UE Red flags and Referral Guidelines

Radiographs

initial imaging for bony pathology (ID Fxs, arthritic changes, joints/fat pads)

CT

imaging for complex fractures, dislocations, bony fragments, calcifications

CTA

Imaging for capsulolabral structures (MRA preferred)

MRI

Imaging for evaluation of rotator cuff muscles, tendons, and neurovascular structures (rotator cuff, instability, labrum)

MRA

Imaging best for labral pathology

PCP

Suspicion of visceral referral warrants a referral to the patient's ____

radiographs

Suspicion of avascular necrosis warrants a referral for ____ (MRA for later stages)

PCP

If infection is suspected and patient is unable to improve w/4 weeks PT AND unable to alter Sx, referral to ____

PCP

Suspicion of malignancy warrants a referral to ____ (labs/MRI next)

emergent MRI

Acute/traumatic worsening neurological status warrants an ____ referral; refer for ____ if symptoms are chronic or mild

humeral shaft

common site for metastasis in cancer

middle

most common place for clavicular fracture is the _____ segment

radiographs

Shoulder Fx referral guidelines: refer for ______; CT/MRI later if needed

age >60 yrs, painful arc sign, drop-arm sign, infraspinatus muscle test

special test cluster for rotator cuff tears (4 things)

radiographs MRI

Rotator cuff tear referral guidelines: initial imaging = ______ to rule out Fx, ____ next

apprehension, relocation

special test cluster for unstable shoulder; ______ test, _____ test

radiographs MRI

Referral guidelines for unstable shoulder: acute 1st time dislocation = ______ and _____ after first week

MRI

Referral guidelines for unstable shoulder: recurring dislocations = _____ (MRA if possible), CT for further investigation of bony abnormalities

MRA

referral guidelines for SLAP lesion: ____ is the gold standard

AC

it is mandatory to examine the ___ joint when performing a shoulder examination

cross body adduction, AC resisted extension, Obriens Active compression test

cluster for AC joint involvement (3 things)

radiographs

Imaging guidelines for AC joint injuries = ______ first (AP non-weight bearing), MRI later

radiographs

Imaging guidelines for glenohumeral OA = ______ (AP)

radiographs

Imaging guidelines for elbow fractures = _____ first (AP, Lateral, Oblique), CT or MRI later

posterior

_____ ulnar dislocation is the most common

emergent

referral guidelines for ulnar dislocation = _____ referral

radiographs

Imaging guidelines for pulled (nursemaids elbow) = ____ (AP, lateral, oblique)

radiographs MRA

Imaging guidelines for UCL injury at the elbow = _____ first to rule out bony pathology, ____ = gold standard after radiographs are completed

radiographs

Imaging guidelines for elbow OA = _____ (AP and lateral)

Colle's Fracture

dorsal displacement of the distal radius (FOOSH with wrist hyperextended with pronated wrist)

Smiths fracture

Volar displacement of distal fragment (fall on back of hand with wrist flexed)

Scaphoid fracture

Most common bone Fx in wrist

Tenderness in anatomical snuff box, pain w/axial loading of the thumb, tenderness over scaphoid tubercle

Cluster for scaphoid fracture (3 things)

Kienbock's disease

Avascular necrosis of lunate

MRI

Imaging guidelines for Kienbock's disease = _____

Bennetts fracture

fracture at base of 1st metacarpal (longitudinal force through thumb)

Boxer fracture

Fracture at base of 5th metacarpal bone (often caused by a missed punch)

Radiographs MRI

Referral guideline for Hand/wrist fractures = ______ first, ____ for necrosis

ultrasound MRI

Imaging guidelines for tendon injuries at the wrist/hand = _____ or _____

Skiers thumb (UCL injury)

forced valgus of MCP of 1st digit

radiographs

Imaging guidelines for UCl injury (Skiers thumb) = _____, MRI later

radiographs

Imaging guideliens for 1st CMC OA = _____ (AP and lateral), MRI in severe cases