Upper Extremity Injury: Clinical Correlations Flashcards Preview

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Flashcards in Upper Extremity Injury: Clinical Correlations Deck (32)
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What are the three mechanisms of fracture?

Acute: from sudden impact of large force exceeding strength of the bone Stress: from repetitive submaximal stresses Pathologic: from normal forces to diseased bone


What do you look for on examination of a fracture?

Deformity: if bleeding with/without fragment suspect open fracture -- orthopedic emergency, needs to be surgically washed out Bony point tenderness Pain with loading bone: indirect loading especially useful


What are some examples of indirect loading tests? 

Axial loading

Bump test

Fulcrum test

Hop test


What imaging modalities may be used to diagnose a fracture? 

Plain x-rays

CT scan 

Bone scan 



What should be done for fracture treatments? 


Avoidance of NSAIDS: some animal studies and models show NSAIDS interfere with bone healing via PGs 


What bones are vulnerable to lack of blood supply with break? 



Femoral head 


What are the contents of the anatomical snuffbox? 

  • Nerve: radial 
  • Vein: cepalic 
  • Artery: radial
  • Bone: scaphoid


What is the artery that supplies a large amount of blood to the head of the femur? 

Medial circumflex femoral artery = most important blood supply to the head and neck of the femur 


What does the history and exam look like for arthritis? 

  • History: Stiffness -- especially after rest, worse after prolonged use
  • Exam: joint line tenderness, mild swelling, deformity, symptoms with both passive and active motions


What is arthritis?

Damage to articular cartilage surface

Can be acute or chronic 


What is capsulitis? 

Capsular thickening -- from inflammation or scarrin g

Idiopathic or  post injury -- risk factors: injury, diabetes, thyroid disease


How does someone with capsulitis usually present their history? 

Limited ROM 

  • Painful early with decreased ROM (freeze phase) 
  • Non-painful with stable, decreased ROM (frozen phase) 
  • Non-painful with improving ROM (thawing phase) 


What will the exam look like for someone with capsulitis? 

  • Decreased ROM 
  • Gradually tightening endpoint
  • Exam otherwise consistent with underlying etiology 


What is used for the treatment of capsulitis? 

  • Reassurance
  • Educate and set expectations
  • Maintenance of ROM 
  • Pain control 


What is a good treatment for a rupture of the long head of the biceps? 

Clinical observation (nothing) -- usually does quite well on its own 


What are some key components to consider when treating musculotendinous ruptures? 

  • Impact of absence of muscle
  • Presence of alternative muscles
  • Functional requirements of patient 


What is enthesopathy? 

A disorder of muscular or tendinous bony attachment 


What is tendonitis? 

Technically acute inflammation of the tendon 

Traumatic -- blow or pull 


What is tendinosis? 

Chronic degenerative condition of tendon

Chronic -- submaximal repetitive irritation 


How do most AC (acromioclavicular) sprains occur? 

Most commonly from a fall directly onto shoulder


What does presentation and exam of AC sprain look like?

Presentation: pain with overhead motions, deformity of superior shoulder

Exam: pain and deformity of AC joint, pain with cross body adduction of arm (positive cross-chest test), painful arc of abduction over 150 degrees 


Explain the grading of AC injuries. 

Grade 1: AC ligament injury

Grade 2: AC ligament tear and coracoclavicular (CC) liagment stretch 

Grade 3: complete tears of both AC and CC ligaments 


What is a sprain? What are some symptoms? 

Ligamentous damage from overloading

Symptoms: Instability or laxity, swelling 


Explain the grading of sprains. 

Grade 1: microscopic damage, no increased laxity, but pain with stress

Grade 2: partial tear, increased laxity and pain 

Grade 3: complete tear, significant laxity 


Which way is the shoulder most likely to dislocate? 

Anteriorly -- usually due to forced extension, abduction and external rotatin of arm or a direct blow to posterior shoulder 


Which nerve is most likely to get hurt with anterior shoulder disloation? How would you test this? 

Axillary nerve 

Test with ability to abduct the arm because the deltoid is innervated by the axillary nerve 


What are the various terms used to describe joint stability? 

  • Dislocation: complete displacement 
  • Subluxation: transient, partial displacement 
  • Laxity: normal varient in "joint looseness" 


What is the most effective passive stabilizer of the shoulder? 

Vacuum phenomena: negative pressure associated with keeping humoral head in place 


What does the exam for shoulder dislocation look like? 

  • Arm held by opposite hand in slight abduction and external rotation
  • Alteration of shoulder contouring: prominent acromion, humeral head anterior to acromion and adjacent to coracoid 
  • Check sensation of axillary (deltoid area) and musculocutaneous (forearm) nerves
  • Positive apprehension test


What causes carpal tunnel syndrome? 

Impingement of palmar cutaneous branch of median nerve