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170 Cards in this Set
- Front
- Back
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What is the most common type of shoulder dislocation? |
anterior dislocation |
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Describe an anterior shoulder dislocation |
-external rotation and abduction -caused by a fall on an outstretched arm |
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How are posterior dislocations caused? |
-falls from a height -epileptic seizures -electric shocks |
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What are atraumatic dislocations are caused by? |
-intrinsic ligament laxity -repetitive microtrauma |
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What are signs and symptoms of a shoulder dislocation? |
-pain -instability (esp. with abd & ex. rot) -obvious deformity -pt holds arm in ext. rotated position -fullness in front of shoulder -axillary nerve injury -atraumatic injuries may be less severe |
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How to Dx a should dislocation? |
-Xray: r/o Fx -MRI: shows soft tissue injuries, rotator cuff tears -CT: bony loss |
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How do you Tx a shoulder dislocation? |
-reduction: inject 22cc 2% lidocaine, traction, int. rot -immobilize for 6 wks -PT after 6 wks -surgery if recurrent or traumatic -acute dislocations: reduce shoulder ASAP, sling for 2-4wks, early PT -traumatic: bankart lesion is common (lesion of ant. glenoid labrum), surgery often required |
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Explain the differences in the types of AC separation injuries |
Type I: very minimal disruption of ligaments Type II: partial or incomplete tear of ligaments Type III: tear of the coraco-cavicular ligament and displacement of AC joint Type IV: coracoacromial ligament intact but AC & CC disrupted Type V: all the ligaments are torn severe displacement of AC joint- requires surgical intervention Type VI: distal end of clavicle displaced inferiorly and lodges in biceps and carcobrachialis muscles |
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How do AC separation injuries occur? |
fall directly on shoulder |
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S/S of an AC separation |
-deformity -pain -swelling -ligamentous tears (coracoclavicular, acromioclavicular, coracoacromial)
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How do you Dx an AC separation? |
-Xray -piano key sign
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How do you Tx an AC separation? |
-reduce -pain meds -surgery if type 5 or 6 -type 3 or 2 just put in a sling and give pain meds (ultra & vicodin are ached II) |
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Where is a clavicle usually fractured? |
mid shaft |
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What is the classification of a clavicle fracture? |
Group 1: Middle 1/3 Group 2: Distal (lateral) 1/3- intra VS extra articular (inside or outside of the joint; medial or lateral to coracoid Group 3: Proximal (medial) 1/3 |
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How do clavicle fx usually happen? |
direct blow fall on point of shoulder |
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what are S/S of a clavicle fx? |
-"tenting" of the skin -deformity, swelling, tenderness -check for chest trauma: PTX (diminished breath sounds), rib fx -check neuromuscular status- subclavian a. & v., brachial plexus -cradling the extremity |
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dx of clavicle fx |
obvious xray |
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Tx of a clavicle fx |
sling: figure 8 splint (don't really like to use) operation: ORIF, fxs assoc w/ trauma, distal fx |
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How do sternoclavicular post. dislocation occur? |
direct blow to any chest wall (usually high energy) |
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How do sternoclavicular ant. dislocations occur? |
lateral blow to shoulder (low energy) arm is abd/ext. |
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what are S/S of sternoclavicular dislocations? |
-deformity, swelling, tenderness of joint -post. dislocations: stridor, dysphagia, venous distention, pulse deficit |
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How do you dx a sternoclavicular dislocation? |
xray CT |
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How do you Tx a sternoclavicular dislocation? |
-ant. dislocation: no surgery -post. dislocation: immediate close reduction is open reduction is required- cardio/thoracic surgeon required -sling and f/u |
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What is a rotator cuff impingement? |
partial rotator cuff tears |
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How do rotator cuff tears happen? |
acute: FOOSH chronic: repetitive injuries |
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what is the MC torn tendon of rotator cuff injuries? |
supraspinatus |
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What are S/S of rotator cuff impingement? |
-gradual onset of pain -frozen shoulder -nigh pain & difficulty sleeping -painful on motion in fwd flexion & abd -atrophy of ms in chronic disease |
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What are S/S of rotator cuff tear? |
-difficulty lifting farm with limited ROM -weakness w/ RROM= full thickness tears |
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How do you dx a rotator cuff tear? |
-a pinching or impingement of acromion, coracoarcomial ligament, AC joint, and coracoid process on the underlying bursa, biceps tendon (long head) and supraspinatous tendon -Hawkins -Neers sign -drop sign -strength test -neurovascular exam -xray: mercedes benz sign -MRI is the best method to visualize rotator cuff tears |
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What is Hawkins test and Neers sign and what do they test for? |
test for rotator cuff impingement Hawkins: don't let pt lean away- shoulder at 90o and elbow flex to 90o you int. rotate humerus; +pain Neers: depress scapular while elevating arm |
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What are the different types of rotator cuff found on X-ray? |
type 1: more vertical type 2: starts close down type 3: big hook |
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What is the tx for rotator cuff impingement? |
-NSAID -PT -steroid injections: q 6wk (4cc in subacromian space, 4cc in glenohumeral jt) -activity precautions- no lifting -if no improvement in 6wk, MRI to eval for tear |
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What is the tx for a rotator cuff tear? |
-full thickness tears: surgery -partial thickness: PT |
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What is the Neer System Classification? |
Proximal Humerus Fx -2part anatomic neck -2 part surgical neck: MC -3 part greater tub -3 part lesser tub -4 part |
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What parts does the Neer System Classification divide the proximal humorous into? |
-humeral head -greater tuberosity -lesser tuberosity -humeral shaft |
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What does the Neer System Classification take into consideration when dealing with prox. humerus fx? |
-displacement (NOT fx line) -considered displaced if angle is >45o or >1cm |
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How do prox. humerus fx happen? |
-direct blow -FOOSH -usually in older pts with osteopenic bone OR in high energy trauma in younger pts -associated with dislocation of greater tub |
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S/S of prox. humerus fx |
-pain -LOF -swelling |
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dx of prox. humerus fx |
xray CT/CT w/ reconstructions |
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tx for prox. humerus fx |
-prox. humerus locking plate -depends on the type of fx, type of pt displacement of fx and number of part -2-3 parts depends on the amy of displacement for possible ORIF or percutaneous pinning -4 part fx if displaced would get an hemiarthroplasty (stent & ball) -reverse total shoulder: chronic pain, no rotator cuff (head is in the glenoid instead on a stem) |
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What nerve do you need to make sure in intact with a humeral shaft fx? |
radial n. |
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How do humeral shaft fx occur? |
FOOSH, direct blow |
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S/S of humeral shaft fx |
-deformity -swelling -tender |
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Dx of humeral shaft fx |
-check neuromuscular status (radial n. runs in mid/distal 1/3 of fx) -xray |
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tx of humeral shaft fx |
lock and plate |
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what do you need to worry about in peds with a distal humerus fx? |
growth plate concerns- outcome usually good but can develop limited ROM |
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how do distal humerus fx usually occur? |
direct blow to elbow |
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S/S of distal humerus fx |
-bursistis -swelling -pain -instability -open |
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dx of distal humerus fx |
xray |
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tx for distal humerus fx |
depends on severity |
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What is the sale sign? |
sign on X-ray when fat pad is showing with a elbow disolocation |
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what associated fx do you need to check for with an elbow dislocation? |
radial head and coronoid |
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What are the classes of elbow dislocation and which is the MC? |
post./post.lat.= MC med., lat., divergent, ant. |
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how do elbow dislocations happen? |
fall with elbow locked in extension |
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S/S of elbow dislocation |
-swelling -deformity -tenderness |
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dx of elbow dislocation |
xray for coronoid fx |
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tx for elbow dislocations |
-closed reduction: lidocaine, axial traction -place in long arm post. splint -early ROM |
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What is the medical term for tennis elbow? |
lat. epicondylitis |
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how does lat. epicondylitis occur? |
-over use and improper back hand -inflammation of extensor muscles in the forearm that extend wrist |
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S/S of lat. epicondylitis |
-post.lat. forearm pain -pain with extension of wrist -pain picking up a gallon of milk and pulling door closed |
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dx of lat. epicondylitis |
extend hand against RROM |
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tx for lat. epicondylitis |
rest, ice, NSAID, bracing, PT, cortisone, surgery (50/50 helpful), stretching exercise x2 wks |
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What is the medical term for golfers elbow? |
med. epicondylitis |
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how does med. epicondylitis happen? |
-overuse -inflammation of flexor muscles of the forearm |
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S/S of med. epicondylitis |
-pain on med. aspect of elbow -swelling -weakness -tingling/numb -swinging golf club, racket, pitching, turning a door knob, picking up palm side down all cause pain |
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dx of med. epicondylitis |
RROM |
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tx for med. epicondylitis |
rest, ice, NSAID, bracing, PT, cortisone (careful of nn.), ulnar n. transition |
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How do olecranon fx happen? |
-direct blow to flexed elbow- check for open fx -could also pull triceps |
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S/S of olecranon fx? |
-deformity -pain -swelling -instability to extended elbow |
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dx of olecranon fx |
xray- check for intra articular involvement, displacement, extensor muscle involvement , comminution |
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tx for an olecranon fx |
-ORIF: lat. position with flexed elbow -tension bad wire (may need redone in time) |
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What is olecranon bursitis? |
inflammation of olecranon bursa |
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Who commonly gets olecranon bursitis? |
pregnant women and DM pts |
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how does olecranon bursitis happen? |
hard blow to tip of elbow usually due to repeated minor injuries like leaning on point of elbow |
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S/S of olecranon bursitis |
-pain -swelling -limited ROM (sometimes) -redness -heat |
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dx for olecranon bursitis |
based on PE findings aspiration to r/o infecion |
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tx for olecranon bursitis |
-NSAIDS -aspirate the bursa -hydrocortisone -recurrent= surgery |
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What are the 3 types of radial head fx? |
1- non displace 2- minimal displacement 3- comminute (ORIF)
MC is 1 or 2 |
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how do radial head fx happen? |
direct blow fall with valgus force |
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S/S of radial head fx |
-decreased ROM -pain in wrist -swelling |
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dx or radial head fx |
xray assess radial n. function |
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tx for radial head fx |
-immobilization -ice, pain med -early ROM -if comminuted then ORIF -3 ace wraps: every wk take one ace wrap off |
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What is a Monteggia fx? |
dislocation of radial head and fx of prox. 1/3 of ulna |
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What is a Galeazzi fx? |
displacement of radio/ulnar joint and fx of distal 1/3 of radius |
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What is the tx for a Galeazzi fx? |
ORIF, kids reduced and casted |
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How is a forearm fx classified? |
-fx pattern -amt of displacement -degree of angulation |
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What is Bado's Classification for Monteggia fx? |
Type I: fx of middle to distal 1/3 of ulna with ant. dislocation of radial head (MC) Type II: fx of proximal or middle 1/3 of ulna with post. dislocation of radial head Type III: fx of ulnar metaphysis with lateral dislocation of radial head Type IV: fx of prox. or middle 1/3 of ulna and radius with ant. dislocation of radial head |
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How do forearm fx usually happen? |
direct blow or fall |
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S/S of forearm fx |
-tenderness -decrease ROM -deformity -check for cuts of lacerations/bone fragments -check pulse, palpate and feel for tenderness |
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dx of a forearm fx |
xray |
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tx for forearm fx |
adults: ORIF children <10 y/o: classed reduction with casting |
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What is a Colles fx? |
fx of distal radius from outstretched hand with dorsal angulation |
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What is a Smith fx? |
fx of distal radius from fall with flexed hand |
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What are the normal radial inclination, length, and congruent? |
Inclination: 22-33o, lose will increase load across lunate Length: shortening of radius is disabling, pt will lose pronation/supination Tilt: 11mm and has range of 2mm-20mm, ms on lateral view |
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how do distal radius fx usually occur? |
trauma
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S/S of distal radius fx |
-compression of median n. -pain -swelling -deformity |
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how do you tx a distal radius fx? |
-based on severity and pt -ORIF -cast |
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What is a Boxer's fx? |
fx of 5th metacarpal |
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S/s of a Boxer's fx |
loss of normal anatomy swelling and pain
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tx for a Boxer's fx |
-6 wks ulna gutter splint with padding btwn fingers and refer to ortho -if minimal tx with ulna gutter cast and manipulation -moderate: pencil reduction and cast -ORIF |
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How many bones are in the hand? |
27 |
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What carpal bone do you usually break with FOOSH? |
scaphoid |
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S/S of a fx on scaphoid |
TTP anatomical snuff box and axial load of thumb |
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how do dx a scaphoid fx? |
xray (repeat in 3-5d) |
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how to tx a scaphoid fx |
-thumb spica splint and ortho referral -non displaced: tx with spica cast for 6wks with weekly visit -look for non union and necrosis -ORIF |
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What do you see on X-ray with a lunate dislocation? |
spilled teacup sign |
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how do you Tx a lunate dislocation |
pins and herbert screw specialty |
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How do scapholunate dislocations happen? |
FOOSH lots of stress on wrist causes scapholunate interosseous ligaments to tear |
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how to dx a scapholunate dislocation? |
X-ray: Terry Thomas or David Letterman sign- gap btwn bones (like a gap btwn teeth) |
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how to tx a scapholunate dislocation? |
closed with splinting ORIF and splint if fresh |
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Whatis carpal tunnel syndrome |
compression of median n in carpal tunnel |
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How does carpal tunnel syndrome happen |
over use- increased fluid pressing on median n (median n can come through or on top of muscle) |
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What are risk factors for carpal tunnel syndrome? |
female pregnant menopause obesity DM thyroid kidney failure |
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S/S of carpal tunnel syndrome |
-pain, numbness,tingling, burning in thumb, middle half of ring finger -weakness (can't hold things) -hands falling asleep -wasting or thenar eminence is severe -initially bothersome during sleep |
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dx of carpal tunnel syndrome |
+ Tinel sign: pain with percussion of wrist + Phalen sign: pain or paresthesia when pt flexes both wrist to 90o for 1m +carpal compression testL numbness and tingling induced by pressure over carpal tunnel US: flattening of median n. |
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tx of carpal tunnel syndrome |
-NSAIDS -cortisone shots -carpal tunnel release surgery
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What is a Ddx of carpal tunnel syndrome? |
Guyon's canal syndrome: entrapment of ulnar n throughout guyans canal |
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Who commonly gets Dupuytren's Contracture? |
Europeans pregnant women DM RA WM >50 y/o M>W |
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What is the name for the position of the hands in someone who has Dupuytren's Contracture? |
Benedictine hands |
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What happens in Dupuytren's contracture? |
-scaring in tendon -thickening of palmar fascia & shortening of tendons -idiopathic -hyperplasia of palmar fascia & relate structure with nodule formation and contracture |
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S/S of Dupuytren's contracture |
-contraction of tendons pull fingers down: pinky and ring finger flexion -onset acute and slowly progressive nodular or cord-like thickening of one or both hands usually 4&5 fingers affected -inability to extend fingers |
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how to tx Dupuytrens syndrome? |
surgical if severe OT collagnease injection of clostridium histolyticum: lyses collagen disrupting the contracted cords |
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How does De Quervian's Syndrome occur? |
-swelling or stenosis of the sheath surrounding abd poll long & ext poll brev -repetitive motion |
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Who is De Quervian's Syndrome MC in? |
middle aged women |
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S/S of De Quervians syndrome |
pain, swelling over radial styloid squeek |
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How to dx De Quervians syndrome |
Finklesteins test |
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tx of De Quervians syndrome |
-Dequervians release -spica splin, steroid, NSAIDs, ice |
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How do Gameskeeper's thumb injuries occur? |
-hyperextension of thumb causing a disruption in ulnar collateral ligament -tears ulnar collateral ligament -"ski pole injury" |
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S/S of Gameskeeper's thumb |
pain laxity of 1st MCP |
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How do tx Gameskeepers thumb? |
-conservative -splint 6-8wks -hand specialist ORIF
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How does Trigger finger happen? |
-tendon thickening from over use -finger locks in place bc tendon locks at A1 pulley |
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What is the MC pulley to cut during surgery for trigger finger? |
A1 pulley (MTP) |
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S/S of trigger finger |
-locking or catching during active flexion/ext. -stiffness -pain over MTP palm -palpable snapping -nodule formation |
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dx of trigger finger |
just by clinical presentation |
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tx for trigger finger |
-open tendon sheath (cut A1 pulley) -corticosteriod injection -splinting |
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What is mallet finger? |
-"jammed finger" -extensor of finger ruptured off -forced flexion of distal phalanx |
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S/S of mallet finger |
pain flexion at DIP |
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tx for mallet finger |
splint for 6-10wks in extended position ORIF |
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What is Boutonniere deformity? |
flex at PIP AND ext at DIP |
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How does Boutonniere deformity occur? |
-forcefull blow to bent finger, unable to extend finger -OA -1/3 of pts with RA |
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S/S of Boutonniere deformity |
-swelling -deformity 7-21d after injury -pain at PIP -flex at PIP AND ext at DIP
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tx for Boutonniere deformity |
-splint, stretch -surgery: RA, tendon is severed, large bone fragment is displaced, condition is not improved with splint -surgery can reduce pain and improve function but not fully correct condition -if not tx for 3wks it gets more difficult to tx |
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What is Swan Neck deformity? |
-extension at PIP, flex at DIP |
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How does swan neck deformity happen? |
injury to finger RA ehler-danloas (connective tissue disorder w/ hyper flex joints and skin) |
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S/S of swan neck deformity |
-swelling -pain -unable to ext finger -ext at PIP, flex at DIP |
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tx of swan neck deformity |
splint and exercises |
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What is jersey finger? |
flexor dig profundus avulsion of ms belly at max contraction during forceful DIP ext grabbing a jersey |
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What is the MC finger affected by jersey finger? |
ring finger |
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S/S of jersey finger |
-pain -swelling -inability to flex finger
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tx for jersey finger
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surgical direct tendon repair -if fx then need to pin DIP arthrodesis |
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What is fight bite? |
when someone gets punched then bitten penetrating wound seeps bacteria into hand |
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S/S of fight bite |
-swelling -redness -fever -drainage |
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tx for fight bite |
augmentin 875mg PO q12h |
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What is felon? |
closed space infx of fingertip pulp |
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What is the most common fingers and bacteria involved in felon? |
thumb and index finger = MC felon and paronychias = 1/3 of all hand infx staph aureus = MC organism |
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S/S of felon |
-swelling -pain -TTP |
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tx for felon |
-abx broad spectrum -I&D -never use EPI bc it'll constrict vessels |
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What is paronychia |
-infx of soft tissue around fingernail |
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What is the MC organism to cause paronychia |
staph aureus
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S/S of paronychia |
painful, purulent drainage |
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dx of paronychia |
culture |
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tx for paronychia |
abx I&D |
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What is the MC strain of Herpetic Whitlow |
HSV1 |
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S/S of herpetic whitlow |
-intensely painful infx -1 or more fingers affected -raised fluid filled bumps |
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dx of herpetic whitlow |
culture |
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tx for herpetic whitlow |
-sx relief- self limiting disease -acyclovir 800mg PO BID -unroof vesicles to help alleviate sx |
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What is flexor tenosynovitis? |
-infx of flexor tendon sheath -penetrating injury with inoculation of tendon sheath -hematogenous spread is limited to isolated cases -RA and DM |
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What are the 4 signs of septic flexor tendon |
-finger held in slight flexion -fusiform swelling -tenderness along the flexor tendon sheath -pain with passive ext of digit |
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S/S of flexor tenosynovitis |
swelling pain
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tx for flexor tenosynovitis |
IV cefazolin 1-2g IV q8h PCN allergies: clindamycin 600-900mg IV q8h surgical drainage if no imprvt in 12-24h |
