Upper Extremity Clinical Correlation

Question 1

Identify

Answer 1

Pancoast tumor

Question 2

Identify

Answer 2

Fabella

Question 3

Identify

Answer 3

calcific tendonitis

Question 4

The calcifications in the attached image are commonly found in what syndrome?

Answer 4

Crest Syndrome

Question 5

Identify

Answer 5

Soft tissue hemangiomas

Question 6

Identify

Answer 6

Lipohemarthrosis

Question 7

In which joint type is effusion generally most easily identified?

Answer 7

knee

Question 8

Identify

Answer 8

Jones fracture

(fracture of the base of the 5th metatarsal)

Question 9

Identify

Answer 9

Rolando fracture

(base of the 1st metacarpal @ CMC joint)

Question 10

Identify

Answer 10

intertrochanteric fracture

Question 11

Identify

Answer 11

avuslion fracture

Question 12

Identify

Answer 12

Segond fracture

Question 13

Identify

Answer 13

tophi (gout)

Question 14

Name (6) modalities commonly used for musculoskeletal imaging

Answer 14

1. Radiographs (plain film x-ray)
2. Fluoroscopy
3. Ultrasound
4. Computed tomography (CT)
5. Magnetic resonance imaging (MRI)
6. Nuclear imaging (ex: PET)

Question 15

Name and describe (3) major categories of fracture

Answer 15

1. Acute: due to sudden impact or force exceeds the strength of bone
2. Stress: due to repetitive submaximal stresses
3. Pathologic: due to otherwise normal stresses on diseased bone

Question 16

Give (3) major examination signs of fracture

Answer 16

Deformity

Bony point tenderness

Pain with loading -> best identified with indirect loading

Question 18

Name (4) indirect loading tests for fracture

Answer 18

1. axial
2. bump test
3. hop test
4. fulcrum test

Question 19

Why might use of NSAIDs be contraindicated in bone fracture?

Answer 19

NSAIDs may interfere with prostaglandin roles in bone healing

Question 20

Name three bones that are especially vulnerable to avascular necrosis in the event of a fracture

Answer 20

1. Scaphoid
2. Talus
3. Femoral head and neck

Question 21

The femoral head and neck are chiefly supplied by what vessel?

Answer 21

medial circumflex femoral artery

Question 22

What is post-traumatic arthritis?

Answer 22

Arthritis developed following dislocation, usually chronic dislocation

Question 23

Name some historical (Hx) and examination (Ex) features found with arthritis

Answer 23

Hx:

1. stiffness, especially after rest
2. progressive pain, worse especially after use

Ex:

1. Joint line tenderness
2. deformity
3. mild swelling
4. pain evoked on passive and active movement

Question 24

Name (3) major risk factors for capsulitis

Answer 24

1. Injury
2. Diabetes
3. Thyroid disease

Question 25

Name and describe the three (3) major phases of capsulitis

Answer 25

1. Freeze: painful with decreasing range of motion (ROM) 2. Frozen: non-painful with stable/minimal ROM 3. Thawing: non-painful with increasing range of motion

Question 26

Identify

Answer 26

Long head biceps tendon rupture

Question 27

What are the key considerations when weighing treatment options for musculotendinous ruptures?

Answer 27

* Impact of missing muscle * Presence of alternative muscles * Functional requirements of the patient

Question 28

Define: **enthesopathy**

Answer 28

Disorder of the bony attachment of a muscle or tendon

Question 29

Define: **tendinitis**

Answer 29

Acute inflammation of a tendon traumatic: pull or blow

Question 30

Define **tendinosis**

Answer 30

Chronic degeneration of a tendon possibly due to repetitive submaximal irritation

Question 31

What is a **strain**? What are its symptoms?

Answer 31

Damage to muscle from overstretching, usually during eccentric loading of the muscle Sx: stiffness, bruising, swelling, soreness

Question 33

Acromioclavicular (AC) sprain... Give the common etiology, presentation, and exam findings

Answer 33

**Etiology:** * fall directly onto the shoulder **Presentation:** * pain with overhead motions * visible deformity of the superior shoulder **Exam findings:** * pain and deformity at AC joint * positive cross-chest test (cross-body adduction) * painful abduction to \>150º

Question 35

**AC injury grading:** AC and CC tear

Answer 35

Grade III

Question 36

**AC injury grading** AC tear with CC injury

Answer 36

Grade II

Question 37

**AC injury grading:** AC injury with no CC involvement

Answer 37

Grade I

Question 38

Define **sprain** what are its primary symptoms?

Answer 38

ligamentous damage from overloading Sx: instability or laxity, swelling

Question 39

Sprain grading: partial tear, significant laxity and pain

Answer 39

Grade II

Question 40

Sprain grading: microscopic damage, no increased laxity, increased pain with stress or load

Answer 40

Grade I

Question 41

Sprain grading: Complete tear, significant laxity, pain that may resolve following acute phase

Answer 41

Grade III

Question 42

Which nerve is generally at greatest risk following an anterior shoulder dislocation?

Answer 42

Axillary n.

Question 43

Define **dislocation**

Answer 43

Complete displacement of the joint

Question 44

Define **subluxation**

Answer 44

transient, partial joint displacement

Question 45

Define **laxity**

Answer 45

"looseness" of the joint may be normal variant

Question 46

What is the most common type/direction of shoulder dislocation?

Answer 46

Anterior (90%)

Question 47

What is (are) the common etiologies of anterior shoulder dislocation?

Answer 47

1. Direct blow to the posterior shoulder 2. Forced extension, abduction, and external rotation of the arm

Question 48

What is Simian (Ape) hand?

Answer 48

Thenar wasting associated with carpal tunnel syndrome