Upper Extremity Injury: Clinical Correlations Flashcards Preview

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Flashcards in Upper Extremity Injury: Clinical Correlations Deck (31)
1

What are mechanisms for fractures?

Acute - Sudden impact of large force exceeding strength of the bone Stress - From repetitive submaximal stresses Pathologic - From normal forces to diseased bone

2

Fracture history (Acute vs Chronic)

Acute - Sudden Blow!
Chronic - Repetitive activity, increase in activity duration, intensity or frequency

3

Fracture Exam

Deformity - Bleeding +/- fragment => suspect open fracture => orthopedic emergency & needs to be surgically washed out ASAP
Bony point tenderness
Pain with loading bone - Indirect loading especially useful

4

Fracture indirect loading tests

Axial loading
Bump test
Fulcrum test
Hop test

5

Fracture diagnostics

Plain x-rays
CT Scan
Bone scan
MRI

6

Fracture Treatments

Immobilization (in generals)
Avoidance of NSAIDs: Some animal studies & models show NSAIDs interfere with bony healing via PGs

7

Bones with "vulnerable" blood supply

Watershed - Central (tarsal) navicular
Retrograde - Scaphoid, talus, femoral head (adults)

8

Snuffbox Contents

  • Radial nerve
  • Cephalic vein
  • Radial artery
  • Scaphoid bone

9

Scaphoid fracture
Common Cause
Clinical Findings
Vascular issues

Common cause: Fall on outstetched hand with impact on thenar eminence
Clinical feedings: Pain, tenderness and swelling in anatomical snuffbox
Vascular issues: Nutrient arteries only enter distal half of scaphoid, so fracture results in osteonecrosis of proimal half

10

Type of femoral head fractures

Type I: Impacted fracture
Type II: Nondisplaced fracture
Type III: Partially displaced
Type IV: Displaced fracture 

11

What is the blood supply of the femoral head?

Chiefly the medial circumflex femoral artery
Fracture can result in osteonecrosis of femoral head
Artery of ligament is usually insignificant

12

Arthritis history & exam findings

History

  • Stiffness - especially after rest
  • Worse after prolonged used

Exam

  • Joint line tenderness
  • Mild swelling
  • Deformity
  • Symptoms with both passive & active motions

13

What is capsulitis?
What are the causes/risk factors?
What are the phases of capsulitis?

Capsular thickening: Inflammation and scarring
Can be idiopathic or post-injury, risk factors include injury, disabetes, thyroid disease

Phases

  1. ​Freeze phase: Painful early with decreasing ROM
  2. Frozen phase: Non-painful stable, decreased ROM
  3. Thawing phase: Non-painful with improving ROM

14

What are the exam findings for capsulitis?

Decreased ROM, gradually tightening endpoint, otherwise consistent with underlying etiology

15

Capsulitis treatment

Reassurance
Educate & set expectations
Maintenance of ROM
Pain control

16

Biceps brachii rupture
Mechanism
Characteristic sign
Treatment

Long head rupture from superglenoid of scapula, only marginally affects muscle strength
Results in the popeye sign
Can be treated with surgery (attachment onto coracoid process), but usually observation of physical therapy is sufficient

17

What are the key components to selecting treatment of musculotendinous ruptures?

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

18

Musculotendinous injuries
Enthesopy
Tendinitis
Tendinosis

Enthesopathy - Disorder of muscular or tendinous bony attachment
Tendinitis - Technically acute inflammation of tendon (Traumatic: Blow or pull)
Tendinosis - Chronic degenerative condition of tendon
Many injuries may be acute on chronic

19

What is a strain?
What are its symptoms?

Muscle fiber damage from overstretching due to eccentric loading (lengthening during fire)
Symptoms: Stiffness, bruising, swelling, soreness

20

Acromioclavicular sprain
What is the etiology?
What is the presentation?

Etiology - Most common fall directly onto shoulder
Presentation  - Pai with overhead motions, deformity of superior shoulder

21

AC Sprain
Findings on exam

  • Pain and deformity at AC joint
  • Pain with cross body adduction of arm
  • Painful arc of abduction over 150 degrees 

22

AC Injury Grading

Grade I - AC ligament injury
Grade II - AC ligament tear & coracoclavicular (CC) ligament stretch
Grade III - Complete AC and CC tears

23

What is a sprain and what are it's symtpoms?

Ligamentous damage from overloading
Symtpoms: Instability or laxity, swelling

24

Sprain Grading

Grade I: Microscopic damage - No increased laxity, but pain with stress on exam
Grade II: Partial tear - Increased laxity & pain on exam
Grade III: Complete tear - Significant laxity

25

Most common shoulder dislocation is.....

Anterior shoulder dislocation (90%)

26

What is the most effective passive stabilizer of the glenohumeral joint?

Vacuum phenomena

27

Joint stability terms:
Dislocation
Subluxation
Laxity

Dislocation - Complete displacement
Subluxation - Transient, partial displacement
Laxity - Normal variant in joint looseness

28

What is the etiology of a shoulder dislocation?
What are findings on examination?

Etiology - Forced extension, abduction & external rotation of arm or direct blow to posterior shoulder
Examination - Arm held by opposite hand in slight abduction & external rotation
Alteration of shoulder contour including: Prominent acromion, humeral head anterior to acromion & adjacent to coracoid
Check sensation of axillary & musculocutaneous nerves
Positive apprehension test - feeling of instability with stress

29

Carpal tunnel syndrome
What are the signs?
What is the mechanism?

Symptoms: Thenar wasting (chronic) and parasthesias in 3.5 radial digts (acute)
Mechanism: Impingement of median nerve

30

Clavicular fracture types

Type I - Fracture with no disruption of ligaments, no displacement
Type II - Fracture with tear of CC ligament and upward displacement of medial fragment
Type III - Fracure through acromicoclavicular joint, no displacement

31

Rotator cuff injury