Term
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Definition
- SLAP tears
- arm flexed and adducted 10-15 degrees and internally rotated so thumb is pointing down> pt resists downward force> pain
- patient supinates hand so palm up> no pain |
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Term
| Impingement occurs when the __ __ of the __ undersurface causes irritation to the underlying __ __ causing symptoms. |
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Definition
- anterior 1/3
- acromion
- cuff tendons |
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Term
| with impingement there is less space for the rotator cuff to slide b/w the acromion and humerus |
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Definition
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Term
| A flat acromion is ideal. A __ or __ acromion may cause impengement symptoms. |
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Definition
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Term
| dull generalized shoulder aching, worse at night, worse with overhead activity, hurts to sleep on, hurts to get things out of cabinet: |
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Definition
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Term
|
Definition
Neer's Impingement sign
Hawkin's sign (better) |
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Term
Neer's test
Hawkin's test: |
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Definition
| both test for impingement |
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Term
|
Definition
- rest
- analgesics
- exercises: strengthening and stretching
- injection: cortisone may weaken tendon and lead to rupture so counsel pt on slow recovery
- surgery- excise and/or smooth acromion |
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Term
| Pt says can't move there shoulder. So you check PROM, it is blocked. What are the 2 ddx now? |
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Definition
- arthritis
- frozen shoulder
Both of these block PROM |
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Term
| Pt says can't move their shoulder, but you check PROM and it is good. What is the likely dx? |
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Definition
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Term
| How do you differentiate b/w frozen shoulder and arthritis? |
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Definition
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Term
| Patients with shoulder arthritis will have progressive pain and loss of __ and __ ROM. Their x-rays will show __ of __ __ and __. |
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Definition
- loss of active and passive ROM
- loss of joint space and osteophytes |
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Term
| Thoracic outlet syndrome is __ or _ of the __ __ and/or __ __ over the __ _ or __ _ or __ __ __ and __ __ _ __ __. |
|
Definition
- compression or pinching
- subclavian artery and/or brachial plexus
- first rib of clavicle rib
- behind the anterior scalene and in front of the middle scalene |
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Term
| Thoracic outlet syndrome symptoms: |
|
Definition
- arm ache
- numbness
- fatigue
- aching with overhead work
- numbness in ulnar nerve area (little, ring finger) |
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Term
|
Definition
| - Thoracic Outlet Syndrome: feel radial pulse at side, extend and abduct arm, ER, extend neck, turn ipsilateral, feel radial pulse diminish |
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Term
| Dx of Thoracic outlet syndrom: |
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Definition
- symptoms, exam
- EMG/nerve conduction study |
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Term
| Differential of Thoracic Outlet Syndrome: |
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Definition
| - Pancoast tumor- upper lung tumor invading the 1st rib and brachial plexus- get chest xray |
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|
Term
| Other ddx of shoulder pain: |
|
Definition
- bone tumor
- myocardial ischemia
- gall bladder disease
- pancoast tumor
- carpal tunnel
- cervical disc |
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|
Term
MRI
Cuff tear/degeneration/tendonitis
SLAP/biceps tear
Bone disease |
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Definition
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Term
|
Definition
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Term
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Definition
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Term
| Anterior apprehension test: |
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Definition
| - externally rotate and abduct arm and look for pt apprehension= + |
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|
Term
| Anterior relocation test: |
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Definition
| internally rotate and adduct> makes patient feel better |
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Term
| Hill-Sachs lesion, also Hill-Sachs fracture, is a cortical depression in the posterior superior head of the humerus bone. It results from forceful impaction of the humeral head against the anteroinferior glenoid rim when the shoulder is dislocated anteriorly. |
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Definition
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Term
| With a distal humerus fracture, what nerve function must you check? |
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Definition
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Term
|
Definition
| - fracture of the distal 1/3 of the humerus resulting in entrapment of the radial nerve |
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Term
| Tennis elbow is aka __ __. It is chronic degeneration of the __ __ __ __ tendon which inserts on the __. This happens with sports where you __ the wrist often. Have the patient put their __ finger __ and __ against ___. |
|
Definition
- lateral epicondylitis
- extensor carpi radialis brevis
- elbow
- extend the wrist
- middle finger down and extend against resistance |
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Term
| Tennis elbow physical exam: |
|
Definition
Palpate maximum pain at lateral epicondyle
Resisted finger or wrist extension
May have weakness finger extension because of pain |
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Term
|
Definition
Rest
Activity modifications
Therapy
Counterforce bracing
Wrist splint
Injection (steroids or platelet rich blood)
Surgery: debride ECRB |
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Term
| ERCB is on the __ elbow, while FCRB is on the __ elbow. |
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Definition
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Term
| golfers can also get tennis elbow |
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Definition
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Term
| Medial epicondylitis is aka __ __ or __ __. |
|
Definition
- baseball elbow
- golf elbow |
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Term
| Lateral Epicondylitis hurts with wrist __, while Medial Epicondylitis hurts with wrist __. |
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Definition
- Lateral- extension
- Medial- flexion |
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Term
| Medial epicondylitis is due to degeneration of __ __ or __ __ __. |
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Definition
| - Pronator Teres or FCR (flexor carpi radialis) |
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Term
| Pain with medial epicondylitis is worse with wrist __ and forearm ___. |
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Definition
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|
Term
|
Definition
|
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Term
|
Definition
| degenerative bone disease, built new bone all deformed looking |
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|
Term
|
Definition
Treatment
Rest and pressure bandage
Aspiration/injection
Surgery
Resect bursa |
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Term
| Nerve Entrapment problems: |
|
Definition
Typical Complaints
Pain (often not specific)
Impaired sensation – numbness
Impaired motor – weakness
Cubital Tunnel Syndrome
Radial Tunnel Syndrome |
|
|
Term
| What 3 places can the ulnar nerve be entrapped? |
|
Definition
- Thoracic outlet
- Cubital tunnel- most common
- Guyon's canal |
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|
Term
|
Definition
Symptoms
Forearm/elbow pain - can radiate to shoulder
Numbness ring and little fingers
Findings
Tender ulnar nerve
+ Tinel’s sign (percussion nerve causes electric shock like sensation)
Decreased sensation ring and little fingers
Weakness intrinsic muscles
Atrophy of hand muscles |
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|
Term
| Tests to run if suspect cubital tunnel: |
|
Definition
- X-ray to r/o bony prominences
- EMG/nerve conduction studies to confirm at level of elbow- double crush |
|
|
Term
|
Definition
- prevent external pressure
- splint elbow in extension at night (pillow splint)
- surgery |
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|
Term
|
Definition
Pain distal to joint and ECRB
No motor or sensory dysfunction
Consider in DDx of lateral epicondylitis |
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|
Term
| Radial tunnel physical exam: |
|
Definition
Tenderness to palpation along radial tunnel
Pain with resisted middle finger extension or resisted forearm supination with elbow extended
EMG usually not helpful |
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|
Term
| Radial tunnel syndrome tmt: |
|
Definition
Treatment
Rest and observation – may recover spontaneously (6-12 weeks)
Can consider injection
Surgery to decompress |
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|
Term
| Posterior Interosseous Nerve (PIN): |
|
Definition
Pain like radial tunnel plus weakness in PIN innervated muscles at same locations:
Supinator
ECU
APL
EPL
EPB
EMG more useful
Decompression of nonop fails |
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Term
| With pronator syndrome there is __ nerve compression at the __. What are the symptoms? |
|
Definition
- median nerve
- elbow
Symptoms:
- pain in volar proximal forearm with repetitive motion
- paresthesias in radial 3 1/2 digits
- rare to have weakness |
|
|
Term
|
Definition
Resisted forearm pronation
Extreme elbow flexion
EMG unreliable |
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|
Term
| Pronator syndrome: Nerve exploration and decompression often necessary |
|
Definition
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