HK 302 Exam 2 pathology

clavicle fractures mechanism

- direct blow

- FOOSH (fall on outstretched arm)

clavicle fracture damage and management

- 80% of clavicle fractures occur in middle

- figure 8 brace vs surgery

humerus fracture mechanism

fall or direct blow

humerus fracture structures damages

surgical neck is the most common site for proximal humerus fracture

humerus fracture management

- immobilize in sling and swathe

- immediate referral to ER/doctor

swathe

a sling that keep the arm in place around the body

glenohumeral joint dislocation (shoulder)

- 90% of shoulder dislocations are anterior and/or inferior

- humeral head is often sitting in axilla anteriorly

with any dislocation

there could be associated fractures or nerve damage

shoulder dislocation looks like

- concave deltoid

- leaning forward because head of humerus in armpit

reduction of shoulder

team doctor

- longer out - harder to put back in

- 1 attempt to reduce

acromioclavicular joint sprain called

"separated shoulder"

AC joint sprain mechanism

- direct blow to the shoulder

- fall on the point of the shoulder

structures damaged in AC joint sprain

- coracoclavicular ligaments (conoid, trapezoid)

- acromioclavicular igaments

- deltoid and trapezius muscles

with most injuries including shoulder sprain

bone AND muscle injured. muscles need rehab

impingement can occur at the acromion

when arms go up the head needs to slide inferiorly

- irritated bursa

- bone spurs

what muscle will be sore from carrying a backpack

levator scapulae

winging of scapula

- caused by weakness in serratus anterior or entrapment of long thoracic nerve

- disrupts the scapular force couple

test winged scapula

5-10 push-ups will make it pop up

rotator cuff tear/ strain mechanisms

- chronic micro trauma over time (overuse)

- acute trauma

- FOOSH

- arm yanked or pulled while muscle contracted

why is rotator cuff a critical zone for injury

the supraspinatus tendon does not get good blood flow

structures damaged in rotator cuff tear or strain chronic

supraspinatus is primarily involved with chronic degenerative tears

structures damaged in rotator cuff tear or strain acute

surpraspinatus/infraspinatus involved in acute episodes

when supraspinatus is hurt

deltoid can't abduct because supraspinatus initiates abduction

biceps tendon rupture mechanism

- prolonged tendinitis

- degenerative - tendon weak

- traumatic - distal rupture

biceps tendon rupture

biceps tendon - proximal or distal

"Popeye" contract in a ball

Tommy John surgery problem

the ligament that connects two arm bones at your elbow gets torn, usually from overuse

Tommy John surgery fix

a surgeon removes the torn ligament, drills tunnels in the two bones, threads the tendon from forearm or leg through tunnels and secures ends together

Tommy John athlete

first successful player to return to play the same success after surgery

"nurse maid's elbow"

annular ligament loose in children and can be pulled out of place from swinging a child by arms

olecranon bursitis

acute or chronic injury - can be septic (infected)

- olecranon area fills with thick fluid

- baseball slide

- check for fracture underneath

bursa

- fibrous sac filled with synovial fluid

- located between adjacent muscles, between bones and skin where a tendon passes over bone

- cushion muscles, help tendons slide more easily over joints

olecranon is covered by

thick bursa

superficial location of bursa

predisposes it to injury

elbow dislocations mechanism

- hyperextension

- FOOSH

- extreme valgus force

elbow dislocations have high percentage of

associated fractures

- most frequent is radial head which hits as it goes with ulna

- or coronoid process which gets broken off on way out or way back in

elbow dislocation management

- immobilize and call 911

- reduce under anesthesia

- may need surgery if there is a fracture

elbow dislocation happens in what joint

humeroulnar joint

colles fracture

- fracture of the distal radius and ulna

- commonly FOOSH

colles fracture management

- immobilization

- doctor referral

- urgent if near growth plate

- bind them where you find them - joint above and below

scaphoid fracture

- most common wrist bone fracture and carpal injury

- difficult to diagnose on x-ray

signs and symptoms of scaphoid fracture

- history of FOOSH

- pain with palpation of anatomical snuff box

management of scaphoid fracture

RICE, application of splint, doctor referral

- surgery for quicker fix for athlete

- scaphoid has bad blood supply- heal slow

triangular fibro cartilage complex - TFCC

if injured can't put weight down on it

if the transverse carpal ligament is too tight

median nerve tingle and wrist problems (carpal tunnel)

carpal tunnel syndrome is the most common

compression syndrome of the wrist and hand

- typically in dominant hand

- transverse carpal ligament too tight

carpal tunnel syndrome signs and symptoms

- pain

- numbness

- tingling

- burning

felt in fingertips or thumb - middle finger

carpal tunnel syndrome management

- ice and NSAIDs

- injection vs surgical release if symptoms don't resolve

syndrome

A group of symptoms typical of a particular disease or condition

NSAIDs

nonsteroidal anti-inflammatory drugs

surgical release for carpal tunnel

small cut of retinaculum to relieve pressure

boxer's fracture

fracture of the distal end of fourth or fifth metacarpal

- phalanges won't be parallel

phalanx dislocation

- MCP joints rare but significant

- PIP joint most common dislocation in body

mechanism of phalanx dislocation

hyperextension with axial compression usually

- often open dislocation because there isn't extra skin there for space

palmaris longus is often

the tendon harvested for surgeries

lateral epicondylitis caused

by eccentric loading of the extensor muscles:

- ex. backhand in tennis

signs and symptoms of lateral epicondylitis

- pain over/around lateral epicondyle

- pain with resisted movement - picking up cup/soda can

lateral epicondylitis treatment

can use a counter force brace below the extensor muscle to disperse stress on extensor tendon

medial epicondylitis can be caused by

pitching

finger tendon injuries

- jersey finger

- mallet finger

- boutonniere deformity

- swan neck deformity

- trigger finger

jersey finger

- rupture and avulsion of flexor digitorum profundus

- from grabbing a jersey twisting and turning to get away

- can't flex DIP can flex PIP

mallet finger

- rupture and avulsion of the extensor tendon at distal phalanx

- tendon can't retract

- immobilize in hyperextension for 8 weeks

- DIP can't extend

boutonniere deformity

- rupture of central slip of extensor tendon at middle phalanx

- flexion of PIP and extension of DIP

- looks like holding a pin hard

swan neck deformity

- hyperextended PIP joint and flexed DIP joint

- caused by loose solar plate at PIP

- rheumatoid arthritis or joint dislocation

trigger finger

- common on middle/ring finger

- inflammation created thick flexor tendon and nodule in tendon sheath

- finger locked in flexion once nodule is to large to pass