UE Orthopedic Conditions

Anterior SC Joint Dislocation

- more common (2/3 of all cases)

- prominent medial end of clavicle

Posterior SC Joint Dislocation

- less common (1/3 of all cases)

- more painful and severe

Anterior SC Joint Dislocation

type of SC joint dislocation wherein the mechanism of injury is a direct trauma to the SC joint.

• Vascular problems

• Breathing/swallowing difficulty

possible complications of posterior SC joint dislocation.

FOOSH or FOS

mechanism of injury for clavicular fractures.

Middle 1/3

80% of clavicular fractures happens in this segment.

Lateral 1/3

15% of clavicular fractures happens in this segment.

Medial 1/3

5% of clavicular fractures happens in this segment.

Immobilization with a sling or figure of 8 bandage.

management for non-displaced clavicular fractures.

Surgery

management for displaced clavicular fractures.

(+) Skin tenting

sign for displaced clavicular fracture.

• Acromioclavicular ligament

• Coracoclavicular ligament

ligaments affected in an acromioclavicular joint sprain.

• O’Brien Test

• Horizontal Adduction Test/Apley’s Scarf Test

special tests for AC joint sprain.

GH pathology

pain in 60-120° of shoulder abduction may indicate

AC pathology

pain in 170-180° of shoulder abduction may indicate

90-130°

painful arc for shoulder impingement syndrome.

• Superior aspect of rotator cuff muscles

• Subacromial bursa

• Biceps tendon

structures affected in shoulder impingement syndrome.

• AC ligament sprain

• CC ligament intact

Rockwood Classication I

• AC ligament torn

• CC ligament sprain

• Increase of <25% coracoclavicular space

Rockwood Classication II

• AC ligament torn

• CC ligament torn

• Increase of 25-100% coracoclavicular space

Rockwood Classication III

• AC ligament torn

• CC ligament torn

• Increase of 25-100% coracoclavicular space

• Clavicle displaced posteriorly

Rockwood Classification IV

• AC ligament torn

• CC ligament torn

• Increase of CC space >100%

• Clavicle displaced superiorly

• Deltotrapezial fascial tear

Rockwood Classification V

• AC ligament torn

• CC ligament torn

• Increase of 25-100% coracoclavicular space

• Clavicle displaced inferiorly

Rockwood Classification VI

Sprengel’s Deformity

- Eulenberg Syndrome

- congenital deformity that results to failure of the scapula to develop and descend properly

- most common congenital deformity of the shoulder

Snapping Scapula

- scapula rubs over the underlying ribs

- scapulothoracic crepitus

• Bursitis

• Atrophy

• Fibrosis

• Anomalous muscular insertion

causes of louder grating sound.

• Tumor

• Osteophyte

• Malunion of rib fracture

causes of louder snapping sound with pain.

Long Thoracic Nerve

nerve affected in medial winging of the scapula.

Spinal Accessory Nerve

nerve affected in lateral winging of the scapula.

Open Book Deformity

- medial winging

- serratus anterior weakness

Sliding Door Paralysis

- lateral winging

- trapezius weakness

Radical Neck Dissection

cause of lateral winging.

• Radical Mastectomy

• Rucksuck Palsy

causes of medial winging.

• Scapular malposition (protracted and forward tilt)

• Infermedial border prominence

• Coracoid pain

• Dyskinesia

symptoms of “sick scapula”

Shoulder abduction and ER

mechanism of injury for anterior shoulder dislocation.

Anteroinferior

most common direction for shoulder dislocation.

• Axillary nerve traction

• Bankart lesion

• Hill-sach’s lesion

associated injuries in anterior shoulder dislocation

Bankart Lesion

- lesion at the anteroinferior labrum

- most common lesion associated with anterior shoulder dislocation

Hill-Sach’s Lesion

compression fracture of the posterolateral aspect of humeral head.

FOOSH or FADIR

mechanism of injury for posterior shoulder dislocation.

• Lesser tuberosity fracture

• Bennett’s lesion

• Reverse bankart lesion

• Reverse hill-sach’s lesion

associated injuries in posterior shoulder dislocation.

Bennett’s Lesion

ossification of the posteroinferior glenoid rim.

Reverse Bankart Lesion

posteroinferior labral lesion.

Reverse Hill-Sach’s Lesion

compression fracture of the anteromedial aspect of humeral head

SLAP Lesion

lesion at the site where the biceps tendon anchors to the labrum.

• FOOSH

• Sudden traction to biceps

• Throwing

• Deceleration when throwing

mechanism of injury of SLAP lesion.

• Late Cocking Phase

• Deceleration

phass of baseball throwing wherein a SLAP lesion can occur.

I - labral fraying, intact biceps tendon

II - labral fraying, detached biceps tendon

III - bucket handle tear, intact biceps tendon

IV - bucket handle tear, detached biceps tendon

synder classification for SLAP lesions.

SLAP II Lesion

most common slap lesion classification.

I - labral fraying, intact biceps tendon

II - labral fraying, detached biceps tendon

III - bucket handle tear, intact biceps tendon

IV - bucket handle tear, detached biceps tendon

V - labral fraying, detached biceps tendon, bankart lesion

VI - labral fraying, detached biceps tendon, unstable flap

VII - labral fraying, detached biceps tendon, middle GH ligament injury

maffet sub-classification for SLAP lesions.

Primary Impingement

- impingement is the primary cause of pain; anatomical

- causes:

• subacromial impingement

• thickening of coracoacromial ligament

Secondary Impingement

type of impingement causes by an underlying disease such as GH instability, scapulothoracic dyskinesia, and weak scapular stabilizers

Os Acromiale

- failure of the acromion to ossify

- anatomical cause of rotator cuff tendinitis

Rotator Cuff Tendinitis

- condition common in throwers and swimmers

- PROM is full but AROM is limited

I - edema and inflammation; <25 y/o

II - tendinitis, bursitis, fibrosis; 25-40 y/o

III - osteophyte formation, bony spur, partial tendon tear; >40 y/o

IV - multiple tendon tear; >40 y/o

neer stages of impingement.

Bicipital Tendinitis

- causes of this condition are:

• rupture of biceps tendon

• overuse/wear and tear

• ligamentous instability of THL

(+) Popeye Sign

sign for bicep tendon tear.

• Speed’s test

• Ludington’s test

• Yergason’s test

special tests for bicipital tendinitis.

Calcific Tendinitis

depositis of hydroxyapatite in any tendon of the body, but more commonly in the rotator cuff muscles.

• Supraspinatus - 80%

• Infraspinatus - 15%

• Subscapularis - 5%

sites for calcific tendinitis in rotator cuff muscles.

- adhesive capsulitis or diabetic periarthritis

- cause: idiopathic

- F > M

- commonly affects 40-60 y/o

ER > ABD > IR

capsular pattern of shoulder seen in frozen shoulder.

Stage I

- pre-adhesive stage

- 1-3 months

- aching pain and moderate limiatation of ROM

- pain present at night

Stage II

- freezing stage

- 3-9 months

- most painful

- progressive LOM

Stage III

- frozen stage

- 9-15 months

- marked LOM (stiffness is predominant)

- decreased pain

- atrophy of deltoid, rotator cuff, biceps, and triceps

Stage IV

- thawing stage

- 15-24 months

- minimal pain and gradual improvement of ROM

• Scalenus anticus syndrome (between the anterior and middle scalenes)

• Hyperabduction syndrome (between the coracoid process and pectoralis minor)

• Costacalvicular syndrome (between the clavicle and 1st rib)

common sites of thoracic outlet syndrome.

• Costoclavicular brace test

• Halstead test

• Allen’s test

• Roo’s Test

• Adson’s Test

• Wright Test

special tests for thoracic outlet syndrome.

Complex Regional Pain Syndrome

- a complex neuropathic pain syndrome characterized by severe pain and automic dysfunction that may lead to crippling contractures of the limb

- distal predominance

• Causalgia

• Reflex sympathetic dystrophy

• Algoneuropathy

• Post-traumatic vasospasm

• Post-traumatic osteoporosis

• Post-infection sclerodactylia

• Stein-brocker’s syndrome

• Sudeck’s atrophy

• Shoulder-hand syndrome

• Sympathalgia

other names for CRPS.

Type 1 CRPS

- reflex sympathetic dystrophy

- no nerve involvement

Type II CRPS

- causalgia

- with nerve involvement

• Sensory problem (alodynia, hyper/hypoalgesia)

• Trophic skin changes (temperature asymmetry)

• Autonomic dysfunction (swelling, edema excessive sweating)

• Motor problem (muscle weakness, atrophy, contractures)

• Pain

signs and symptoms of CRPS.

Lateral Epicondylitis

- caused by repetitive wirst extension

- tennis elbow

- management: use 2 hand backhand grip, counterforce FA brace, larger and more comfortable grip, and softer ball

Medial epicondylitis

- overuse of wrist flexors and pronators

- golfer’s elbow

- management: use a larger and looser grip, improve trunk rotation, strike the ground less

Pronator Teres

muscle commonly affected in medial epicondylitis.

Extensor Carpi Radialis Brevis

muscle commonly affected in lateral epicondylitis.

Medial Epicondylitis Test

special test for medial epicondylitis.

• Cozen’s Test

• Mill’s Test

• Maudsley’s Test

special tests for lateral epicondylitis.

Pushed Elbow

- mechanism of injury is FOOSH

- direction: posterolateral

Pulled Elbow

- causes

• traction force to the extended elbow and pronated forearm

• annular ligament laxity

• under developed laxity

Little League’s Elbow

- MCL injury at elbow

- age 9-12 y/o

- mechanism of injury are excessive valgus force at the elbow

• Late cocking phase

• Acceleration

phases of baseball throwing wherein MCL injury can occur.

Olecranon Bursitis

- hallmark: goose egg apearance

- signs and symptoms:

• pain

• swelling

• slight LOM

Student’s Elbow

other name for acute olecranon bursitis.

• Miner’s elbow

• Draftsman elbow

other name for chronic olecranon bursitis.

~70° of elbow flexion

position of comfort of patients with olecranon bursitis.

Staphylococcus Aureus

bacteria that causes septic olecranon bursitis.

Myositis Ossificans

- abnormal bone growth in the muscle following trauma

- signs and symptoms:

• pain

• palpable mass

• flexion contracture

Brachialis

most common site of MO in the upper extremity.

Quadriceps

most common site of MO in the lower extremity.

• Passive ROM and stretching

• Massage

contraindicated management for MO.

Boxer’s elbow

- posterior elbow impingement

- MOI: excessive extension and valgus force at the elbow

- signs and symptoms:

• LOM towards flexion

Volkmann’s Ischemic Contracture

- anterior FA compartment syndrome

- complication of supracondylar fracture (injury to the brachial artery)

• Claw-like deformity

• Atrophy

• 5 P’s (pain, pallor, pulselessness, paresthesia, paralysis)

presentation of volkmann’s ischemic contracture.

Paneer’s Disease

- avascular necrosis of capitulum

- common in 7-10 y/o

Osteochondritis Dissecans

- focal lesion at the capitulum

- common in 9-15 y/o

Scaphoid

most commonly fracture carpal bone.

Lunate

most dislocated carpal.

Boxer’s Fracture

5th metacarpal neck fracture.