Upper Extremity MSK Flashcards
(116 cards)
1
Q
What fractures are at a increased risk for AVN?
A
- Shoulder fx
- Scaphoid fx: retrograde blood supply
- Hip fx
- Femoral neck fx
2
Q
What is an open and closed fracture?
A
- Open or “compound”: breaks the skin (risk for infection)
- Close: does not break the skin
3
Q
What is the SALTER acronym?
A
- S: straight across
- A: above
- L: lower or beLow
- TE: through everything
- R: cRush
4
Q
What is a type 1 salter harris fracture?
A
Through the physis (growth plate) alone
5
Q
What is a type 2 salter harris fracture?
A
Through the physis and metaphysis
- (MC)
6
Q
What is a type 3 salter harris fracture?
A
Through the physis and epiphysis
7
Q
What is a type 4 salter harris fracture?
A
Through the physis, metaphysis, and epiphysis
8
Q
What is a type 5 salter harris fracture?
A
Crush injury to physis
9
Q
What is the definition of a fracture?
A
Disruption of all or part of the boney cortex
10
Q
What is a greenstick or torus fracture?
A
Incomplete disruption of cortex usually in peds
- bone is “bent” but not broken all the way through
11
Q
What is a stress or hairline fracture caused by?
A
Fatigue induced from repeated stress over time.
12
Q
What is a transverse fracture?
A
Fracture line is perpendicular to the shaft of the bone
13
Q
What is a spiral/torsion fracture?
A
Bone has a twist appearance
14
Q
What is an oblique fracture?
A
Break is diagonal and through the bone
15
Q
What is a comminuted fracture?
A
Crushed, several little pieces
16
Q
What is a segmental fracture?
A
Several large pieces of bone
17
Q
What is an angulation displacement?
A
Deviation from straight (in angle position)
18
Q
What is displacement?
A
Abnormal position of fragmenets
19
Q
What is the definition of dislocation?
A
Complete disruption from the joint
20
Q
What is subluxation?
A
- Partial disruption of joint
- Altered but bones of the joint still remain in contact
21
Q
What is a sprain?
A
Injury of the bands of tissue that connect 2 bones together
22
Q
What is a strain?
A
Injury to a muscle or to the band of tissue that attaches a muscle to a bone
23
Q
What is a tear?
A
Tendon is torn away from the bone
24
Q
What historical component is common with a scaphoid fracture?
A
- Fall on out stretched hand (FOOSH)
- MC carpal bone fracture and highest rate of nonunion occult fracture
25
What are the PE findings of a scaphoid fracture?
Pain at the anatomical snuffbox (base of thumb)
26
What is the tx for a scaphoid fracture?
- XR: may not show fx, pt should be casted w/ repeat imaging in 7-10 days
- Thumb spica cast for 6-12 wks depending on fx location.
27
What is a shoulder tendonitis?
Inflammation of the subacromial bursitis
28
What are S/Sxs of a shoulder tendonitis?
- Pain to lateral shoulder that radiates to the deltoid
- Pain with active shoulder ROM (overhead)
- Nocturnal pain is common
29
What is the tx for shoulder tendonitis?
Rest, ice, NSAIDs, cortisone injection, PT, MRI if needed
30
What is bursitis?
Injury or trauma; prolonged pressure; overuse or strenuous activity; crystal-induced arthropathy; and inflammatory arthritis
31
What are the S/Sx of shoulder bursitis?
- Swelling pain
- Decreased active ROM
- Full passive ROM
32
What are the S/Sx of a rotator cuff inflammation/tear?
Pain involving the SITS muscles
- Supraspinatus (MC)
- Infraspinatus
- Teres minor
- Subscapularis
33
What are the PE test for a rotator cuff inflammation/tear?
Empty can test
34
What is the tx for a rotator cuff inflammation/tear?
Rest, ice, NSAIDs, cortisone injection, PT, MRI
35
What is shoulder impingement syndrome?
Anything that entraps RTC muscles under acromion usually caused by repetitive overhead work or fall on hand.
36
What are S/Sx of shoulder impingement syndrome?
Pain and difficulty moving (abducting arm)
37
What are the PE finding for shoulder impingement syndrome?
- Pain at greater tuberosity
- Lateral shoulder pain and difficulty abducting arm
- Positive Neer and Hawkins signs
38
What is the tx for shoulder impingement syndrome?
Imagining to r/o RTC, rest, ice, NSAIDs, PT, steroid injections
39
What is thoracic Outlet Syndrome?
Idiopathic compression of brachial plexus (MC), subclavian vein or artery as they exit the narrowed space between the shoulder girdle and 1st rib.
40
Thoracic Outlet Syndrome is Mc'ly seen in who?
Women in 20-50 YOA
41
What are the S/Sx of Thoracic Outlet Syndrome?
- Pain/paresthesia to forearm, arm or ulnar side
| - Swelling/discoloring of the arm esp. w/ abduction of the arm
42
What is the PE test for Thoracic Outlet Syndrome?
Adsons test: loss of radial pulse w/ head rotated to affected side
43
What is the tx for Thoracic Outlet Syndrome?
PT, avoid strenuous activities, ortho consult, surgery
44
What is a Acromioclavicular separation?
Tearing of the acromioclavicular and/or coracoclavicular joints
45
What are S/Sxs of an Acromioclavicular separation?
- Fall on shoulder or impact to tip of shoulder
| - Step off deformity
46
What are the PE findings of a Acromioclavicular separation?
- Pain at the end of the collar bone w/ swelling and "bump" depending on severity of injury
- Pain with crossover test
47
What is grade 1 of a Acromioclavicular separation?
Simple sprain w/ minor ligament injury and no dislocation
48
What is grade 2 of a Acromioclavicular separation?
Rupture of the acromioclavicular ligament
49
What is grade 3 of a Acromioclavicular separation?
Rupture of AC and coracoclavicular ligaments w/ superior dislocation of clavicle
50
What is grade 4 of a Acromioclavicular separation?
Posterior dislocation of clavicle
51
What is grade 5 of a Acromioclavicular separation?
Grade 3 + severe superior dislocation
52
What is grade 6 of a Acromioclavicular separation?
- Inferior dislocation of the clavicle
| - Can impinge on nerves
53
What are the txs for grade 1-3 of a Acromioclavicular separation?
Non operative- PRICE
54
What are the txs for grade 4-6 and 3 (if not responsive to conservative tx) of a Acromioclavicular separation?
Surgery to reconstruct the AC joint.
55
What is the tx for sprains and strains?
```
RICE, NSAIDs, heat, and XR
P: protect the joint
R: rest
I: ice
C: compression
E: elevate
```
56
What is a biceps rupture?
- Fall on outstretched arm or rapid extension of arm.
| - Long head of the biceps partially tears or ruptures from its attachment to the top of the socket.
57
What is the PE findings in a biceps rupture?
- Visible or palpable mass "Popeye" deformity
| - Tenderness along biceps tendon and muscle.
58
What is the tx for a biceps rupture?
- Rest, avoid heavy lifting and overhead activity, NSAIDs, PT
- Surgery during the first 2-3 wks following injury
59
What is a clavicle fracture?
Broken collar bone from forceful fall on outstretched hand
60
What part of the Clavicle shaft is usually fracture and who is this MC'ly seen in?
- Middle third (mid shaft)
| - MC fracture in children and adolescents (<25 yrs old)
61
What is the PE findings of a clavicle fracture?
- Pain with ROM
- Deformity at site: tenting of skin
- Crepitus
- May hold arm against chest to protect against motion.
62
What is the tx for a clavicle fracture?
- Sling, pain control, PT
- For complete fx: primary plate fixation.
- make sure to r/o brachial plexus injury
63
What is Nursemaid’s elbow (radial head subluxation) caused by?
- Lifting/swinging/pulling a child while the forearm is pronated and extending
- Radial head wedges into the stretch annular ligament.
- MC: 2-5 yrs old
64
What is the S/Sxs of Nursemaid’s elbow (radial head subluxation)?
- Tenderness of radial head, arm slightly flexed, unable to use arm, usually no swelling.
- PE: TTP of radial head, pain with supination and flexion
65
What is the tx for Nursemaid’s elbow (radial head subluxation)?
Reduction of pressure on radial head
- observe function if normal for 15 min no XR needed, but it not XR needed to r/o fracture
- Consider concomitant dislocation at elbow (Monteggia fracture/dislocation)
66
What is Olecranon bursitis?
Inflammation of the bursa over the bony prominence
67
A pt that you suspect has olecranon bursitis usually has a history of what?
Hx of gout, RA, OA, direct trauma, and infection
68
What are PE findings of Olecranon bursitis?
- Abrupt goose egg, swelling, tenderness, boggy, red elbow
- Limited range of motion with flexion.
- Observe for associated cellulitis
69
What is the tx for Olecranon bursitis?
- NSAIDS, steroid injection, padding, avoid respective motions.
- If worried about septic bursitis: do bursa aspiration
70
What is Medial epicondylitis (golfers elbow) caused by?
Injury or overuse of the wrist forearm tendons
71
What are S/Sx of Medial epicondylitis (golfers elbow)?
Pain with wrist flexion and pronation
72
What are the PE findings of Medial epicondylitis (golfers elbow)?
- Pain worsening with pulling activates
| - Pain w/ wrist flexion against resistance w/ elbow fully extended
73
What is the tx for Medial epicondylitis (golfers elbow)?
RICE, NSAIDs, PT, brace/elbow straps, steroid injection, surgery if needed
74
What is Lateral epicondylitis (tennis elbow) caused by?
Injury or overuse of the extensor wrist and forearm tendons at the lateral epicondyle
75
What are the PE findings of Lateral epicondylitis (tennis elbow)?
- Lateral elbow pain with gripping, and with forearm pronation and wrist extension against resistance
- Pain w/ lifting objects with forearm prone
76
What is the tx for Lateral epicondylitis (tennis elbow)?
RICE, NSAIDs, PT, brace/elbow straps, steroid injection, surgery if needed
77
What is Carpal tunnel syndrome caused by?
Compression of the median nerve under the transverse carpal ligament
78
What can Carpal tunnel syndrome be precipitated by?
- Premenstrual fluid retention
- Early RA
- Acromegaly
- Trauma
- Pregnancy
- Repetitive flexion/extension of wrist
- Alcohol abuse
- Diabetes
- Lupus
79
What are the S/Sx of Carpal tunnel syndrome
- Numbness and tingling in hand (1st, 2nd, and ,1/2 middle) and wrist
- Night pain
80
What are the PE tests used to dx Carpal tunnel syndrome?
Phanels sign and Tinels sign
81
What is the tx for Carpal tunnel syndrome?
NSAIDs, splint, surgical infection to decompress the nerve if needed
82
What is a Ganglion cyst?
Benign joint or synovial fluid cyst
83
Ganglion cysts are MC'ly located where and are usually seen in who?
- Dorsal wrist
| - In women between 20-40
84
What are the S/Sx of a Ganglion cysts?
- Painful or painless
- Numb
- Soft and mobile
85
What is the tx for a Ganglion cysts?
Reassurance, splint, aspiration, surgical cyst excision
86
What is Dupuytren’s syndrome?
Slowly progressive fibrosing disorder of the palmar fascia which can lead to debilitating contractrures of the hand
87
Dupuytren’s syndrome is MC'ly seen in who and is caused by what?
- Men 40-60
| - Genetic, ETOH abuse, and DM
88
What are the S/Sx of Dupuytren’s syndrome?
- Fixed flexion deformity and contractures at MCP
| - Painful nodules over distal palmar crease of proximal phalanx, esp. little and ring finger
89
What is the tx for Dupuytren’s syndrome?
- Enzyme tx to soften fibrous cords
| - Surgery: subtotal fasciectomy
90
What is DeQuervain’s disease (Nursemaids wrist)?
Tendonitis of the sheath and tendons of the first dorsal extensor compartment of the thumb.
- MC tendinitis in wrists
91
DeQuervain’s disease is MC'ly seen in what age range and who?
- 30-50 yrs of age
- Women
- Diabetics
92
What are the S/Sx of DeQuervain’s disease?
- Swelling near base of thumb
- Crepitation
- Pain with lifting at the wrist
- Pain when grabbing or pinching
- Radiating pain in forearm
93
What is the PE test used to dx DeQuervain’s disease?
Finkelstein test
94
What is the tx for DeQuervain’s disease?
- Rest, ice, NSAIDs
- Thumb spica splint
- Cortisone injection
- XR for recalcitrant case
- Consider surgery for failed 6-12 mos of conservative tx
95
What other dx should be considered when you are suspecting a pt has DeQuervain’s disease?
Consider concomitant dislocation at wrist (Galeazzi fracture/dislocation)
96
What is trigger finger?
Inflammation and disparity of the size and flexor tendon and its pulley system which causes catching or locking of the involved finger
97
What are the S/Sx of trigger finger?
- Pain at A-1 pulley
- Difficulty extending finger
- Audible snap and pain
98
What is the tx for trigger finger?
Cortisone tx, surgery or percutaneous needle release if needed
99
What is Mallet finger?
Ruptured EDC w/ possible avulsion fx at the DIP joint
100
What is the cause of Mallet finger?
- Blunt force and axial load to DIP
| - Long fingers MC'ly involved.
101
What are S/Sx of Mallet finger?
- Inability to straighten finger
| - Pain at the DIP with extension lag
102
What is the tx for Mallet finger?
Extension splitting at DIP for 6-8 wks, or surgery ORIF for larger fragments or joint subluxation (pinned)
- Referral to ortho if fracture is >25% of joint space
103
What is the cause of Gamekeeper’s thumb?
- Injury to the ulnar collateral ligament MPJ of the thumb
| - aka thumb sprain
104
Gamekeeper’s thumb can be associated with what fracture?
Avulsion fracture: base of the proximal phalanx
105
What are the S/Sx of Gamekeeper's thumb?
- Swelling and laxity of the UCL (UCL functions to resist against valgus forces)
- Thumb is far away from other digit
- MCP tenderness, weakness and pain with grip and pinch function
106
What is the Tx of Gamekeeper's thumb?
- Partial tear: spica splint
| - Complete tear: ORIF or extension of fracture fragment
107
What is a Subungual hematoma?
Collection of blood under toenail or finger nail caused from blunt trauma
108
What is the tx for a Subungual hematoma?
- Ice and elevate
- If >50% may need trephination to relieve pain
- XR is useful if nail bed appears injured
109
What is a boxer fracture?
Hand fracture of 4th and 5th metacarpal bones by hitting an object with closed fist
110
What are the PE findings of a boxer fracture?
- Loss of knuckle on exam
| - +/- Rotational deformity
111
What is the Tx for a boxer fracture?
- Volar tilt, cast or splint
- Early protected ROM
- Consider closed reduction w/ hematoma block or percutaneous pinning for rotational deformity.
112
What are some possible complications caused by a boxer fracture?
- Malunion
- Non-union
- Decreased strength and ROM (pseudo-clawing)
113
What is a Colle's Fracture?
Distal radial angulation or displacement caused by FOOSH
114
Colle's Fracture is MC'ly occurs in who?
- Postmenopausal women
- Osteoporotic women
- DM
- Asians
115
What is the PE finding of a Colle's Fracture?
Dinner fork deformity
116
What is the Tx for a Colle's Fracture?
- Closed reduction w/ hematoma block
- Percutaneous pinning for rotational deformity
- Cast immobilization 4-6 wks
- XRs if unstable: percutaneous pinning, external fixation, ORIF
