Upper Extremity Emergencies -- SD

Question 1

True or false

Clavicle fractures typically occur in the proximal 1/3?

Answer 1

False

Distal 1/3

Question 2

What is important to look for on exam when a patient has a clavicle fracture?

Answer 2

Tenting – can convert to an open fracture

Question 3

How do we treat a clavicle fracture?

Answer 3

Sling and ortho referral in a few weeks

Question 4

A posterior fracture of the clavicle may result in?

Answer 4

Punctured lung – apex of the lung

Question 5

Patient presents with a low hanging shoulder – whatcha thinking?

Answer 5

AC separation

Question 6

How do we treat AC separations?

Answer 6

Put them in a sling and they should heal on their own – more severe grades may require surgery

Question 7

Humeral head fractures are common in what populations?

Answer 7

Elderly, osteoporotic

Question 8

How do most humeral head fractures occur?

Answer 8

Fall with arm locked which drives the humeral head straight up into the glenoid

Question 9

How do we treat shoulder fractures?

Answer 9

Sling, refer to ortho – not much we can do for them

Question 10

Shoulders most commonly dislocate anteriorly or posteriorly?

Answer 10

Anteriorly

Question 11

Common cause of shoulder dislocations?

Answer 11

FOOSH

Question 12

what are the causes of a posterior shoulder dislocation?

Answer 12

Epilepsy, electrocution, EtOH

Question 13

Why do we need a lateral view x-ray when looking at shoulder dislocations?

Answer 13

Need to know where you are in space! otherwise can’t tell if its posterior or anterior

Question 14

What actions do we take once a shoulder has been reduced?

Answer 14

Post-reduction films (if first dislocation or trauma)

Make sure they are neurovascularly intact!

Shoulder immobilization

Ortho follow-up

Question 15

Limited ROM of shoulder is key to diagnosis

Answer 15

Rotator cuff

Question 16

How do we treat rotator cuff tears in the ED setting?

Answer 16

Sling

Question 17

Do elbows most commonly dislocate anteriorly or posteriorly?

Answer 17

Posteriorly

Question 18

Which is elbow fracture is bad?

Answer 18

Supercondylar

Question 19

Why are supercondylar fractures more serious?

Answer 19

They are prone to malalignment problems – should always refer to ortho

Question 20

Do we always see an anterior or posterior fat pad?

Answer 20

Anterior

Question 21

Posterior fat pad on x-ray is pathologic for?

Answer 21

fracture

Question 22

What is a sail sign on x-ray of an elbow?

Answer 22

It describes the elevation of the anterior fat pad

Question 23

Whenever we find a fracture in a two bone structure – what else must we do?

Answer 23

Look higher! Energy can move up and create another fracture

Question 24

What is the classic wrist fracture?

Answer 24

Distal radius +/- ulnar styloid

Question 25

How are we going to rule out a scaphoid fracture?

Answer 25

Palpate the anatomical snuff box

Question 26

What type of splint do we put most wrist fractures in?

Answer 26

Volar splint

Question 27

What kind of splint do we use for scaphoid fractures of even suspected scaphoid fractures?

Answer 27

Thumb spica splint

Question 28

What test do we use to diagnose DeQuervian's tenosynovitis?

Answer 28

Finkelstein's (ulnar deviation)

Question 29

What people are at risk for developing DeQuervian's?

Answer 29

Carpenters -- repetitive hammering type motion

Question 30

What two signs can we do for suspected carpal tunnel syndrome?

Answer 30

Tinnel's and Phalen's

Question 31

What can we do to treat carpal tunnel?

Answer 31

Splint at night and when working -- can do a release

Question 32

Are fingers easy to dislocate and reduce?

Answer 32

Yup

Question 33

What do we call it when your thumb goes backward and you tear the medial collateral ligament?

Answer 33

gamekeeper's thumb