Upper Extremity MSK Problems Flashcards Preview

Clin Med IV - Ortho > Upper Extremity MSK Problems > Flashcards

Flashcards in Upper Extremity MSK Problems Deck (93):
1

Suggested X-ray views for AC joint

AP with and without weights

2

Suggested X-ray views for chest

PA
Lateral (full inspiration)

3

Suggested X-ray views for clavicle

AP
Axial (20 deg. cephalad)

4

Suggested X-ray views for humerus

AP
Lateral

5

Suggested X-ray views for SC joint

AP
Obliques (bilateral)

6

Suggested X-ray views for shoulder

AP
Grashey
Y-scapular

7

Most common location of clavicle fractures

Middle 3rd > Distal 3rd > Proximal 3rd

8

Clinical presentation of clavicle fracture

Pain with active and passive ROM, esp. abduction/flexion of shoulder

9

Tx non- or minimally displaced clavicle fracture (most)

Conservative tx b/c usually heal in 6 wks → sling, ICE, NSAIDs, analgesics, PT

**PROM within 3 days to prevent freezing

10

Tx displaced clavicle fracture

ORIF → sling, ROM as soon as tolerated, analgesics, PT

11

Common mechanism of injury for AC joint injuries

Direct force to lateral shoulder with arm adducted → acromion driven inferiorly and medially with respect to clavicle

12

Grade AC joint injuries (Hint: 3 classes)

Grade I - sprain AC ligament (stretched fibers)
Grade II - tear AC ligament
Grade III - tear AC and coracoclavicular ligaments → AC joint dislocation

13

Clinical manifestation of AC joint injury

- Pain in affected shoulder with decreased ROM
- TTP over AC joint

14

What special test can be used to determine AC joint injury?

Cross-arm test

15

Tx AC joint injury

Grade I, II → Conservative tx
Grade III → +/- surgery
Grade IV-VI → surgery

Note: Mild superior subluxation of AC joint may persist after surgery

16

Mechanism of injury of sternoclavicular joint dislocation

Fall on abducted and extended arm

17

Clinical manifestation of sternoclavicular joint dislocation

Initially presents as SCM muscle pain/spasm → may not dislocate until days after injury

18

Indications for surgical repair of sternoclavicular joint dislocation

Posterior dislocation
Cosmesis

19

Presentation of proximal humerus fracture

- Moderate/severe shoulder pain, increases with active and passive ROM
- Swelling and ecchymosis possible
- Arm adducted against side

20

What's important to know about proximal humerus fractures?

If fracture in shaft, check radial nerve and vascular integrity → wrist extension and sensory on dorsum of 1st web space

21

Tx impacted or non-displaced proximal humerus fracture (most)

- Conservative tx w/ sling or collar/cuff
- Begin ROM of elbow/wrist as soon as tolerated**

22

Tx unstable proximal humerus fracture

ORIF or total shoulder replacement

IM rodding falling out of favor d/t lingering pain

23

Most shoulder dislocations are _______

Anterior

24

Posterior shoulder dislocations are usually due to _______, ______, or ______

Falls from height
Epileptic seizures
Electric shock

25

Atraumatic shoulder dislocations are usually due to ________ or ________

Ligament laxity
Repetitive microtrauma (swimmers, gymnasts, pitchers)

26

Presentation of shoulder dislocation

- Obvious deformity
- Arm abducted and in external rotation

27

90% young active pts with traumatic shoulder dislocation have ________, too

Inferior labral injuries (Bankart lesions)

28

What is important to assess in shoulder dislocation?

- Axillary and radial nerve function
- Rotator cuff tears

29

Tx shoulder dislocation

- Reduction ASAP → sling immobilization for 2 wks w/ pendulum exercises and PT

30

What counseling point should you provide pt after reducing shoulder dislocation?

Limited ROM and pain may persist for 4-6 wks

31

________ is the only tx shown to decrease recurrence of shoulder dislocation

Surgery

32

_______ pts have high risk of redislocation of shoulder

Age <21

33

Redislocation of shoulder is associated with ______ and ______

Increased arthritis risk
Further bony deterioration

34

Impingement syndrome is also known as ______

Rotator cuff tendonitis

35

Epidemiology of impingement syndrome

Age >40

36

Clinical presentation of impingement syndrome

- Pain with overhead activities
- Nocturnal pain with sleeping on shoulder
- Pain on internal rotation (putting on jacket/bra)
- Tenderness over anterolateral shoulder at greater tuberosity
- Decreased AROM but preserved PROM**
- Possible atrophy in supraspinatus fossa

37

Special test that suggests impingement syndrome

+Hawkin's impingement test

38

Imaging for impingement syndrome

MRI b/c X-ray may appear normal

39

_________ are one of the most common causes of impingement syndrome

Partial rotator cuff tears

40

Tx impingement syndrome

- Conservative → activity modification, PT, NSAIDs, steroid injection
- Surgery → arthroscopic acromioplasty with coracoacromial ligament release, bursectomy, or debridement/repair of rotator cuff tears

41

Rotator cuff muscles

SITS
- Supraspinatus
- Infraspinatus
- Teres minor
- Subscapularis

42

Function of supraspinatus

Abduction

43

What special test is used to assess supraspinatus?

Empty the can test

44

Function of infraspinatus

External rotation from neutral position

45

Function of teres minor

External rotation from 90 deg.

46

Function of subscapularis

Internal rotation

47

Most commonly torn tendon in rotator cuff tear

Supraspinatus

48

Common mechanism of injury of acute rotator cuff tear

- Fall on outstretched arm
- Pulling on shoulder

49

Common mechanism of injury of chronic rotator cuff tear

Repetitive injuries with overhead movement and lifting

50

Presentation of rotator cuff tear

- Weakness or pain with overhead movement
- Limited AROM but normal PROM
- Night pain/inability to sleep on affected side

51

Imaging for rotator cuff tears

MRI b/c X-ray commonly appears normal

High-riding humeral head = supraspinatus tendon tear

52

Tx partial rotator cuff tear

Conservative tx but 40% progress to full-thickness tears in 2 yrs

53

Tx full-thickness rotator cuff tears

- Surgery for young, active pts
- PT option for older, sendentary pts

54

SLAP lesion

Injuries of glenoid labrum at long head biceps attachment

55

Imaging for SLAP lesion

MR arthrogram w/ gadolinium injection → high signal fluid in T2

56

Tx SLAP lesion

- Type I → usually asx and doesn't need tx
- Type II and III → surgical reattachment

57

Adhesive capsulitis is also known as _______

Frozen shoulder

58

Pathophysiology of adhesive capsulitis

Thickening and inflammation of shoulder capsule around glenohumeral joint

59

Epidemiology of adhesive capsulitis

Age 40-65
Women > men
Endocrine disorders (DM, thyroid)

60

Clinical presentation of adhesive capsulitis

- Pain with decreased AROM *and* PROM
- Strength mostly normal
- Usually lasts 24 months

61

Different phases of adhesive capsulitis

- Inflammatory phase → pain out of proportion
- Freezing phase → stiffness
- Thawing phase → resolution

62

Tx adhesive capsulitis

- Conservative tx
- Surgery (rare)

63

Calcific tendonitis most commonly occurs in _______

Supraspinatus

64

Presentation of calcific tendonitis

- Very painful shoulder triggered by minimal or no trauma
- Specific point of pain
- Acute onset

65

Tx calcific tendonitis

- Conservative tx
- Arthroscopy with aspiration of mineralized material

66

Epidemiology of humeral fracture

Bimodal distribution → Age 20s male, Age 60s female

67

Clinical presentation of humerus fracture

- Severe pain in mid-arm area
- Swelling and ecchymosis
- TTP, crepitus

68

Tx humerus fracture

- Functional bracing for non-surgical candidates
- ORIF for moderate-severe displacement or young pt

69

Radiologic signs of elbow fracture

Anterior fat pad sign ("sail sign")
Posterior fat pad sign
May not see fx immediately, may show up on f/u

70

Suggested X-ray views of elbow

AP
External oblique
Lateral

71

Treat radial head fracture

- Long arm posterior splint for 3-4 days
- Sling for 1-2 wks
- Analgesics, gentle ROM, PT
- Serial radiographs at 2 wks

72

Epidemiology of supracondylar elbow fx

Age 5-9

73

Tx supracondylar elbow fracture

- Conservative if non-displaced
- ORIF, flexion reduction maneuver

74

Epidemiology of olecranon fracture

Bimodal distribution

75

Clinical presentation of olecranon fracture

- Pain localized to posterior elbow with palpable defect
- Inability to extend elbow

76

Tx olecranon fx

ORIF with tension band or plate/screw fixation

77

Most elbow dislocations are ______

Closed and posterior

78

Mechanism of injury of elbow dislocation

Hyperextension, posterolateral rotatory mechanism

79

Treatment of elbow dislocation

- Closed reduction for simple dislocation
- ORIF for complex fracture-dislocation
- Long arm posterior splint/sling for 1-2 wks

80

Lateral epicondylitis is also known as _______

Tennis elbow

81

Medial epicondylitis is also known as ______

Golfer's elbow

82

Clinical manifestation of lateral epicondylitis

Pain with resisted wrist extension

83

Clinical manifestation of medial epicondylitis

Pain with resisted wrist flexion

84

Tx epicondylitis

Rest
Ice cube massages
Brace
NSAIDs
PT
Cortisone

85

Tx both bones forearm fracture

Sugar-tong splint in ED → Casting for nondisplaced, ORIF for displaced (more common)

86

Greenstick fracture

Incomplete fx of long bone

87

Epidemiology of greenstick fx

Forearm of young child

88

Tx greenstick fx

- Sugar tong splint
- Analgesics
- Casting for 3-4 wks

89

Buckle fracture is also known as _______

Torus fracture

90

Tx buckle fracture

- Volar splint
- Analgesics
- Casting x3-4 wks

91

Colles fracture

Fx of distal radial metaphyseal region with DORSAL angulation of distal fragment

92

Tx Colles fx

- Conservative → closed reduction, sugar tong splint followed by long/short arm cast for 4-6 wks
- Surgery → ORIF followed by cast/splint for 4-6 weeks

93

Smith fracture

Fracture of distal radius with VOLAR angulation of distal fracture fragment