Upper Extremity Emergency

Front 1

What is the most common cause of flexor tendon injuries?

Back 1

Lacerations

Front 2

What is the most common cause of extensor tendon injuries?

Back 2

laceration and blunt trauma such as a mallet finger

Front 3

How can you tell if a flexor tendon injury is deep or superficial?

Back 3

PIP joint is superficial, DIP joint is deep

Front 4

Explain why extensor tendons are the ones most commonly injured

Back 4

extensor tendons have a superficial nature on the dorsum of the hand.

Front 5

What gets injured more often; flexor or extensor tendons?

Back 5

extensor

Front 6

Discuss what should be examined with a flexor or extensor injury

Back 6

PE: devascularization, skin status, posture of fingers, deformities, bleeding, grip strength, compare bilaterally, nerve testing, tendon testing, x-rays and consult.

Front 7

Discuss the management of flexor and extensor injuries

Back 7

treat anything with neurovascular compromise ASAP. Control px and swelling. NPO if surgery. Consult prn. immobilize

Front 8

Define the term Mallet finger, MOI, tx and consequences of not treating

Back 8

Zone 1 extensor tendon injury of distal phalanx and DIP. MOI: sharp or blunt trauma. Most common injury in athletes. tx: splint DIP in extension or hyper extension. If 25% refer. Consequences: necrosis

Front 9

DISORDERS OF THE UPPER EXTREMITIES

Back 9

DISORDERS OF THE UPPER EXTREMITIES

Front 10

What are the 2 most common types of injuries with PIP dislocations

Back 10

lateral involving the radial collateral ligament and dorsal involving the volar plate.

Front 11

What is the treatment for PIP injuries

Back 11

splint at 30* flexion for 3 weeks. However, if not reduceable, may need surgery.

Front 12

What should you do prior to reducing any fracture?

Back 12

Get an x-ray! 2 views; AP and always get a lateral

Front 13

List 2 terms referring to a ruptured thumb metacarpal-phalangeal ligament and discuss how they are evaluated and treated

Back 13

Gamekeepers or skier's thumb. Check for weakness of pincer function and point tenderness at volar-ulnar aspect of thumb MCP joint. Surgery recommended.

Front 14

What kind of injuries are a gamekeeper's or skier's thumb?

Back 14

ulnar collateral ligament injuries

Front 15

How are distal phalynx fractures classified? MOI? Tx?

Back 15

tuft (nailbed) shaft or intraarticular MOI: crush or shearing Tx: tx as a soft tissue injury

Front 16

Mallet finger

Back 16

What kind of injury is this?

Front 17

Discuss MOI of distal phalanx injuries, and Tx

Back 17

MOI: crush or shearing which may involve nailbed lacerations. Tx: protective splinting

Front 18

Discuss Tx of proximal and middle phalange injurues

Back 18

Stable: buddy tape. Unstable: closed reduction, splint from elbow to DIP with wrist at 20* extension and MP joint in 90* flexion or surgery

Front 19

What is a boxer's fracture? MOI? Tx?

Back 19

fracture of the 5th metacarpal NECK. MOI: direct impact force. Tx: closed reduction and splint/cast with wrist dorsiflexion of 20* and MCP @90*'s

Front 20

Describe a paronychia, MOI, Tx

Back 20

infection of lateral nail fold or perionychium. MOI: biting, manicures or hangnails. Tx: warm soaks, abx, I&D

Front 21

Describe a felon, pathogen, and Tx

Back 21

infection of the pulp of tip of finger. presents red, swollen, painful. staph, I&D on lateral aspect of finger.

Front 22

List the 4 cardinal signs of flexor tenosynovitis

Back 22

slight flexion, swelling, tenderness over flexor tendon sheath, pain on passive extension

Front 23

What is the most common ligamentous injury to the wrist

Back 23

scapholunate ligament injuries

Front 24

What is the MOI for scapholunate ligament injuries? Tx?

Back 24

fall on outstretched extremity. Tx: Don says orthopedic referral / surgery. Book says gutter splint or short arm volar posterior mold

Front 25

What 3 radiographic signs help to diagnose scapholunate ligament injuries

Back 25

1. Terry Thomas sign: widening of joint space mor than 3mm 2. Grip-compression or motion study 3. Dorsal intercalated segment instability (DISI)

Front 26

Describe the PE, MOI, Tx and complications for scaphoid fractures

Back 26

PE: px in snuffbox. Most occur in middle 1/3 of scaphoid. MOI: fall on outstretched. Tx: splint dorsiflexion, radial deviation. Unstable long arm spica and refer. Consequences: avascular necrosis

Front 27

What is a colles fracture? MOI? PE? Tx?

Back 27

fx of distal radius with displacement / angulation. MOI: fall outstretched. PE: dinner-fork deformity, palmar paresthesias, tension on median nerve. Tx: reduce splint, unstable surgery

Front 28

What is a Smith's fracture

Back 28

reverse colles fx. produces a garden-spade deformity but angulation is volar rather than dorsal!

Front 29

What is a type I supracondylar fracture?

Back 29

undisplaced

Front 30

What is a type II supracondylar fracture?

Back 30

displaced nad have cortical contact.

Front 31

What is a type III supracondylar fracture?

Back 31

subdivided into posterolateral and posteromedial fx's based on displacement and have no cortical contact.

Front 32

What age is more at risk for supracondylar fractures?

Back 32

children from a fall off swings or jungle gyms

Front 33

Name the 2 kinds of supracondylar fractures and Tx

Back 33

Extension (most common) and Flexion. Tx: Don says refer! Book says non-displaced splint long arm cast 4-6 wks, displaced surgery

Front 34

What important signs should you look for on plain films with a supracondylar fracture

Back 34

fat pad sign in undisplaced fx

Front 35

Describe MOI, PE and Tx for radial head fractures

Back 35

MOI: fall on outstretched. PE: radiocapitellar line; radial head should always face capitellum. XR show abnormal fat pad. Tx: nondisplaced splint. displaced surgery

Front 36

What is the most common kind of elbow fracture

Back 36

radial head fracture

Front 37

Describe MOI, PE, and Tx of proximal biceps rupture

Back 37

MOI: repetitive microtrauma and overuse. PE: snap heard, swelling, tender, crpitus over bicipital groove, arm "ball" Tx: sling, ice, analgesics, referral

Front 38

Describe MOI, Tx for radius and ulna fractures

Back 38

MOI: high impact MVC. Tx: nondisplaced rare! tx with plaster immobilization. Refer quickly

Front 39

Identify the 2 major nerves that can be injured in a forearm fracture

Back 39

Radial and ulnar

Front 40

How would you evaluate the radial nerve for potential injury from ulnar/radial fracture

Back 40

have pt extend both the wrist and fingers against resistance. Sensation is tested over the dorsum of the thumb index web space

Front 41

How would you evaluate the ulnar nerve for potential injury from ulnar/radial fracture

Back 41

ability to abduct index finger against resistance and 2-point discrimination over the tip of the little finger

Front 42

Describe MOI, PE, Tx and typcial patient for a proximal humerus fracture

Back 42

PT: elderly female with osteoporosis MOI: fall on outstretched PE: px, swelling, ecchymosis Tx: sling, analgesics

Front 43

Discuss the MOI and treatment of humeral shaft fractures

Back 43

bimodal age distribution in 30's & 70's. MOI: direct blow resulting in transverse fx. Torsion forces results in oblique fx sometimes with comminution. Tx: coaption splint, sling

Front 44

What is the most common MOI of clavicular injury for any patient?

Back 44

Blow to shoulder

Front 45

What is the most common part of clavical to sustain a fracture? Tx?

Back 45

80% middle 1/3 of clavicle. Immobilize with sling, dispaced with figure 8. Severely displaced shoulder spica or open reduction.

Front 46

Describe MOI, PE and associated injuries with scapular fractures

Back 46

MOI: high energy, MVC's. PE: tenderness over scapula, flattened appearance. Associated: lung, shoulder, humeral head, girdle, rib, abd, spine

Front 47

Identify the MOI, PE, and Tx for an AC joint injury

Back 47

MOI: trauma with arm adducted. PE: tenderness, deformity. Tx: rest, ice, analgesics, immobilization

Front 48

What is a more common injury - anterior or posterior shoulder dislocation?

Back 48

Anterior.

Front 49

What is MOI, PE and complications of anterior shoulder dislocations

Back 49

MOI: abduction and external rotation. PE: px, squared off. Complications: recurrent dislocations

Front 50

What is the MOI for posterior shoulder dislocations

Back 50

Adduction and internally rotated, flat and posterior aspect appears full, coracoid process prominent

Front 51

What nerve is at risk for injury with anterior shoulder dislocations

Back 51

axillary nerve

Front 52

What nerve is at risk with a lateral elbow injury

Back 52

ulnar