Upper Extremity Injuries Flashcards
(80 cards)
1
Q
What types of GLENOID FRACTURES would require surgical fixation?
A
- if >20% of anterior rim involved
- if unstable neck
2
Q
CORACOID FRACTURES typically occur with what other pathology? Are they treated SURGICALLY or CONSERVATIVE?
A
- AC joint trauma
- CONSERVATIVE ~76% of the time
3
Q
What is the typical MOI for HILL SACH’S LESION?
A
- Anterior shoulder dislocation (humeral abuts up against glenoid)
- 100% occurrence in those with recurrent shoulder instability
4
Q
How should CLAVICLE FRACTURE be managed in the early stage of injury?
A
- Splint/Sling
- Assess NEUROVASCULAR status
5
Q
What is the typical TIMEFRAME for bone healing post fracture?
A
- 6-8 weeks
* can vary based on age, complexity
6
Q
Regarding instability: DIFFERENTIATE b/t glenohumeral joint LAXITY due to injury and glenohumeral joint HYPERMOBILITY?
A
- LAXITY = is due to injury (with symptoms) and not considered a true instability
- HYPERMOBILITY = congenital
7
Q
What constitutes multi-directional INSTABILITY of the shoulder?
A
- must have side to side glenohumeral laxity in MORE THAN ONE quadrant
8
Q
Why do athletes with shoulder instability injuries often present with ROM deficits?
A
- likely due to HYPERACTIVITY of muscles
- also seen with: decreased ability to control humeral translation in glenoid OR inability to maintain congruency b/t glenoid and humeral head
9
Q
In athletic population, what are the primary factors that contribute to ROTATOR CUFF disease?
A
- RTC dysfunction or weakness (especially the EXTERNAL ROTATORS) and associated ROM deficits
10
Q
What is the difference in treatment for RTC tears between ATHLETES and the GENERAL POPULATION?
A
- Athletes need SURGERY = high demands of sport (conservative will fail)
- General pop’n = CONSERVATIVE
- if during season - may try rehab and then surgery at end of season
- Difficult to return to prior levels
- Re-tear rates HIGH (11-94%) - depends on size and location
11
Q
What is the ACUTE management of a BRACHIAL PLEXUS injury (stinger, burner)?
A
- *CLEAR c-spine first
- assess dermatomes and myotomes
- Can RTP when strength and sensation are RECOVERED and SYMMETRICAL
12
Q
What are the signs and symptoms of THORACIC OUTLET SYNDROME?
A
Arm and hand:
- numbness and tingling
- decreased sensation (of fingers)
- muscle weakness
- swelling
13
Q
What is PAGET-SCHROETTER SYNDROME?
A
- aka EFFORT THROMBOSIS
- THROMBOSIS of axillary-subclavian vein
*may be initially diagnosed as TOS
14
Q
What is the UE Closed Kinetic Chain Test?
A
- used for RTP testing
- pushup position (hands 3 feet apart)
- alternate touching hands for 15 seconds
- do 3 trials (rest 45 seconds between)
*Norm values = 21 men, 23 women
15
Q
What is the Upper Quarter Y-balance test used for?
A
- UE RTP testing
- calculate limb symmetry (want less than 10% or less difference between sides)
16
Q
What does the Seated Shotput Test measure?
A
- Unilateral strength and power (open chain test for possible RTP testing)
- Shot put of 6 lbs weight
17
Q
What are the PRIMARY stabilizers of the elbow?
A
- ulno-trochlear articulation, MCL, LCL complexes
18
Q
What are the SECONDARY stabilizers of the elbow?
A
- radial head, capsule, common flexor and extensor muscle origins
19
Q
Which part of the elbow MCL complex is the primary restraint of valgus force?
A
- Anterior band/bundle
20
Q
Which part of the elbow MCL complex is the primary restraint of pronation of ulna on humerus?
A
- Posterior band/bundle
21
Q
Which muscle is indicated in ~50% of cases of LATERAL EPICONDYLOSIS?
A
- Anterior portion of Extensor digitorum (extensor digitorum communis)
22
Q
How does TENDINOSIS differ from TENDONITIS?
A
- Tendinosis is degenerative
- see collagen disruption, mucoid degeneration, angiofibroblastic proliferation
23
Q
What pathology needs to be ruled out with suspected LATERAL EPICONDYLOSIS?
A
- radial nerve entrapment/compession at elbow
24
Q
What types of athletes is Medial Epicondylosis common in? Which muscles are most commonly associated with this condition?
A
- overhead throwing athlete
- flexor carpi radialis, pronator teres (flex and pronate forearm - with follow through)
- ALSO, constant valgus force = can lead to tearing
25
What is the cause of MEDIAL CONDYLE APOPHYSITIS/LITTLE LEAGUER'S ELBOW? What can it progress to?
- VALGUS stress from UCL and flexor-pronator mass tension on medial epicondyle
- AVULSION fracture (can also be from acute episode)
26
What are key SIGNS AND SYMPTOMS of MEDIAL EPICONDYLE APOPHYSITIS/LITTLE LEAGUER'S ELBOW?
- insidious onset of pain with history of chronic overuse throwing
- pain and loss of velocity with throwing
- point tenderness, swelling
*possible mild loss in elbow ext ROM
27
What are key SIGNS AND SYMPTOMS of MEDIAL EPICONDYLE AVULSION FRACTURE?
- unable to throw due to pain
- pain with late cocking, acceleration phases
- difficulty with elbow extension
28
What is the TREATMENT for MEDIAL EPICONDYLE APOPHYSITIS/LITTLE LEAGUER'S ELBOW?
- 4-6 weeks rest (from pitching)
- change positions BUT shut down if pain with playing
- Normalize ROM and strength
29
What is the TREATMENT for MEDIAL EPICONDYLAR AVULSION fracture?
- MINIMAL DISPLACEMENT = immobilize shortly; ROM and strength at 2-3 weeks; start throwing if -> pain-free, normal strength/ROM, -ve radiographs
- LARGE DISPLACEMENT or NON-UNION = surgery (4-6 months until RTP)
30
How should you treat DISTAL BICEPS TENDON TEAR, RUPTURE ?
- Need SURGERY within 2 weeks to prevent RETRACTION and SCARRING of muscle
31
What is the typical MOI for POSTERIOR OLECRANON IMPINGEMENT?
- due to VALGUS stress overload, common with OVERHEAD throwing athletes
- BALL RELEASE = elbow extends --> medial osteophytes impinge with fossa
- with LAX UCL = stress gets transferred to posterior medial olecranon
32
What are the conservative TREATMENT options for POSTERIOR OLECRANON IMPINGEMENT?
- Emphasis on ECCENTRIC control of FLEXOR-PRONATORs, shoulder ROM, and dynamic stability during pitching motion
* RESECTION of osteophytes if conservative tx fails
33
What are the two MOIs for olecranon stress fracture?
- Repetitive microtrauma from olecranon impingement (oblique fx from valgus overload)
- Excessive tensile stress from triceps OR extension force (transverse Fx)
34
How is OLECRANON STRESS FRACTURE treated?
Conservative = rest, brace/splint, gradual return to throwing
Surgery possible for = osteophytes, loose bodies, chondral damage
35
What is PANNER’s DISEASE? Who does it affect most?
- Osteochondritis of humeral capitellum due to excessive, continued lateral compression (with valgus stress medially)
- Affects BOYS> girls; 4-9 y/o
36
What are the signs and symptoms of PANNERS DISEASE? How is it treated?
- weeks of pain and stiffness in elbow; worse with activity and valgus stress
- TX = avoid provoking activities, work on strength and ROM impairments
* most heal without morbidity
37
What is the TERRIBLE TRIAD of the elbow?
- Ulnohumeral dislocation
- Coronoid fracture
- ligament compromise
38
What is the MOI for radial head fracture?
FOOSH in pronated position
39
What is the secondary restraint to VALGUS force at the elbow? The
- Radial head
| - important for stability with UCL injuries
40
What are the treatment options for RADIAL HEAD FRACTURE?
- use Mason Classification - treatment based on type (4 types of fractures)
- can be treated conservatively
- surgery can include: ORIF, excision, or replacement (of radial head)
41
What is the MOI for supracondylar humerus fracture? Who is it most common in?
- FOOSH with elbow extended
| - most common elbow fracture in kids
42
How is a SUPRACONDYLAR HUMERAL FRACTURE treated? What is a common concern with this injury in kids?
- depends on severity
- Garland 1 and 2 classification = conservative (casting); 2 may require surgery if deformity noted (rotation, angled)
- Garland 3 = surgery ORIF, or closed reduction
*concern in kids = PHYSIS injury (SALTER HARRIS - 4 and 5 poorest prognoses)
43
What is a common MOI in sports for UCL injury?
- throwing - repetitive microtrauma (late cocking, early acceleration)
44
What are the primary stabilizers against valgus force of the elbow? Secondary?
- Primary = anterior band of UCL- tightens <90 deg flex (radial head, ant capsule, flexor muscle group)
- Secondary = posterior band of UCL - tightens >90 deg flex
45
What is an injury that must be considered with UCL pathology?
- ulnar nerve pathology
- courses around medial epicondyle
- traction forces over time can lead to damage
46
What are the signs of UCL ligament pathology? How is it diagnosed?
- vague elbow pain
- decreased velocity and control over time
- ulnar symptoms (N&T in 4-5 digits)
- positive valgus load, milking sign
*MRA more accurate for diagnosis versus MRI
47
What are treatment options for UCL tears?
- PRP may benefit partial tears (~88% RTP and dec valgus laxity)
- large percentage will require surgery (Docking technique common; internal bracing augments repair and allows for earlier RTP)
48
What are post operative considerations for REHAB following UCL repairs?
- hinge brace to limit full extension initially
- interval throwing program ~4 months
- throwing from mound ~ 6 months
- RTP ~ 10-18 months
* revision UCL has less predictable rate of return
49
What is CUBITAL TUNNEL SYNDROME? What is the MOI?
- Entrapment of ULNAR NERVE in cubital tunnel (medial epicondyle with retinacular roof)
- Commonly due to excessive COMPRESSION or TRACTION with sport (baseball, football, wrestling
- Can be due to: post-med osteophytes, loose bodies, soft tissue mass
50
What are some Special Tests for diagnosing CUBITAL TUNNEL SYNDROME?
- Wartenburg sign = inability to adduct 5th finger
- Tinnel’s Sign - maintain elbow in flexed position to close cubital tunnel
* if severe = intrinsic weakness with resulting clawing of 4th and 5th digit
51
What are some TREATMENTS for CUBITAL TUNNEL SYNDROME?
- AVOID repetitive movement OR sustained postures that COMPRESS (direct pressure) or TRACTION (full flexion) the nerve
- NIGHT splint
- NEURAL mobilizations
52
Which UE nerve entrapment around the elbow is purely sensory?
RADIAL TUNNEL SYNDROME (entrapment of radial sensory nerve)
- close to lateral epicondyle (differential diagnosis for lateral epicondylosis)
53
What is POSTERIOR INTERROSEUS NERVE SYNDROME? What are the signs and symptoms?
- Compression of the nerve at the Arcade of Frohse (supinator arch)
- Pain with RESISTED wrist and finger extension
- Possible lack of full thumb extension
54
What is PRONATOR SYNDROME? What are other potential sites of compression?
- MEDIAN NERVE COMPRESSION through one of:
- Pronator Teres
- proximal Flexor digitorum superficialis
- Ligament of Struthers
- bicipital aponeurosis
55
What are the signs and symptoms of PRONATOR SYNDROME?
- PARESTHESIA in digits 1-4 (1/2 of ring finger
- DISCOMFORT/PAIN proximal forearm
- DISCOMFORT pronation and supination
* PAIN resisted pronation = entrapment at PRONATOR TERES
* PAIN resisted middle finger flexion = compression at FIBROUS ARCH
56
Why is it important to manage wrist and hand injuries early?
- TO MINIMIZE LONG TERM ISSUES
57
How do you treat a suspected SCAPHOID FRACTURE acutely?
| Why is there greater urgency for surgical intervention?
- IMMOBILIZE and remove from play
- ICE (for pain)
- REFER for imaging
*Risk of non-union, collapse of bone
58
What are the two areas of the SCAPHOID that fracture?
- WAIST (TTP at anatomical snuffbox)
| - PROXIMAL POLE (TTP at distal radius over scapho-lunate joint)
59
What are the RTP guidelines s/p SCAPHOID fracture treated CONSERVATIVELY and SURGICALLY?
- NONDISPLACED conservative tx = 12-15 weeks
- SURGERY = 8-12 weeks
REHAB starts @ 6 weeks
* may be able to return earlier with cast (thumb spica) if allowed
* will have serial imaging to monitor healing
60
The HOOK OF THE HAMATE is the distal aspect of what structure? What does this structure contain?
- GUYON’S CANAL
| - contains ulnar nerve and artery
61
How does a HOOK OF HAMATE FRACTURE occur? What is a complication with this diagnosis?
- MOI = Direct trauma (fall onto palm OR repetitive stressors (gripping club, bat)
- Risk of NON-UNION (due to poor anastomosis between 2 blood supplies)
62
What are signs of a HOOK OF HAMATE fracture?
- PAIN and tenderness over hypothenar eminence
- PAIN with gripping and/or movement of 4,5th digits
* screen for neuro vascular compromise (ulnar n and a)
63
How are suspected hand fractures (scaphoid, hook of hamate, 5th metacarpal), scapholunate dissociation managed ACUTELY?
- IMMOBILIZE and remove from play
- ICE for pain
- REFER for imaging
64
What are the TREATMENT options for HOOK OF HAMATE fracture?
- SURGERY (excision of bone) - RTP = 6-8 weeks
| - SHORT ARM CAST (including 4 and 5 fingers) for up to 6 weeks
65
What different types of deformity might you see with a Boxer's fracture?
- VOLAR deformity
| - VOLAR and under 4th digit
66
What are the different types of MOI for BOXER'S FRACTURE?
- Punch
- Direct trauma/blow
- Fall onto lateral hand
67
How is BOXER'S FRACTURE managed?
- SPLINT/CAST 3-4 weeks (no activity)
- PROM to AROM and tendon gliding (after cast removed)
- STRENGTHEN, GRIPPING @ 6 weeks
68
What is the function of the Triangular Fibrocartilage Complex?
Rotation, Stability, Transmission of loads through ULNOCARPAL and DISTAL RADIOULNAR joints
69
What is the MOI for TFCC injury? What are the signs and symptoms of injury to this structure?
- FOOSH (wrist extended, pronated with axial load) = similar to MOI for scaphoid fracture
- Pain (ulnar sided wrist)
- Painful and weak - grip, ulnar dev, wrist flex
- Pain with ROM - flex, ext, uln dev
*Assess scaphoid fracture first!
70
How do you ACUTELY manage a TFCC injury?
- STABILIZE IMMEDIATELY (avoid radial and ulnar deviation)
* Use rigid brace/splint if allowed by sport (otherwise, if MILD = tape) to RTP
* if stability and strength acceptable = RTP
71
How is a TFCC Injury treated?
- CONSERVATIVE (steroid injection may help decrease pain and increase function short term)
OR
- SURGERY - immobilize 6 weeks; RTP ~3-4 months
72
What is Stener's Lesion?
- AVULSION fracture at proximal attachment (1st metacarpal) of Thumb UCL from valgus force
- EXAMINE FOR SUBSTANTIAL MASS - if present, DON'T VALGUS STRESS THUMB
*If present = REFER FOR RADIOGRAPHS
73
At what angle should you test for VALGUS LAXITY with suspected Thumb UCL sprain? Why?
- @ 30 deg flexion
- Anatomy = ligament is taut in flexion, loose in extension (origin dorsal side of 1st metacarpal; inserts solar side of 1st phalange)
74
How should a Thumb UCL tear be managed? Acutely? Partial Tear? Complete Tear?
- ACUTE = can RTP immediately if immobilized (with normal functioning hand)
- PARTIAL tear = immobilize with short arm thumb spica for several weeks; rehab after pain and swelling resolve; pinching and thumb adduction rehab last
- COMPLETE tear = surgery; immobilize; rehab; RTP ~4 months
75
Which tendon is affected in a MALLET FINGER diagnosis?
- Extensor Digitorum Communis
| * middle finger most common
76
What signs of fracture would warrant referral with suspected MALLET FINGER?
- blood under the nail
77
How long should a MALLET FINGER diagnosis be immobilized?
- up to 8 weeks
* SHOULD continue to immobilize for months after ward (at 12 weeks = still effective)
* MAY NOT fully heal (up to 10 degree extension lag)
78
What muscle(s) are affected with a suspected JERSEY FINGER diagnosis?
- flexor digitorum profundus (most common)
| - flexor digitorum superficialis
79
What injury may include a popping sensation in the palm of the hand followed by loss of AROM into flexion at the IP and/or DIP of the digit?
- Jersey Finger
| * may show muscle deformity with rupture and retraction
80
What are the MANAGEMENT consideration for Jersey Finger? Acute
- ACUTE = remove from game, splint, refer to physician (can RTP with splint or buddy tape)
- CONSERVATIVE = long term splinting (similar to Mallet finger treatment)
- SURGERY = requires 12-16 weeks healing; early PROM important (to prevent SCARRING and deformity); DON'T lift, carry or grasp first 6-8 weeks; want full grip strength and full extension ROM
