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