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55 Cards in this Set

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What are 2 lesions associated with recurrent shoulder dislocations?
• Bankhart lesion: anterior capsular injury associated with a tear of the glenoid labrum
• Hill-Sachs lesion: compression fracture of the articular surface of the humeral head
The medial border of the scapula articulates with the posterior aspect of which ribs?
ribs 2-7
What does a "popeye" muscle indicate?
a proximal rupture of the long head of the bicep
What does scapular winging indicate?
serratus anterior injury due to long thoracic nerve injury
What are some tests that can be done to evaluate for impingement syndrome?
• impingement sign: passive forward flexion; (+) pain > 90º
• Hawkins Test (dump out can): passive forward flex to 90º and internal rotation; pain = impingement syndrome
What is the apprehension test?
• abduction to 90º and external rotation
• positive apprehension test = anterior shoulder instability
A crossed chest, adduction test is touch your shoulder with your other hand. What are the different pathologies if you can't touch your shoulder and if you have pain while trying to touch your shoulder?
• pain: AC pathology
• unable to touch: shoulder dislocation
What is the Yergason test?
• resisted supination
• pain: bicipital tendonitis
What is the Wrights test?
• extension, abduction, external rotation of arm; neck rotated away
• loss of pulse & reproduction of symptoms = thoracic outlet syndrome
What is the mechanism of injury of an AC separation?
fall onto point of shoulder
What are 2 signs of AC separation?
• pain with cross chest abduction test
• pain at AC junction
Describe the different grades of AC separation
• Grade I: AC ligament sprained, but joint remains intact
• Grade II: rupture of AC ligament & joint separation
• Grade III: coracoclavicular & AC ligaments ruptured w/ wide separation of joint
What are the treatment options for the various grades of AC separation?
• Grade I-II: sling, ice x 2 weeks then ROM

• Grade III:
- sling, ice x several weeks until pain subsides, then ROM
OR
- surgical repair
What are causes of glenoid labrum injury?
• repeated anterior subluxation of the shoulder

• anterior instability during acceleration phase of throwing (secondary to long head of biceps pulling on anterior labrum

• repetitive bench pressing and overhead pressing

• fall on outstretched arm
What are findings on physical exam of a glenoid labrum injury?
• pain on forced external rotation @ 90 degrees abduction
• "pop" or "click" on forced external rotation
• weakness of rotator cuff muscles
What is the treatment of a glenoid labrum injury?
• physical therapy
• arthroscopic repair
What are the 4 muscles that make up the rotator cuff?
• supraspinatus
• infraspinatus
• subscapularis
• teres minor
What is the mechanism of injury for a shoulder dislocation?
• external rotation or abduction force on humerus
• direct posterior blow to proximal humerus
• posterolateral blow on the shoulder
What is the treatment for shoulder dislocation?
• closed reduction
• immobilzation in internal rotation
List 5 types of closed shoulder reduction
• stimson maneuver: pt prone on table with weight on arm
• mitch maneuver
• hippocratic maneuver: examiner places sole of foot in axilla
• traction/countertraction
• scapular manipulation: stimson maneuver with medial manipulation of the tip of scapula
What is treatment for bicipital tendonitis?
• physical therapy
• activity modifiation
• NSAIDs
What are causes of thoracic outlet syndrome?
• usually due to irritation of C8 and T1

• caused by:
- a cervical rib
- a fiber spanning from a rudimentary cervical rib
- tendinous bands from te scalenus anterior to the medius muscles
- hypertrophic clavicle fracture callus
What is the treatment for thoracic outlet syndrome?
• postural exercises
• surgical resection of cervical rib, first rib, or scalenotomy
What is the most common bone in the body fractured?
clavicle
What is weakest part of the clavicle?
the junction of the middle and lateral thirds
Name and describe the 3 classes of clavicle fractures
• Class A - middle third fracture
• Class B - distal third fracture
• Class C - proximal third fracture
What is the most common mechanism of injury for a proximal humerus fracture?
FOOSH
A fracture of the humerus at the surgical neck can injure which nerve?
axillary nerve
A fracture of the humerus at the radial groove can injure which nerve?
radial nerve
A fracture at the distal end of the humerus can injure which nerve?
median nerve
A fracture of the humerus at the medial epicondyle can injure which nerve?
ulnar nerve
What is the treatment for midshaft humerus fracture?
• coaptation splint
• change to Sarmiento brace after 2 weeks
• may require ORIF w/ plate, screws, or nails
Which part of the humerus articulates with the radial head?
capitulum
Which part of the humerus articulates with the ulna?
trochlea and olecranon fossa
What is a Monteggia fracture?
a fracture of the mid or proximal ulna with anterior dislocation of the radial head
What is a Galeazzi fracture?
a radial shaft fracture with associated dislocation of the distal radioulnar joint
What are signs of a radial head fracture on xray?
• sail sign
• fat pad sign
What is Tennis elbow?
• pain at the lateral humeral epicondyle, reproduced by extending the wrist against resistance
• seen in patients who perform repetitive wrist extension
What is Pitcher's elbow (or Golfer's elbow)?
• pain at the medial humeral epicondyle
• seen in patients who golf, or perform throwing sports, such as baseball, football, javelin
What 2 tendons form the snuffbox?
• extensor pollicis brevis tendon
• extensor pollicis longus tendon
What radiographic studies should be obtain for a possible scaphoid fracture?
• obtain AP/lat/obliq/scaphoid views
• plain xray may not demonstrate fx for up to 4 weeks
• if x rays are still negative at 10-14 days & pt is symptomatic, obtain bone scan for definitive diagnosis
What is the treatment for a scaphoid fracture?
• initially: thumb spica (always treat snuffbox tenderness, even if xray negative

• definitve:
- long arm thumb spica cast x 4-8 weeks
- ORIF (if scaphoid is displaced)
Carpal tunnel syndrome affects which nerve?
median nerve
Cubital tunnel syndrome affects which nerve?
ulnar nerve
The radial nerves provides sensation to what part of the hand?
• dorsum of hand on radial side of 3rd metacarpal & dorsal thumb, index, & middle fingers as far as the distal phalanges
How do you test the motor innervation of the radial nerve?
test thumb extension (hitchiking)
The ulnar nerve provides sensation for what part of the hand?
to the ulnar side of hand (dorsal & palmar), ring & little finger
How do you test the motor innervation of the ulnar nerve?
• test opposition of the little finger
• finger adduction
The median nerve provides sensation to what part of the hand?
• palm & palmar surfacve of thumb, index, middle, and ½ of ring finger
• may supply dorsum of terminal phalanges of these fingers
How do you test the motor innervation of the median nerve?
test thumb opposition
What is flexor tenosynovitis?
infection of the digital synovial sheaths
What are the 4 classic findings for diagnosis of flexor tenosynovitis?
• tenderness over flexor tendon sheath
• symmetric swelling of the finger (sausage finger)
• pain with passive extension
• flexed posture of the involved digit at rest
What is trigger finger?
• a painful condition caused by a narrowing of the sheath that surrounds the finger tendon
• inflamed nodule of tendon gets trapped behind tendon sheath and finger becomes stuck in flexed position
What is De Qyervain's Tenosynovitis?
• an entrapment tendonitis of the tendons contained within the first dorsal compartment at the wrist
• results in pain with thumb motion
What type of splint is used to treat a Boxer's fracture?
ulnar gutter splint