NPTE Musculoskeletal
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| GHJ Subluxation or dislocations mostly occur | in anterior-inferior direction
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| MOI for A/I GHJ dislocation | ABD UE is forcefully ER leading to tearing of inferior GH lig, anterior capsule and possibly labrum
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| Incidence of Posterior GHJ dislocation | rare and with multidirectional laxity
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| MOI of Posterior GHJ dislocation | HADD and IR of GHJ
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| Complications of GHJ Dislocation | Hill-Sachs lesions, SLAP lesions, Bankart’s lesion, axillary nerve bruising
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| Compression fx of posterior humeral head is called | Hill-Sachs lesion
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| Tearing of SUPERIOR glenoid labrum from posterior to anterior (above the middle of the socket) | SLAP lesion, may also involve biceps tendon
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| Avulsion of anteroinferior capsule & inferior GH lig assoc with glenoid rim (below the middle of the socket) | Bankart’s lesion
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| PO precautions from GHJ D/L surgery | avoid apprehension position (F >90d, HABD >90d, ER to 80d)
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| GHJ instability characterized by | popping/clicking, repeated sublux of GHJ
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| Traumatic GHJ instability is common in | young throwing athletes
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| Atraumatic GHJ instability is common in | pts with congenitally loose CT around the shoulder
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| What Dx test is very effective in Dx labral tears? | MRI
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| PO GHJ Instability plan | Sling 3-4wk, at 6wk sport specific training, full fitness 3-4m
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| Labral tear characterized by (7) | non-localized Sho pain, worsened by OH activities or HBB, weakness, instability, pain on resisted FLEX of biceps, anterior tenderness
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| Gold standard for ID of labral tear | arthroscopic surgery
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| Compression of NVB in thoracic outlet between bony and soft tissue | Thoracic outlet syndrome
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| What comprises NVB in thoracic outlet? | brachial plexus, subclavian a/v, vagus n, phrenic n, sympathetic trunk
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| Common areas of compression in TOS include | superior thoracic outlet, scalene triangle, clavicle/1st rib, PMinor/thoracic wall
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| Sx procedures for TOS | Cx rib removal, anterior/middle scalenectomy
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| Clinical tests for TOS include | Adson’s, Roos’, Wright’s, Costoclavicular
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| If Sx repair of impingement, pt should avoid | shoulder elevation >90d
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| Irritation between RTC & Greater Tuberosity or posterior glenoid/labrum | Internal or posterior impingement
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| Cause of bicipital tendonitis | mechanical impingement of the proximal tendon between anterior acromion & bicipital groove
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| Humeral neck Fx commonly occur in | older osteoporotic women with FOOSH
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| Greater Tuberosity Fx commonly occur in | middle age and elder adults related to fall on shoulder
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| Humeral Neck/Gtr tuberosity Fx require Sx or immobilization? | no, fairly stable. Needs early mobilization to prevent adhesions of capsule
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| Restriction in shoulder motion as a result of inflammation & fibrosis of the shoulder capsule | Adhesive capsulitis
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| Adhesive capsulitis usu assoc with | disuse following surgery, repetitive microtrauma, DM2
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| Restrictions in Adhesive capsulitis | ER > ABD > FLEX > IR
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| Sx of primary Impingement Stage 1 | intermittent mild pain with OH activities, >35yo
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| Sx of primary impingement Stage 2 | mild-mod pain with OH activities
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| Sx of primary impingement Stage 3 | pain at rest or with activities, possible night pain, scapular/RTC weakness noted
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| Sx of RTC tears (full thickness) | classic night pain, weakness in ABD & ER, loss of motion
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| Sx of adhesive capsulitis | loss of motion in capsular pattern
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| Sx of anterior instability | apprehension with HABD & ER, slipping, popping, sliding, weak scapular stabilizers
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| Sx of posterior instability | slipping of humerus out the back, esp with FLEX & IR
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| Sx of multidirectional instability | looseness in all directions, most pronounced with carrying luggage or turning over in bed, +/- pain
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| Lateral epicondylitis is a chronic inflammation of | ECRB at proximal attachment to lateral epicondyle of humerus (tennis elbow)
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| PPT factors for lateral epicondylitis | repetitive wrist extension or strong grip with wrist extended
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| Medial epicondylitis is an inflammation of | Pronator teres & FCR tendons at medial epicondyle of humerus
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| PPT factors for medial epicondylitis | pitching, driving golf swings, swimming, strong hand grip, excessive pronation of the forearm
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| Complications of distal humeral Fx | loss of motion, myositis ossificans, malalignment, NV compromise, ligament injury, CRPS
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| Things important to remember in distal Humeral Fx | examine quickly for NV status esp radial n, vascular-Volkmann’s ischemia, growth plates in youth
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| Distal humeral fx has high incidence of | malunion
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| Lateral epicondyle Fx common in | young people
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| Most lateral epicondyle Fx require what to ensure absolute alignment | ORIF
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| Osteochondrosis of humeral capitellum | OCD of central or lateral capitellum or radial head
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| OCD of humeral capitellum caused by | repetitive compressive forces between radial head and humeral capitellum
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| OCD of humeral capitellum usu occurs in | adolescents 12-15yr
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| Localized avascular necrosis of capitellum leading to loss of subchondral bone with fissuring & softening of articular surfaces of radiocapitellar joint in kids 10yr and younger | Panner’s disease
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| Repetitive valgus stresses to medial elbow with OH throwing can lead to | Ulnar collateral ligament injuries
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| Clinical Sx of UCL injury | pain at medial elbow at distal insertion of lig, sometimes parasthesias in ulnar nerve
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| Focus of rehab for UCL injury | after pain and inflammation begin strengthening of elbow flexors
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| Inability to ABD arm >90d and pain in shoulder on ABD can be injury to what nerve? | Spinal accessory n
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| Pain on FLEX fully EXT arm, inability to FLEX fully EXT arm, winging at 90d FLEX can be injury to what nerve? | Long thoracic nerve
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| Pain on forward shoulder FLEX, Sho weakness, Pain with scap ABD or CL Cx ROT can be injury to what nerve? | Suprascapular nerve
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| Inability to ABD arm with neutral rotation can be injury to what nerve? | Axillary nerve
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| Weak elbow FLEX with forearm SUP can be injury to what nerve? | Musculocutaneous nerve
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| Causes of ulnar nerve entrapment | direct trauma to cubital tunnel, traction due to medial elbow laxity, compression due to thickened retinaculum or hypertrophy of FCU, recurrent subluxation, DJD affecting cubital tunnel
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| Clinical findings of Ulnar nerve entrapment | medial elbow pain, paresthesia in ulnar distribution
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| Median nerve entrapment occurs where | within pronator teres and under superficial head of flexor digitorum superficialis
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| Median nerve entrapment due to | repetitive gripping
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| Sx of Medial nerve entrapment | aching pain with weakness of forearm muscles and paresthesias in median distribution
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| Radial nerve entrapment occurs where & why? | posterior or interosseous nerve occurs in radial tunnel as a result of OH activities and throwing
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| Sx of radial tunnel syndrome | lateral elbow pain, pain over supinator muscle, paresthesias in radial nerve distribution
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| What type of dislocation most frequent at elbow? | Posteriolateral
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| Posterolateral elbow dislocations occur as a result of | elbow hyperextension from a FOOSH
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| Posterior dislocations of elbow frequently cause | avulsion Fx of medial epicondyle 2/2 traction of MCL
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| What complications occur with complete elbow dislocation? | Ulnar collateral lig rupture, anterior capsule rupture, LCL lig, brachialis muscle, wrist flexor or extensor muscle
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| Clinical sx of elbow D/L | rapid swelling, severe elbow pain, deformity
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| Sx of CTS | burning, tingling, pins and needles, numbness in median nerve distrib at night, + Tinel’s, + Phalen’s
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| Long term CTS causes | atrophy and weakness of thenar muscles and lateral two lumbricals
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| Inflammation of extensor pollicis brevis and abductor pollicis longus at 1st dorsal compartment | DeQuervain’s tenosynovitis
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| Cause of DeQuervain’s | repetitive microtrauma, 2/2 swelling during pregnancy
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| Sx of DeQuervain’s | pain at anatomical snuff box, swelling, decreased grip & pinch, + Finkelstein’s
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| Most common wrist fracture resulting from FOOSH | Colles’ fracture
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| Med tx of Colles Fx | immobilized 5-8wk
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| Complication of Colles Fx | median nerve compression with excessive edema
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| “Dinner fork” deformity | results from dorsal or posterior displacement of distal fragment of radius with radial shift of wrist/hand
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| Wrist Fx with distal fragment of radius dislocation in volar direction | Smith’s Fx
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| Characteristic deformity of Smith’s fx | Garden spade deformity
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| Carpal Fx commonly during FOOSH | Scaphoid
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| Complications of scaphoid fx | AVN of proximal scaphoid
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| Medical tx of scaphoid fx | Immobilized 4-8wk
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| Banding on palm & digit flexion contractures resulting from contracture of palmar fascia | Dupuytren’s contracture
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| Typically affected joints in Dupuytren’s | MCP and PIP of 4th & 5th digits. 3 & 4 digits in diabetics
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| Rupture of central tendinous slip of extensor hood leads to | Boutonniere deformity
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| Sx of Boutonniere deformity | MCP extension, DIP extension, PIP flexion
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| Boutonniere deformity common | following trauma or RA with degeneration of central extensor tendon
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| Contracture of intrinsic muscles of finger with dorsal subluxation of lateral extensor tendons | Swan neck deformity
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| Sx of Swan neck deformity | MCP flexion, DIP flexion, PIP extension
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| Swan neck occurs | following trauma or RA with dengeration of lateral extensor tendons
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| Ape hand deformity | thenar muscle wasting with 1st digit moving dorsally until in line with 2nd
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| Ape hand deformity results from | median nerve dysfunction
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| Mallet finger | rupture or avulsion of extensor tendon at insertion into DP, flexion of DIP results
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| Mallet finger occurs due to | trauma forcing distal phalanx into flexion
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| Gamekeeper’s thumb | sprain of UCL of MCP joint of thumb resulting in medial instability
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| When does gamekeeper’s happen | fall during skiing
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| Boxer’s Fx | Fx of neck of 5th metacarpal
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| Boxer’s Fx occurs | punching
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| Boxer’s Fx medical tx | 2-4wk of immobilization
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