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37 Cards in this Set
- Front
- Back
Acromioclavicular joint separation- consideration
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not to be confused with shoulder dislocation which occurs when the humerus separates from the scapula at the glenohumeral joint.
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Acromioclavicular joint separation- general
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*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 |
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Acromioclavicular joint separation- Dx/PE
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* 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 |
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Acromioclavicular joint separation- Tx
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* 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 |
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Carpal tunnel syndrome- general
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* 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 |
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Carpal tunnel syndrome- Dx/PE
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* Tinel sign, phalen sign, carpal compression test
* Px, burning, or tingling of the median n. * bothersome at night |
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Tinel sign
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tingling or shock like pain on volar wrist percussion
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Phalen sign
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pain or paresthesia in the distribution of the median n. when the patient flexes both wrists to 90 degrees for 60 sec.
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Carpal compression test
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numbness and tingling are induced by the direct application of pressure over the carpal tunnel
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Carpal tunnel syndrome- Tx
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* RICE
* Splint (especially at night) * Surgery |
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De Quervain’s tenosynovitis- description
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* a tenosynovitis of the sheath or tunnel that surrounds two tendons that control movement of the thumb.
* idiopathic, maybe overuse injury |
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De Quervain’s tenosynovitis- S/S
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1) pain, tenderness
2) swelling over the thumb side of the wrist 3) difficulty gripping. 4) positive Finkelstein's test |
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Finkelstein's test
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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. |
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De Quervain’s tenosynovitis- Tx
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* RICE/NSAIDs
* INJ Steroids * Surgery |
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Dupuytren’s tenosynivitis (contracture)- general
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* 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 |
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Dupuytren’s tenosynivitis (contracture)- S/S Tx
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* C/O tightness in the involved digits w/ inability to extend fingers
* +/- tenderness * Tx w/ surgery common |
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Lateral Epicondylitis- general
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* 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 |
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Lateral Epicondylitis- S/S
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* 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 |
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Lateral Epicondylitis- Tx
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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 |
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Medial Epicondylitis- general
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* over usage is common
* involves the wrist flexors and MC the pronator teres tendon. * Ulnar neuropathy and cervical radiculopathy DDX |
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Medial Epicondylitis- S/S
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* 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 |
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Ganglion cyst- all
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* 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, |
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Radial head subluxation (Nursemaid elbow) - general
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* 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 |
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Radial head subluxation (Nursemaid elbow) - S/S
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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. |
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Boutonniere deformity
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* 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. |
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Mallet finger- description
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Fracture and tendon disruption at DIP
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Mallet finger- MIO/Tx
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* 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 |
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Swan neck deformity
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* 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 |
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Rotator Cuff Tears/Tendonitis - general
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* 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 |
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Rotator Cuff Tears/Tendonitis - S/S
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* 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 |
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Rotator Cuff Tears/Tendonitis - Supraspinatus strength test
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shoulder abduction at 90 degrees with slight forward flexion to around 45 degrees "open can test"
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Rotator Cuff Tears/Tendonitis - Tx
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PT, subacromial injection
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Thoracic outlet syndrome - general
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* 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 |
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Thoracic outlet syndrome - Presentation (vascular)
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* arterial ischemia causes pallor of fingers on elevation of extremity
* sensitivity to cold * possible gangreene of the digits, edema, cyanosis |
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Thoracic outlet syndrome - Presentation
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* 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 |
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Thoracic outlet syndrome - PE
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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)
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Thoracic outlet syndrome - Tx
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• Treatment – PT, subacromial injection
• MRI – tendinitis, partial vs full thickness tear • Surgery – subacromial decompression, repair |