Upper Extremity

Stretching or partial tear in the muscle or muscle-tendon unit

Strain

Stretching or tearing or a ligament (bone-bone) or joint capsule

Sprain

Injury to soft tissue resulting from direct trauma

Contusion

Partial dislocation is called

Subluxation

Acute or chronic ligamentous laxity or tearing

Dislocation

Bone fragment no longer communicating with the source bone

Avulsion fracture

What is the order of most commonly fractured part of the finger

distal, middle, proximal

Pt closed hit his a hard surface. PE releveal TTP over metacarpal, ecchymosis, and swelling. An x-ray reveals a fracture of the 5th metacarpal

Boxers fractures

How does the treatment of a boxer’s fracture change if it is a closed wound vs if there is a fight bite or open area

spinting to surgical

Pt fell and caught themselves with their hand. PE shows tenderness in the anatomical snuffbox and pain with wrist motion

Scaphoid fracture

What is a potential complication of a scaphoid fracture and why

avascular necrosis, dorsal carpal branch of the radial artery supplied proximal 80 of scaphoid

Pt has a fall. PE shows swelling, ecchymosis, and limited ROM. X-ray shows the distal radius fragment moved posteriorly (dorsally). Pt had a fall on an outstretched head

Colles fracture

Pt has a fall. PE shows swelling, ecchymosis, limited ROM. X-ray shows distal fragment moves anteriorly (volarly). Typically occurs from falling onto a flexed wrist.

Smith fracture

What are some complications of distal radius fractures (colles/smith)

median nerve neuropathy, extensor pollicis longus rupture

Patient had a direct fall onto the shoulder, direct blow, or birth trauma. PE reveals TTP, pain, swelling, and tenting of the skin.

Clavicle fracture

What can you do for treatment/pain management of a clavicle fractire

sling for comfort

Patient presents after contact sport or fall injury with an arm that is abducted and externally rotated. PE reveals squaring of the should and reduced nerve sensation of the lateral shoulder

Shoulder dislocation

inflammation of the bursa that results in compression of the rotator cuff muscles. most common in 40+

Sub-acromial impingement syndrome

Patient presents with a gradual onset of tenderness of top of the shoulder, can have weakness and stiffness. PE reveals TTP, limited ROM due to pain, and normal strength.
Positive: neer, hawkins, jobe, and painful arc test
X-ray ruled out other associated pathology

Sub-acromial impingement syndrome

Calcific tendinitis mimics sub-acromial impingement syndrome. During the formative phase there is typically no pain. During which phase does pain begin

Resorptive

Injury commonly occurs during fall (foosh), direct blow, or chronic repetitive overhead movement or lifting. Presents with pain that is felt on the outside of the shoulder and deltoid region, limited ROM, and decreased strength
Positive: Neer, Hawkins, Jobe, painful arc

Rotator cuff injury

What is the gold standard for rotator cuff injury diagnosis

MRI

Which type of shoulder instability
post-traumatic or prior dislocation w/o emergent reduction- ____________
Microtrauma from overuse (athletes) or generalized ligamentous laxity (ehlers danlos/marfans)- _________

Unidirectional, Multidirectional

Multidirectional instability is also referred to as AMBRI which stands for

atraumatic, multidirectional, bilateral, rehabilitation (responds), inferior capsular shift

Patient presents with pain, varying dregree of instability, sensation of subluxation. PE may show muscle atrophy and sulcus sign.

X-rays can be normal, show impression fracture of posterolateral humeral head (Hill-sachs lesion), or ant/post glenoid bone loss

Shoulder instability

Patient experience a direct blow to the tip/edge of the shoulder via an upward forms. PE reveals pain over the AC joint, step off deformity, and bruising

Acromioclavicular joint sprain/separation

Why do we get an x-ray of an AC joint separation/sprain

rule out fracture, observe for widening of AC joint

How is Acromioclavicular joint sprain/separation treated

sling, pain control, PT

What Grade of AC sprain/separation:
Mild sprain of AC ligament

Grade I

What Grade of AC sprain/separation:
AC ligament rupture, coracoclavicular ligament partial tear

Grade II

What Grade of AC sprain/separation:
Complete tear of AC/CC ligaments

Grade III

What Grade of AC sprain/separation:
Complete tear of AC/CC ligaments, plus disruption of deltoid/trap

Grade IV

What Grade of AC sprain/separation:
Complete tear of AC/CC ligaments, plus disruption of deltoid/trap AND clavicle displaced 100% on contralateral side

Grade V

Progressive loss of motion and increased pain with or w/o injury due to a thickened joint capsule. Decreased active and passive ROM with stiff capsular end feel, pain. Takes 18-24 months to resolve

Adhesive Capsulitis

Pain in the anterior shoulder that extends distally. Pain is worse at night and is aggravated by lifting, pulling, supination, and overhead movement. Inflammation of the long head of the biceps tendon.

Bicipital Tendinitis

Overuse of the wrist flexor tendons, specifically the flexor carpi radialis. Presents with pain at the epicondyle, pain with handshakes, and when grasping things. PE reveals pain with wrist flexion.

Medial epicondylitis

Overuse of the wrist extensor tendons, specifically the extensor carpi radialis brevis, which originates from the elbow. Presents with pain at the lateral epicondyle, pain with handshakes, and when grasping things. PE reveals pain with wrist/ digit extension. Common in tennis players. more common

Lateral epicondylitis

Pain and paresthesia in the 1st 3 digits and half of the 4th. Worst at night. weakness and clumbsiness

Carpal Tunnel

What two tests would you expect to be positive for carpal tunnel syndrome

Phalen (back of hand), Tinel (tap median n)

Patient presents with radial sided wirst pain. pain over the 1st dorsal compartment. Impacts the extensor pollicis bevis and abductor pollicis longus. Positive finkelstein’s test

De Quervains Tenosynovitis

If you suspect De Quervains Tenosynovitis what test would you expect to be positive

Finkelstein’s

Soft tissue mass/cyst filled with mucinous materal often on the dorsum of the hand/wrist near the scapholunate ligament

Ganglion cyst

Patient presents with stiffness and possible range of motion, commonly in the 4th and 5th. Painless thickening of the palmar fascia. PE shows progressive loss of full extension, fixed flexed deforinity of MP/PIP joint, and skin dimpling over a flexor tendon

Dupuytrens contracture

Rupture of the extensor tendon, commonly associated with avulsion fractures. Pt has the inability to extend DIP and is usually caused by a blow to the fingertip

Mallet finger

Patient presents with the inability to extend the PIP and secondary hyperextension at the DIP joint. A rupture of the central aspect of the extensor tendon at its insertion to the middle phalanx

Boutonniere deformity

DIP forced into extension, and inability to flex DIP. Commonly impacts the ring finger. Etiology is a rupture of the flexor digitorum profundus tendon from its distal attachment.

Jersey Finger

How is jersey finger treated

surgery within 10-14 days, splint

patient presents with point tenderness at A1 pulley plus catching if digits. Caused by chronic inflammation that causes nodular enlargement / tenosynovitis of the flexor tendons at the A1 pulley.

Trigger finger

injury to the ulnar collateral ligament of the thumb at the MCP joint commonly associated with a fracture at the base of the proximal phalanx. Pt presents with instability of MCP and decreased thumb grip.

Gamekeepers thumb

Blood that is trapped under the nail after trauma. Pain and throbbing in the distal phalanx secondary to trauma.

Subungal hematoma

What studies and treatment do we do for a subungal hemotoma

X-ray to r/o fracture (esp if 50+% of the nail). Trephination (hole), fracture+hematoma = open wound give antibioitics, and tetanus

With a rotator cuff injury or impingement what tests might be positive

neer test, hawkins test, jobe, painful arc test, drop arm