Radiology Upper Extremities
Terms
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- what are ligament injuries called?
- sprains
- what degree sprain would be detectable joint laxity with localized pain and tenderness
- 2nd degree
- which test would you perform to determine the full extent of a sprain injury
- MRI
- the tearing of a muscle-tendon unit
- A strain (also termed tendonitis)
- what causes strains?
- strains may be caused by prolonged overuse or by a single episode of over activity
- define dislocation and sublaxation
-
In a dislocation the normally apposing joint surfaces are completely displaced,
while in a subluxation those surfaces are partially displaced - what is a greenstick fracture
- an incomplete break where one side of the bone is broken and the other side is bent
- what do you call a Fx in which the bone is broken in several places
- a comminuted fracture
- in this fracture, there is failure of the bone to complete the healing process
- nonunion fracture
- in this fracture, a ligament or tendon tears away (avulse) a small piece of a bone
- avulsion fracture
- how do you treat open fractures?
- debrided, irrigated and parenteral antibiotics administered in the OR within 6 hours of injury
- which fracture heals more quickly, metaphyseal or diaphyseal fractures?
- metaphyseal fx heals more rapidly because there is more blood supply in this area
- which fractures usually have a transverse pattern
-
Stress and pathologic fractures
Ex- "night stick" fx involving the ulna -
These fractures have a tendency to displace after reduction and immobilization;
typically require ORIF - Spiral or oblique fractures
- these fractures have the potential to cause growth disturbance of the involved bone
- Salter-Harris/growth plate fractures
- what are the stages of fracture healing
-
hematoma formation
inflammatory phase
reparative phase
remodeling phase - how do you treat AC separation?
-
Grade I-II: sling, ice x 2 wks then ROM
Grade III: sling, ice x several wks until pain subsides, then ROM & strengthening vs. surgical repair - Compression fracture of the articular surface of the humeral head, created by the sharp edge of the anterior glenoid as the humeral head dislocates over it
- Hill-Sachs Lesion
- what is the most common mechanism of injury for a proximal humerous fracture?
- FOOSH- fall on an outstretched hand
- what is a Monteggia Fracture
-
Monteggia Fracture
Usually a fx of the mid or proximal ulna with anterior dislocation of the radial head - what is a Galeazzi Fracture?
- involves a radial shaft fracture with associated dislocation of the distal radioulnar joint (DRUJ), which disrupts the forearm axis joint
- this fracture is assoc. with sports requiring a throwing motion
- "little leaguer's elbow"- a fracture involving the medial epicondyle of the humerous
- what is the MC fx about the wrist
- Colles Fracture- Extra-articular fx with volar angulation and dorsal tilt
-
this fracture is the reverse Colles fx:
Fracture of the distal radius with anterior palmar displacement - Smith’s fx
- a fracture of the radial styloid is called?
- Chauffer's Fracture (Hutchinson's fx)
- MC fx’d carpal bone
- Scaphoid
- why is there great risk of vascular necrosis of the scaphoid?
- because the proximal scaphoid has no direct blood supply
- how do you treat snuffbox tenderness
- treat as if it was a scaphoid fracture bcoz XR may not show fx for upto 4 wks
- this fracture most frequently occurs at the 5th metacarpal as a result of a direct blow delivered to the hand or by the hand
- Boxer’s fx
- A comminuted Fx of the first metacarpal
- Rolando's fracture; Treatment by external fixation
- what is a Jones fracture
- a fracture of the fifth metatarsal of the foot
- what is the MC injury to the knee requiring surgery
- Meniscal tear of the knee
- what is a varus deformity
- a term for the inward angulation of a joint
- what is a valgus deformity
- the outward angulation of the distal segment of a bone
- what type of force could injure the MCL
- Valgus force
- this ligament is most likely injured by twisting of knee while foot is firmly planted on ground
- ACL
- Caused by hyperextension of knee or direct blow to anterior aspect of flexed knee (Dashboard)
- PCL sprain
- What is the Unhappy Triad?
-
1. ACL tear
2. MCL tear
3. Medial meniscus tear
usually due to a lateral blow to the knee with the foot fixed - name the tarsals of the foot
-
7 tarsals:
Talus
Calcaneus
Navicular
Medial Cuneiform
Intermediate Cuneiform
Lateral Cuneiform - Bones of the foot
-
Bones of the foot:
7 tarsals
Talus
Calcaneus
Navicular
Medial Cuneiform
Intermediate Cuneiform
Lateral Cuneiform
5 metatarsals
“rays of the footâ€
14 phalanges - the #1 most common foot problem
- Plantar fasciitis;inflammation due to repeated overstretching of the plantar fascia ligament (fat pad of the foot); Pain is most severe in the morning and stepping down onto foot, decreases as day goes on
- contributing factors of Plantar Fascitis
-
flat feet
high arches (supinated feet)
increasing age
sudden weight increase
sudden increase in activity level
running in sand -
the most common deformity of the foot;
Results in excessive valgus angulation of the big toe - Hallus Valgus
- what other test should be done on a pt with a calcaneous fracture
- CT Scan of calcaneus and lumbar spine XRay
- what are the Ottawa ankle rules
-
IF:
<55 y/o
able to walk 4 steps
No tenderness over the posterior edge (distal 6 cm) or tip of either malleolus
No tenderness at base of 5th metatarsal or navicular
Then: No XRay needed - what is the MC ankle ligament sprained
- Anterior talofibular ligament; usually due to inversion injury
- this is a fracture of the proximal fibula with syndesmosis rupture and associated medial malleolus fracture or deltoid ligament rupture
- Maisonneuve Fx
-
what are these symptoms assoc. with?:
C/O acute pain in lower calf & difficulty ambulating
+/- palpable defect or mass in post. calf
+ Thompson test - Achilles tendon rupture
- what is a + Thompson test
- squeeze calf, foot should plantarflex, if no plantarflexion then achilles tendon is out
- what are femoral head fractures usually associated with?
- hip dislocations
- the Hill-Sachs lesion can be caused by which maneuver
- The Mitch maneuver to repair a shoulder dislocation
- This injury is an anterior capsular injury assoc with a tear of the glenoid labrum off the anterior glenoid rim
- Bankhart Lesion
- paralysis of this muscle causes the "winging" of the scapula
- serratus anterior
- describe the brachial plexus
-
C5-T1
Musculocutaneous nerve
Axillary
Radial
Median
Ulnar - Injury to these nerves can cause Erb's Palsy or "waiter's tip"
- C5, C6 and sometimes C7 nerves are involved
- Klumpke's Palsy (claw hand)involves these nerves
- C8 and T1
- which nerve is assoc with your funny bone
- Ulnar nerve
- If you have a Fx of the surgical neck of the humerous, which nerve can be injured
- Axillary nerve (C5-C6)
- A Fat Pad sign is most commonly assoc. with this fracture
- A radial head or neck fracture
- what is Myositis ossificans
- muscle that becomes bone (horseback riders)
- what is Bennet's Fx
- Fracture of the proximal 1st metacarpal
- Barton's Fracture
- A dislocation of the distal radial joint
- when do you often see a ulnar styloid Fx
- with a Colle's Fx
- what is Game Keeper’s Thumb, Skier’s Thumb
- Injury to the ulnar collateral ligament of the MCP joint of the thumb
- MC place for a clavicular Fx
- at the junction of the middle and distal part
- the two ligaments surrounding the snuff box
- longus and brevis
- some symptoms you may see with a meniscal tear injury
-
locking
catching episodes
giving way episodes
pain with squatting
Swelling - what do you suspect if a patient cannot actively extend knee
- patellar tendon rupture
- what is a lisfranc injury
- dorsal dislocation of the 2nd metatarsal
- this is a transverse fracture of the 5th metatarsal at the junction of the diaphysis and metaphysis
- Jones Fx
- A Pseudo Jones Fx?
- a fracture of the proximal part of the 5th metatarsal
- Stress fracture usually of the middle of the shaft of the 3rd metatarsal (or 4th)
- March Fracture
- where do most sprains tend to occur?
- shoulder, the elbow, the knee and the ankle
- 4 things to describe a fracture
-
open or closed
site
fracture pattern
degree of displacement - what injury can be caused by external rotation & abduction force on humerus
- shoulder dislocation
- how do you treat a midshaft humerous fracture
-
Coaptation splint:
Carefully molded plaster slab placed around medial & lateral aspects of arm, extending from axilla around elbow & over deltoid & acromion x 2 wks - how does a Boutonniere deformity present?
- with a flexed PIP joint (hand)& hyperextended DIP joint
- how does a Mallot finger present?
- with a flexion at the DIP joint & extension or hyperextension at the PIP joint
- what is the most classic finding in de Quervain tenosynovitis
- a positive Finkelstein test, which is when the pt makes a fist with the thumb inside the fingers; pain is usuallly in the radial side of the wrist
- what is Saturday night palsy?
- when the hand is pronated, the wrist and hand will drop
- which dermatome ennervates the middle and index fingers
- C7
- which dermatome ennervates the ring and pinky
- C8
- which dermatome ennervates the thumb
- C6
- With this syndrome, patients develop popping with knee extension
-
Discoid Meniscus (Popping Knee Syndrome)
Congenitally round (discoid) lateral meniscus that does not acquire its normal semilunar shape -
what condition may you have if you have a:
+ Lachman
+ Anterior drawer - ACL tear
- what condition may you have if you have a + Tibia sag test
- PCL tear
- what disease is caused by overuse of the tendon attached to the tibial tuberosity; usually assoc. with adolescents and sports
- Osgood-Schlatters Disease
- what is the most common mass in the popliteal fossa called that results from fluid distension of the gastrocnemio-semimembranosus bursa
- Baker's cyst, also termed popliteal cyst
- What is Virchow triad?
-
Risk factors for DVT:
venous stasis
hypercoagulability
vessel intimal injury - what is Homan’s sign?
-
A sign of DVT;
presents with discomfort in the calf muscles on forced dorsiflexion of the foot with the knee straight - what test is used to rule out DVT, but not to confirm the diagnosis of DVT?
- The D-Dimer assays
- What study is best to confirm DVT?
- duplex ultrasonography
- what joint is responsible for a Hammer toe deformity?
- flexion deformity of the PIP joint