Shoulder

Front 1

shoulder girdle bursae

Back 1

-subacromial: below the acromion
-subdeltoid: below the insertion of the deltoid on the humerus

Front 2

shoulder ROM

Back 2

Forward elevation: 0º-180º
ABD w/Int rot: 0-90º
ABD w/Ext rot: 0-110º
External rotation at side: 0º-90º
Scapular elevation, protraction, and retraction

Front 3

impingement syndrome

Back 3

-common cause of painful shoulder
-MOI: repetitive overhead activities or direct blow causing the humeral head to impinge the soft tissue against the acromion
-Neers test: pain w/passive forward elevation @ 45º adduction
-Hawkins test: pain w/passive forward elevation and internal rotation @ 45º abduction
-Tx: intra-articular infection, cold application, NSAIDs, PT

Front 4

Glenohumer dislocations and subluxations

Back 4

MOI: chronic overuse as in overhand throwing motion or acute trauma where arm is externally rotated and abducted forcefully (anterior most common)
-tests: apprehension test, sulcus sign
-Tx: reduction, cold, injections, NSAIDs, sling

Front 5

A/C separations

Back 5

-MOI: fall on outstretched arm, direct blow to humerus, or extreme downward force on humerus
-Tx: sling and cold to surgical intervention

Front 6

S/C separation

Back 6

-MOI: fall onto outstretched arm, direct blow to lateral humerus or anterior chest
-no tests, rely on palpation
-Tx: airway mgmt, sling, PT, NSAIDs

Front 7

Adhesive capsulitis

Back 7

-aka frozen shoulder
-MOI:Immobility or failure to move glenohumeral joint for extended periods of time
Test:s abduction, check 2:1 ratio of GH:ST
-Tx: AAROM/PROM exercises, heat modalities, PT/OT, NSAIDS, capsular release

Front 8

Biceps tendinitis

Back 8

-MOI:Chronic overuse, acute injury or hyperextension of the elbow, forceful ER against resistance
-Tests: Yergasons test, speeds test
-Tx: Rest, cold application, ROM exercises, strengthening, NSAIDS, possible biceps tenodesis

Front 9

Subacromial bursitis

Back 9

-MOI:Overuse as in repetitive overhand motion, or acute trauma as in fall on outstretched arm
-Tests: Extend arm and palpate subacromial region. Impingement signs can also indicate subacromial bursitis.
-Tx: Rest, cold application, ROM exercises, intra-articular injection, NSAIDS

Front 10

Brachial plexus injuries

Back 10

-MOI:Stretching of brachial plexus as it exits between the anterior and middle scalenes. Commonly, the head is laterally rotated and flexed to the opposite side and the ipsilateral arm is forced downward.
-Tx: usually self-resolve, if recurrent consider c-spine stenosis and xrays

Front 11

Clavicle fxs

Back 11

-most common fx of childhood!
-most occur in middle 1/3
-distal fxs more severe --> osteolysis
-MOI: Fall onto outstretched arm, or direct blow to lateral humerus or to clavicle
-Tx: sling, most heal in 6 wks. partial clavicle resection or ORIF

Front 12

sternum fx

Back 12

-consider tracheal involvement and manage airway

Front 13

Apprehesion test

Back 13

-tests shoulder dislocation
-maximally abduct and externally rotate arm
-will hurt

Front 14

Drop arm test

Back 14

-detects rotator cuff tears
-have pt fully abduct arm, then slowlt lower it
-if pt cannot smoothly lower arm this is a + test
-If pt is able to hold arm in abduction, a gentle tap on the forearm will cause the arm to fall to the side in a rotator cuff tear.

Front 15

Yergason test

Back 15

-Tests the stability of the long head of the biceps tendon in the bicipital groove.
-With the arm flexed, externally rotate the pt’s arm as s/he resists and pull downward on the elbow.
-If the biceps tendon pops out of the groove and pain is experienced, the test is positive.

Front 16

Apley scratch testd

Back 16

-Quick assessment for shoulder range of motion.
-Assesses ER and abduction (L arm)
-Assesses IR and adduction (R arm)

Front 17

describing fxs

Back 17

-open or closed
-location: distal 1/3, mid-shaft, proximal etc.
-types: transverse, oblique, comminuted, avulsion etc.
-joint involvement: intra-articular
-other

Front 18

elbow ROM

Back 18

Flexion: 0º-150º
Extension: 0º (-5º)
Pronation: 0º-90º
Supination: 0º-90º

Front 19

carrying angles

Back 19

-males: 0-5 degrees
-females: 0-15 degress

Front 20

Tenis elbow

Back 20

-lateral epicondylitis
-MOI:Repetitive wrist extension motion or acute trauma forcing the wrist in extreme flexion
-Tests: pain is elicited over the lateral epicondyle region with resistive wrist extension
-Tx: rest, cold, bracing, exercises, injections, NSAIDs, surgery

Front 21

Pitchers/golfers elbow

Back 21

-MOI:Repetitive wrist flexion or acute trauma forcing the wrist in extreme extension
-tests: pain to palpation, pain against resistance
-Tx: rest, cold, bracing, exercises, injections, NSAIDs. strengthening

Front 22

Nursemaild elbow

Back 22

-subluxation of the radial head
-MOI: Child is pulled up abruptly by the arm
-tests: Arm held at side w/elbow flexed and pronated, child will not move arm
-Tx: reduction by extending and supinating elbow, watch child for 15 min to assure they are using arm

Front 23

Supraconfylar fx

Back 23

-MOI:Fall on an outstretched hand. Common in children ages 3-11
-xray: posterior fat pad sign
-tx: assess median nerve ad brachial artery, ortho consult, arm cast, ORIF

Front 24

Olcrenon bursitis

Back 24

-MOI: trauma to olcrenon area
-Tests: swelling with erythema
-tx: aspiration, gram stain, cx, IV abx

Front 25

Elbow dislocation

Back 25

-MOI: Fall on an extended arm
(posterior constitute 90%)
-Tests: Elbow flexed with prominent olecranon posteriorly
-tx: Check peripheral nerves and distal pulses, X-ray confirmation, early reduction, long-arm posterior splint with elbow flexed to 90º, re-evaluate distal nerve and vascular supply during the next 24-48 hours (ulnar nerve, brachial artery)

Front 26

Olcrenon fxs

Back 26

-MOI: direct blow to olcrenon (fall)
-tests: xray
-tx: examine integrity of nerves, immobilization with long arm cast

Front 27

Radial head fxs

Back 27

-MOI: fall on outstretched hand
-tests: Tenderness over radial head, pain w/supination, X-ray to confirm-will see posterior fat pad sign and anterior fat pad sign (sail sign)
-tx: Examine the integrity of the ulnar nerve, immobilization with a long-arm cast, ortho consult, ORIF, radial head excision

Front 28

Tennis elbow test

Back 28

-with forearm stabilized, have pt make fist and extend his wrist, then apply pressure in an attempt to force the wrist into flexion. A sudden severe pain at the lateral epicondyle is a positive test.

Front 29

Test for ligamentous stability

Back 29

-varus and valgus stress applied to elbow when flexed about 10º

Front 30

Tinel sign

Back 30

-tapping the ulnar nerve in the groove between the olecranon and the medial epicondyle will send a tingling sensation down th forearm to the ulnar distribution in the hand. (Everyone will have + test)