Term
| Which muscles make up the rotator cuff? |
|
Definition
| Subscapularis, Supraspinatus, Infraspinatus, Teres minor |
|
|
Term
| What is the A and N of the Supraspinatus m? |
|
Definition
Action - ABduction
Innervated C5 & C6 |
|
|
Term
| What is the A and N of the Infraspinatus m? |
|
Definition
Action – external rotation
Innervated C5 & C6 |
|
|
Term
| What is the A and N of the Teres Minor m? |
|
Definition
Action – external rotation
Innervated C5 |
|
|
Term
| What is the A and N of the Subscapular m? |
|
Definition
Action – internal rotation
Innervated C5 & C6 |
|
|
Term
| Which Rotator Cuff test tests the Supraspinatus m? |
|
Definition
|
|
Term
| Which rotator cuff test tests for AC impingement? What is a positive test? |
|
Definition
| Neer’s Impingement Test - Positive Test = pain with forward flexion |
|
|
Term
| Which rotator cuff test tests for AC impingement and the supraspinatus? What is a positive test? |
|
Definition
Hawkins-Kennedy Impingement Test
Positive Test - Pain with 60 degree arm flexion |
|
|
Term
| What are the signs and symptoms of rotator cuff syndromes? |
|
Definition
Shoulder pain, increases at night
“Catching” during use
Night pain – full thickness tear
Abduction & lateral rotator weakness – full thickness tear
Loss of ROM – full thickness tear |
|
|
Term
| What type of imaging is used to asses rotator cuff injuries? |
|
Definition
Plain film – AP & lateral = NL
High Riding Humerus
MRI – 95% sensitive for partial and full thickness tears
US – 91 % sensitive for full thickness
Arthrography – 99% sensitive for full thickness, but useless in partial thickness tears |
|
|
Term
| What are some radiologic changes that occur with large rotator cuff tears? |
|
Definition
Proximal migration of humeral head
Humerus head becomes sclerotic, small spurs may become present |
|
|
Term
| On which tendon is calcific tendonitis MC? |
|
Definition
|
|
Term
| What is the treatment for calcific tendinitis? |
|
Definition
Decrease weights (for weightlifters)
Rest
NSAIDS
Ortho consult |
|
|
Term
| What is present on imaging with calcific tendonitis? |
|
Definition
|
|
Term
| Where is the pain of bicipital tendonitis MC found? |
|
Definition
| pain in the antero-lateral aspect of the shoulder |
|
|
Term
| In which types of pts is bicipital tendonitis found MC? |
|
Definition
| young athletes and pt older than 40 y/o |
|
|
Term
| What is the treatment for bicipital tendonitis? |
|
Definition
Rest then ROM exercises
Heat
NSAIDS
Ortho – steroid injection then surgery |
|
|
Term
| If a patient presents with complaints of Sudden sharp snap/pop, Followed by pain and weakness, Abnl large mass (Popeye sign) in their bicep area, what condition should you suspect? |
|
Definition
|
|
Term
| What is the treatment for biceps rupture? |
|
Definition
|
|
Term
| If a pt present with loss of internal rotation of their arm, what condition should you suspect? |
|
Definition
| Adhesive Capsulitis
(frozen shoulder) |
|
|
Term
| What are the signs and symptoms of Adhesive Capsulitis
(frozen shoulder)? |
|
Definition
Insidious pain
Restrictive ROM
Deltoid & spinatus atrophy
Decreased active & passive ROM
Hallmark – loss of internal rotation |
|
|
Term
| What is the treatment for Adhesive Capsulitis? |
|
Definition
Ortho consult
Steroid injections
PT |
|
|
Term
| Which grade of AC separation is described as strain to ligament, but no displacement? |
|
Definition
|
|
Term
| Which grade of AC separation is described as tear acromioclavicular ligament but no disruption to the coracoclavicular ligament with clavicle mildly displaced upwards? |
|
Definition
|
|
Term
| Which grade of AC separation is described as disruption to all ligaments w/ full dislocation? |
|
Definition
|
|
Term
| Which grade of AC separation is described as disruption to all ligaments w/ full dislocation w/ deltoid & trapezius disruption? |
|
Definition
|
|
Term
| If a patient presents with Scapula appearing to sag, Tenderness in the lateral clavicle, Shoulder movement in all direction – painful, what condition should you suspect? |
|
Definition
|
|
Term
| For which grade(s) of AC separation is surgery recommended? |
|
Definition
|
|
Term
| What is the treatment for AC separations? |
|
Definition
Grade I - III:
NSAIDS
Sling (brace is no longer used)
PT
No sports for 6 weeks
Grade IV:
Ortho-surgery |
|
|
Term
| What is the MC type of shoulder dislocation? |
|
Definition
|
|
Term
| What is the MC cause of Posterior shoulder dislocation? |
|
Definition
|
|
Term
| What nerve is important to check with shoulder dislocations? |
|
Definition
| Axillary n. (check sensation on mid-deltoid) |
|
|
Term
| What is the treatment for shoulder dislocation? |
|
Definition
| Ortho referral = Reduction |
|
|
Term
| Which test will be positive with a shoulder dislocation? |
|
Definition
|
|
Term
| What is a common mechanism that results in proximal humeral fractures? |
|
Definition
| Elderly fall on out stretched hand |
|
|
Term
| What are the signs and symptoms of proximal humeral fracture? |
|
Definition
Pain & swelling around shoulder joint
Ecchymosis, elbow to neck
Pain w/ ROM
Pt supporting/guarding arm |
|
|
Term
| What imaging studies should be done if a proximal humerus fracture is suspected? |
|
Definition
Plain film: AP, lateral & scapular Y-view
CT Scan - so that you can prep for surgery |
|
|
Term
| How is a proximal humerus fracture treated? |
|
Definition
|
|
Term
| What classification is used to describe proximal humeral fractures? What are the 4 parts? |
|
Definition
Neer Classification
1 - Humeral Head
2 & 3 - Lateral and medial tuberosities
4 - Shaft |
|
|
Term
| What is the MC cause of clavicular fractures? |
|
Definition
|
|
Term
| What imaging studies should be done for clavicular fracture? |
|
Definition
|
|
Term
| How is a clavicular fracture treated? |
|
Definition
Ortho
Protected: 4-6 wks – children, 8 wks -adult |
|
|
Term
| What are the indications for surgery for a patient with a clavicular fracture? |
|
Definition
Tenting (significant displacement or protrusion of skin)
Nonunion - (No bone growth after 6 months of treatment)
Cosmesis (Cosmetic)
Manual laborer/athlete (lots of physical labor = lots of stress)
Significant separation of fragments ( |
|
|
Term
| What physical tests are used to diagnose Thoracic Outlet syndrome? |
|
Definition
Adson test
Roos test
Halstead test |
|
|
Term
| What are the three components of thoracic outlet syndrome and what are their symptoms? |
|
Definition
Nerve - numbness, tingling, decreased strength, burning
Artery - pallor, decreased pulses, claudication of forearm m.
Vein - abnormal swelling of affected side |
|
|
Term
| What is the treatment for thoracic outlet syndrome? |
|
Definition
|
|
Term
| What is the MC cause of humeral fractures? |
|
Definition
| Major trauma - MVA, motorcycles, falls from heights, pedestrian accidents |
|
|
Term
| What is a patient with a humeral fracture at a highest risk for? |
|
Definition
NV compromise is high with displaced fractures/high energy fractures
-Radial Nerve
-Brachial Artery |
|
|
Term
| What are the surgical indications for a humeral fracture? |
|
Definition
NV compromise
Significant displacement
Bilateral fractures
Pathologic fractures
Floating elbow |
|
|
Term
| What are the benefits of surgical repair of humeral fracture? |
|
Definition
Early ROM
Aggressive PT
Quicker RTF |
|
|
Term
| What is the treatment for humeral fractures? |
|
Definition
Ortho – consult
Ice
Closed reduction
Sugar tong splint
Sling
NSAIDS
Most are managed non-operatively |
|
|
Term
| When repositioning any fractures, what is one type of deformity that the body cannot tolerate? |
|
Definition
|
|
Term
| What is the cause of medial epicondylitis? |
|
Definition
|
|
Term
| What is the treatment for medial epicondylitis? |
|
Definition
Severe pain: splint 1-2 weeks
Rest: 4-6 weeks
NSAIDS – drug of choice
Rarely – steroid injections
PT after 6 weeks of rest |
|
|
Term
| Which nerve can be affected by medial epicondylitis? |
|
Definition
|
|
Term
| What is the common name for medial epicondylitis? |
|
Definition
|
|
Term
| What is the common name for lateral epicondylitis? |
|
Definition
|
|
Term
| What conditions should you r/o if you suspect lateral epicondylitis? |
|
Definition
|
|
Term
| What motion causes lateral epicondylitis? |
|
Definition
| Repetitive or forceful wrist extension |
|
|
Term
| What is the tx for lateral epicondylitis? |
|
Definition
Counterforce brace (tennis elbow brace)
Rest
Ice
NSAIDS
PT
Occasionally steroid injections
Surgery for extreme cases |
|
|
Term
| What is an important distinction between olecranon bursitis and septic arthritis of the elbow? |
|
Definition
| There will be Full ROM with olecranon bursitis, where as ROM will be affected with septic arthritis |
|
|
Term
| What is the treatment for olecranon bursitis? |
|
Definition
Aspirate fluid
Antibiotics if infected
Steroid injection
Surgical excision |
|
|
Term
| What is the MC cause of elbow fractures? |
|
Definition
| Fall on outstretched hand |
|
|
Term
| What is important to do in your physical assessment with an elbow fracture? |
|
Definition
|
|
Term
| How is an elbow fracture treated? |
|
Definition
Undisplaced: sling or sling w/ posterior splint 7-10d
Ice
NSAIDS
PT - early ROM
Ortho surgery – all w/ neuro/vascular compromise |
|
|
Term
| When does a fracture of the radial head require surgical repair? |
|
Definition
| If pronation or supination is physically impeded or if there is a large separation of the radial head |
|
|
Term
| What is the MC cause of olecranon fractures? |
|
Definition
|
|
Term
| What is the MC treatment for olecranon fracture? |
|
Definition
| Surgery due to attachment of the triceps tendon |
|
|
Term
| What does a fat pad sign indicate in adults? |
|
Definition
|
|
Term
| What does a fat pad sign indicate in children? |
|
Definition
| supracondylar fx of humerus |
|
|
Term
| What is a fracture to the proximal 1/3 of ulna & dislocation of radial head called? |
|
Definition
|
|
Term
| How is a Monteggia Fracture treated in children? In adults? |
|
Definition
Children – closed reduction
Adults – open reduction w/ internal fixation |
|
|
Term
| What is a fracture to the Distal 1/3 of radius is fx with disruption of DRUJ commonly called? |
|
Definition
|
|
Term
| How is a Galeazzi Fracture treated? |
|
Definition
|
|
Term
| What is the MC wrist injury? |
|
Definition
|
|
Term
| What type of fracture is commonly caused by a fall on outstretched hand? |
|
Definition
|
|
Term
| What type of fracture is described as a distal radius fx w/ dorsal displacement and shortening? |
|
Definition
|
|
Term
| What nerve can be affected with a Colle's fracture? How can you prevent permanent damage? |
|
Definition
Median n
Immediate reduction |
|
|
Term
| What is the treatment for a colle's fracture? |
|
Definition
If closed reduction shortly after fx – local anesthesia
Cast x6 weeks
Ice
F/U in 1-2 weeks repeat xray – occassionally loss of reduction
Surgery
Advantages to surgery: Quicker RTF, Less risk of nonunion, Return to normal anatomy |
|
|
Term
| What is a flexion fracture of the radius or a distal radius fracture with vular displacement called? |
|
Definition
|
|
Term
| What is the classic test used to asses for De Quervain's Tenosynovitis? |
|
Definition
|
|
Term
| If a patient presents with pain/tenderness to the posterior lateral aspect of the wrist? |
|
Definition
| De Quervain's Tenosynovitis |
|
|
Term
| What is the treatment for De Quervain’s Tenosynovitis? |
|
Definition
Thumb spica splint
Rest
NSAIDS
Ice
Possible steroid injection
Possible surgery |
|
|
Term
| What risk factors can lead to Carpal tunnel syndrome? |
|
Definition
Repetitive hand work
Working on keyboards
Thyroid disorder
Pregnancy
Trauma
Alcoholism
DM
Gout |
|
|
Term
| Which signs are helpful in indicating carpal tunnel syndrome? |
|
Definition
Tinel's sign
Phalen's sign |
|
|
Term
| What condition should you suspect if the pt complains of Paresthesia in median nerve distribution, Weakness in the hand, Awaken from sleep w/ pain? |
|
Definition
|
|
Term
| What is the best study for assessing Carpal Tunnel Syndrome? |
|
Definition
|
|
Term
| What is the treatment for carpal tunnel syndrome? |
|
Definition
OT consult
Cock-up wrist splint (worn at work & sleep) x3-4 months
NSAIDS
Ortho - Steroid injection
Ortho – Surgical release |
|
|
Term
| What muscular sign can be found in patient's with carpal tunnel syndrome? |
|
Definition
|
|
Term
| What is the Allen's test used for? |
|
Definition
| To asses the competency of the radial and ulnar arteries |
|
|
Term
| What is the MC missed wrist fracture? |
|
Definition
|
|
Term
| What is the common sign of a scaphoid fracture? |
|
Definition
|
|
Term
| What imaging should be done to asses a pt if a scaphoid fracture is suspected? |
|
Definition
Plain film: PA, lateral & Scaphoid view = NL
Bone scan: + in acute phase |
|
|
Term
| How is scaphoid fracture treated? |
|
Definition
| Ortho Consult - surgical (recommended) or non-surgical |
|
|
Term
| What is the common name for a sprain or displacement of the ulnar collateral ligament? |
|
Definition
|
|
Term
| What images should be done if gamekeeper's thumb is suspected? |
|
Definition
| Plain film: AP, lateral & oblique |
|
|
Term
| How should gamekeeper's thumb be assessed? |
|
Definition
| Digital block and manipulation of the thumb to assess the degrees of movement |
|
|
Term
| How is a boxer's fracture treated? |
|
Definition
Closed vs open reduction
Ulnar gutter cast (very important to splint) |
|
|
Term
| What is important about the ulnar gutter cast? |
|
Definition
| fingers splinted at 90 degrees so that the extensor hood doesn't take over and cause the patient not to be able to move their fingers after casting is removed |
|
|
Term
| What is a fracture of the distal 5th metacarpal known as? |
|
Definition
|
|
Term
| What is the treatment for boutonniere deformitiy? |
|
Definition
|
|
Term
| What is a boutonniere deformity? |
|
Definition
Flexion of the proximal interphalangeal joint
Extension of the distal interphalangeal joint |
|
|
Term
| What are the two important parts of a boutonniere deformity? |
|
Definition
Loss of active extension secondary to central slip tear
Unopposed finger flexion with migration of lateral bands |
|
|
Term
| What is a loss of terminal extensor tendon insertion called? |
|
Definition
|
|
Term
| What condition causes the distal interphalangeal joint to become flexed and is unable to extend? |
|
Definition
|
|
Term
| What condition is characterized by Hyperextension of PIP, Flexion of DIP and the volar plate is unable to prevent hyperextension? |
|
Definition
|
|
Term
| What is the treatment for a finger fracture? |
|
Definition
Undisplaced – buddy tape
NSAIDS
Ice
OT consult |
|
|
Term
| What MUST be done during the treatment of a seymour fracture? |
|
Definition
| Remove nail to prevent infection of the bone (osteomyelitits) |
|
|
Term
| What condition is described as painful locking or snapping w/ extension of the finger with a module distal to the palmar crease that moves? |
|
Definition
|
|
Term
| What is the treatment for trigger finger? |
|
Definition
Ortho consult
Steroid injection into tendon sheath, avoid tendon – rupture
Surgical release |
|
|
Term
| What is the difference between the nodules formed with Dupuytren's Contracture and Trigger finger? |
|
Definition
| Nodules with Dupuytren's fracture are tender, nodules with trigger finger are not |
|
|
Term
| If a pt presents with 1 or more painful nodules in palm 4th & 5th digit that are tender to palpation, Often bilaterally, and Web space contracture what condition should you suspect? |
|
Definition
|
|
Term
| What physical diagnosis test is used to diagnose Dupuytren’s Contracture? |
|
Definition
|
|
Term
| What is the treatment for Dupuytren’s Contracture? |
|
Definition
| ortho surgery (5 different procedures options) |
|
|
Term
| What condition has characteristics including Genetic disorder w/ connective tissue laxity, Skin laxity, Joint hypermobility, Joint instability, and Scoliosis? |
|
Definition
|
|
Term
| If you suspect a patient has Ehlers-Danlos Syndrome, what important referral should you make due to possible complications of the disease? |
|
Definition
|
|
Term
| How is Ehlers-Danlos Syndrome treated? |
|
Definition
PT - muscle training
Cardiology - heart eval |
|
|
Term
| What is an infection of the tendon sheath called? |
|
Definition
| Suppurative Tenosynovitis |
|
|
Term
| What is the treatment of Suppurative Tenosynovitis? |
|
Definition
|
|
Term
| How is Suppurative Tenosynovitis diagnosed? |
|
Definition
Kanavel Signs:
1 - talon grip
2 - palpable cording of tendon
3 - painful extension
4 - pallor (followed by redness) |
|
|
Term
| What is an infection of the distal phalanx (full of pus) known as? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What is an infection on the edge of the nail called? |
|
Definition
|
|
Term
| How is a paronychia treated? |
|
Definition
| Digital block with I & D (Important to remove the pus!) |
|
|
Term
| What are the most common types of bites? |
|
Definition
|
|
Term
| What should you always check with bites? |
|
Definition
| Always get an x-ray to look for teeth left behind |
|
|
Term
| What is the treatment for bites? |
|
Definition
Irrigate with copious amounts of saline (1 L at least)
DO NOT suture bites in the hand
Augmentin 7 - 10 days |
|
|
Term
| Where is RSD most commonly found? |
|
Definition
|
|
Term
| What condition presents as a persistent burning pain or excessive (out of proportion) pain after an injury? |
|
Definition
| RSD - Reflex Sympathetic Dystrophy |
|
|
Term
| In RSD what occurs in the dystrophic and atrophic phase? |
|
Definition
Joint becomes restricted
Becomes cool
skin and muscle become atrophied |
|
|
Term
| What is the MC location for osteoarthritis in the body? |
|
Definition
| carpometacarpal joint in the thumb |
|
|
Term
| What occurs in the acute phase of RSD? |
|
Definition
Pain is localized to area of injury
Spreads throughout extremity
Hypersensitivity to light touch
Extremity – swollen, warm & excessive perspiration |
|
|
Term
|
Definition
Not well understood....
PREVENTION
Difficult to tx |
|
|
Term
| What is the treatment for severe osteoarthritis in the wrist? |
|
Definition
|
|
