Msk Obj #5 (Upper Extremity Disorders)

Front 1

Acromioclavicular joint separation- consideration

Back 1

not to be confused with shoulder dislocation which occurs when the humerus separates from the scapula at the glenohumeral joint.

Front 2

Acromioclavicular joint separation- general

Back 2

* common in sports

* most common mechanism of injury is a fall on the tip of the shoulder or also a fall on an outstretched hand

Front 3

Acromioclavicular joint separation- Dx/PE

Back 3

* an be identified point tenderness
* Px at the AC joint with cross-arm adduction (flexing the elbow to a 90° angle, and adducting the arm across the chest)
* relief with an injection of a local anesthetic
* X-ray

Front 4

Acromioclavicular joint separation- Tx

Back 4

* depends on the severity of the injury.
* RICE/NSAIDS
* Type I and type II shoulder separation are the most common types of separated and rarely need surgery

Front 5

Carpal tunnel syndrome- general

Back 5

* Px, burning, or tingling of the median n.
* bothersome at night
* late is weakness or atrophy of thenar
* MOI: repetitive motions
* Common in Pregnancy, DM, RA

Front 6

Carpal tunnel syndrome- Dx/PE

Back 6

* Tinel sign, phalen sign, carpal compression test
* Px, burning, or tingling of the median n.
* bothersome at night

Front 7

Tinel sign

Back 7

tingling or shock like pain on volar wrist percussion

Front 8

Phalen sign

Back 8

pain or paresthesia in the distribution of the median n. when the patient flexes both wrists to 90 degrees for 60 sec.

Front 9

Carpal compression test

Back 9

numbness and tingling are induced by the direct application of pressure over the carpal tunnel

Front 10

Carpal tunnel syndrome- Tx

Back 10

* RICE
* Splint (especially at night)
* Surgery

Front 11

De Quervain’s tenosynovitis- description

Back 11

* a tenosynovitis of the sheath or tunnel that surrounds two tendons that control movement of the thumb.
* idiopathic, maybe overuse injury

Front 12

De Quervain’s tenosynovitis- S/S

Back 12

1) pain, tenderness
2) swelling over the thumb side of the wrist
3) difficulty gripping.
4) positive Finkelstein's test

Front 13

Finkelstein's test

Back 13

examining physician grasps the thumb and the hand is ulnar deviated sharply, as shown in the image. If sharp pain occurs along the distal radius.

* DeQuervain's tenosynovitis is likely.

Front 14

De Quervain’s tenosynovitis- Tx

Back 14

* RICE/NSAIDs
* INJ Steroids
* Surgery

Front 15

Dupuytren’s tenosynivitis (contracture)- general

Back 15

* relatively common disorder characterized by hyper-plasia of the palmar fascia and related structures
* nodule formation and contracture of the palmar fascia, common at the 4/5 fingers

Front 16

Dupuytren’s tenosynivitis (contracture)- S/S Tx

Back 16

* C/O tightness in the involved digits w/ inability to extend fingers
* +/- tenderness
* Tx w/ surgery common

Front 17

Lateral Epicondylitis- general

Back 17

* over usage is common
* Pain with lifting objects with forearm pronation and gripping
* involves the wrist extensors, especially the extensor carpi radialis brevis
* Ulnar neuropathy and cervical radiculopathy DDX

Front 18

Lateral Epicondylitis- S/S

Back 18

* TTP at lateral epicondyle
* Pain with resisted wrist extension and grip, worse with elbow extended than flexed
* Px w/ the arm and wrist extended
* Px reproducible with resisted wrist extension and thrid digit extension

Front 19

Lateral Epicondylitis- Tx

Back 19

NSAID’s, topical NSAIDs, rest, tennis elbow strap

* Physical Therapy – deep instrumented massage (incites healing response)
* Surgery- debridement of diseased tendon -extensor carpi radialis brevis

Front 20

Medial Epicondylitis- general

Back 20

* over usage is common
* involves the wrist flexors and MC the pronator teres tendon.
* Ulnar neuropathy and cervical radiculopathy DDX

Front 21

Medial Epicondylitis- S/S

Back 21

* Px durring motions in which the arm is repetitively pronated or wrist is flexed.
* "golfer's elbow"
* TTP directly over epicondyle, especially over the posterior aspect where the tendon inserts
* Px reproducible with resisted wrist pronation and wrist pronation

Front 22

Ganglion cyst- all

Back 22

* or synovial cyst, Bible cyst or Bible bump

* non-neoplastic soft tissue tumor that may occur in any joint, but most often occurs on or around joints and tendons in the hands or feet

* "an out-pouching or distention of a weakened portion of a joint capsule or tendon sheath."

* Surgical treatments remain the primary option, other than doing nothing at all,

Front 23

Radial head subluxation (Nursemaid elbow) - general

Back 23

* a dislocation of the elbow joint caused by a sudden pull on the extended pronated arm, such as by an adult tugging on an uncooperative child

* distal attachment of the annular ligament covering the radial head is weaker in children than in adults

* reported in infants younger than six months and in older children up to the preteen years. MC in girl in L arm

Front 24

Radial head subluxation (Nursemaid elbow) - S/S

Back 24

1)child stops using the arm, which is held in extension and pronated.
2) Minimal swelling.
3) All movements are permitted except supination.
4) little complaint of pain, and the patient generally reports pain in the proximal forearm.

Front 25

Boutonniere deformity

Back 25

* deformed position of the fingers or toes, in which the joint nearest the knuckle (PIP) is permanently bent toward the palm while the farthest joint (DIP) is bent back away
* (PIP flexion with DIP hyperextension).

* commonly caused by injury or by an inflammatory condition like rheumatoid arthritis.

Front 26

Mallet finger- description

Back 26

Fracture and tendon disruption at DIP

Front 27

Mallet finger- MIO/Tx

Back 27

* MOI – direct blow to the tip of the finger, such as when a ball strikes the fingertip or fingertip strikes a rigid surface

* TX - Splint DIP joint

Front 28

Swan neck deformity

Back 28

* deformed position of the finger
* joint closest to the fingertip is permanently bent toward the palm while the nearest joint to the palm is bent away from it
* (DIP hyperflexion with PIP hyperextension).

* commonly caused by injury or inflammatory conditions like RA

Front 29

Rotator Cuff Tears/Tendonitis - general

Back 29

* Caused by acute injuries (falls w/ outstretched arm) or repetitive motions.
* Partial cuff tears are major reason for impingement syndrome
* Most common torn tendon is supraspinatus

Front 30

Rotator Cuff Tears/Tendonitis - S/S

Back 30

* Px or weakness w/ overhead movement
* Night Px
* Impingement syndrome
* Lateral shoulder Px w/ possible radiation to lateral arm and elbow
* TTP at greater tuberosity.
* Pain with resisted abduction

Front 31

Rotator Cuff Tears/Tendonitis - Supraspinatus strength test

Back 31

shoulder abduction at 90 degrees with slight forward flexion to around 45 degrees "open can test"

Front 32

Rotator Cuff Tears/Tendonitis - Tx

Back 32

PT, subacromial injection

Front 33

Thoracic outlet syndrome - general

Back 33

* results from compression of the neurovascular structures supplying the UE

* can be compressed b/w anterior or middle scalene muscles, or a cervical rib

* MC is cased by scarred scalene due to neck trauma or sagging shoulder girdle from age, or obesity

* symptoms depend on whether affecting neural or vascular structures

Front 34

Thoracic outlet syndrome - Presentation (vascular)

Back 34

* arterial ischemia causes pallor of fingers on elevation of extremity
* sensitivity to cold
* possible gangreene of the digits, edema, cyanosis

Front 35

Thoracic outlet syndrome - Presentation

Back 35

* pain radiating from point of compression to the base of neck, axilla, shoulder, arm, forearm, and hand.

* paresthesias are common and distributed to the volar aspect of the fourth and girth digits (ulnar n. or C8)
* aggravated at night
* weakness and muscle atrophy

Front 36

Thoracic outlet syndrome - PE

Back 36

can be provoked within 60 seconds of 90% by having the patient elevate the arms in a "stick-em-up" position (abducted at 90 degrees in external rotation)

Front 37

Thoracic outlet syndrome - Tx

Back 37

• Treatment – PT, subacromial injection
• MRI – tendinitis, partial vs full thickness tear
• Surgery – subacromial decompression, repair