where in the Ulnar collateral ligament does it usually hurt when it is injuried?
distal insertion
48
Where is paresthesias with ulnar collateral ligament injuries?
Ulnar Nerve distribution
49
Where does direct trauma have to occur for ulnar nerve entrapment?
Cubital Tunnel
50
Traction due to laxity at ___ aspect of elbow causes Ulnar Nerve entrapment
Medial Aspect
51
Compression due to hypertrophy of what muscle causes ulnar nerve entrapment?
Flexor Carpi Ulnaris Muscle
52
What causes Median Nerve entrapment?
Pronator Teres Muscle and under superficial head of flexor digitorum superficialis
53
What action causes median nerve issues?
Excessive gripping
54
What causes Radial Nerve Entrapment?
Entrapment of distal ranches (posterior interosseus nerve) in radial tunnel
55
Most common direction for elbow dislocations
Posterolateral
56
How does a posterolateral dislocation of and elbow occu?
Elbow hyperextension from FOOSH
57
What percentage of elbow disloations are anterior or radial head?
1-2 percent?
58
What will rupture with a complete elbow dislocaiton
Ulnar Collateral ligament, possible anterior capusule
59
What nerve is compressed with Carpal Tunnel syndrome?
Median Nerve
60
4 major causes of Carpal Tunnel
1. Repetitive wrist Motions/gripping 2. Pregnancy 3. DM 4. RA
61
3 differential diagnosis of carpal tunnel syndrome
1. C-spine 2. TOS 3. Peripheral nerve entrapment (median)
62
Long term compression in carpal tunnel leads to weakness of:
Thenar muscles and lateral two lubricles
63
DeQuervain's Tenosynovitis
Inflamatation of extensor poliicis brevis and longus
64
What compartment does dequervain's tenosynovitis affect?
First Dorsal Compartment
65
3 signs of De Quervain's tenosynovitis
1. Pain at anatomical stuff box 2. Decreased grip/pinch strength 3. (+) Finkelstein
66
Most common wrist fx
Colles Fracture
67
How long do you immobilze a colles gx?
5-8 weeks
68
What nerve can be affected with a colles fx
Median Nerve
69
Colles fx
Posterior displacement of distacl radisus with radial shift of wrist and hand
70
What causes a colles fx?
FOOSH
71
Smith's Fx
Distal radius dislocates anteriorly
72
Most commonly fx carpal?
Scaphoid
73
Most common issue with scaphoid fx
Avascular Necrosis
74
Carpals immobilized ___ weeks after scaphoid fx?
4-8 weeks
75
Dupuytren's Contracture
Banding on palm and digit flexion contractures due to contracture of palmar fascia to skin
76
What digits does a dupuytren contracture affect?
4-5th
77
What digits does a dupuyten contracture affect with DM?
3-4th
78
Boutonniere's Deformity Cause
Rupture of central tendinous slip of extensor hood
79
Boutonniere's Deformity Presentation
Extension of MCP and DIP with Flexion of PIP
80
Swan Neck Deformity Cause
Contracture of intrinsic muscles with dorsal sublux of lateral extensor tendons
81
Swan Neck Presentation
Flexion of MCP and DIP with Extension of PIP
82
Mallet Finger Cause
Rupture of extensor tendon at insertion into DIP
83
Mallet finger presentation
Flexion of DIP joint
84
Ape Hand Deformity
Thenar muscle wasting so 1st digit moves dorasally until it is inline with 2nd digit
85
Cause of ape hand
Median Nerve dysfunction
86
Gamekeeper thumb cause
Sprain/rupture of ulnar collateral ligament of MCP joint of 1st digit
87
Boxer's Fx
Fx of 5th Met
88
How long casted for boxer's fx?
2-4 weeks

Muscskel (12 decks)

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