Taylor Stone Final Exam Study Guide Chapter 19 1 Elbow Assessment past history mechanism of injury type quality duration of pain swelling Observation deformities swelling carrying angle valgus vs varus flexion and extension Palpation soft tissue epicondyles olecranon etc Prevention of Injuries vulnerable to acute and chronic injuries protective gear chronic injury reduction limit repetitions utilize proper mechanics use equipment that is appropriate for skill level maintain strength flexibility endurance Injuries Olecranon Bursitis superficial location makes it extremely susceptible to injury caused by direct blow swelling spontaneous pain and point tenderness acute cases ice chronic cases protective therapy Elbow Sprains Lateral Epicondylitis elbow hypertension or a valgus force pain along medial aspect of elbow inability to grasp object point tenderness repetitive microtrauma to insertion of extensor muscles of lateral epicondyle aching pin of region of lateral epicondyle after activity pain worsens and weakness in wrist and hand decreased ROM pain with wrist extension Medial Epicondylitis repeated forceful flexion of wrist and extreme valgus torque of elbow pain with forceful extension and flexion point tenderness and swelling passive movement of wrist seldom elicits pain but active movement does Elbow Osteochondritis Dissecans 2 Forearm Injuries Contusion impairment of blood supply to anterior surface resulting in degeneration of articular cartilage sudden pain locking swelling pain crepitation Ulnar Nerve Injuries pronounced cubital valgus may cause deep friction problem ulnar nerve dislocation traction injury from valgus force subluxation of ulnar nerve paresthesia in 4th and 5th fingers Dislocation of Elbow high incidence in sports caused by fall on outstretched hand or severe twist swelling severe pain disability complication w median and redial nerves and blood vessels rupture and tearing of stabilizing ligaments will usually accompany the injury immobilize and refer to physician for reduction ulnar side receives majority of blows due to arm blocks can be acute of chronic direct contact or blow pain swelling and hematoma possible bony callus RICE and protection Forearm Splints forearm strain most come from severe static contraction repeated static contractions creates minute tears in CT of forearm dull ache between extensors weakness and pain w contraction point tenderness in interosseus membrane Forearm Shaft Fractures common in youth due to falls and direct blows fracturing ulna or radius individually is more rare then both audible pop or crack by moderate to severe pain swelling disability edema ecchymosis crepitus Colles Fracture occurs in lower end of radius or ulna MOI is fall on extended wrist forcing radius and ulna into hyperextension displacement occurs posteriorly a smith fx involves falling on flexed wrist less common occurs anteriorly visible deformity if not present can be seen as bad sprain bleeding and swelling tendons may be torn avulsed possible nerve damage 3 Head and Wrist Injuries Wrist Sprains arises from abnormal forced movement falling on hyperextended wrist violent flexion or torsion pain swelling and difficulty with movement Wrist Tendinitis overuse of wrist repetitive accelerations and decelerations pain on active use or passive stretching tenderness and swelling Carpal Tunnel Syndrome carpal tunnel compression of median nerve due to inflammation of tendons and sheaths of result of repeated wrist flexion or direct trauma to anterior aspect sensory and motor deficits weakness in thumb conservative treatment Scaphoid Fracture caused by force on outstretched hand compressing scaphoid b t radius and carpal bones swelling severe pain in snuff box often fails to heal due to poor blood supply occurs as a result of a fall or more commonly from contact while holding Hamate Fracture something Wrist Ganglion synovial cyst following wrist strain or repeated forced hypertension back of wrist occasional pain w lump at site pain increases with use Metacarpal Fracture direct axial force or compressive force associated with boxing or martial arts pain and swelling palpable defect is possible Soft Tissue calluses blisters 4 Fingers Injuries Mallet Finger caused by a blow that contacts tip of finger avulsing extensor tendon from insertion pain at DIP x ray shows avulsed bone on dorsal proximal distal phalanx unable to extend distal end of finger point tenderness Boutonniere Deformity rupture of extensor tendon dorsal to the middle phalanx forces DIP joint into extension and PIP into flexion severe pain obvious deformity inability to extend DIP joint Jersey Finger rupture of flexor digitorium profundus tendon from insertion on distal phalanx often occurs w ring finger when athlete tries to grab a jersey DIP can not be flexed finger remains extended pain and point tenderness over distal phalanx Gamekeeper s Thumb sprain of UCl of MCP joint of the thumb mechanism is forceful abduction of proximal phalanx occasionally combined w hyperextension pain over UCL in addition to weak and painful pinch tenderness and swelling over medial aspect of thumb Subungual Hematoma contusion of distal finger causing blood accumulation in the nail bed nail loss will occur discoloration slight pressure on nail will exacerbate condition Chapter 18 Shoulder 1 Special Tests Active and Passive Range of Motion flexion and extension abduction and adduction Muscle Testing muscles of shoulder and those that serve as scapula stabilizers Apprehension test used for anterior glenohumeral instability Test for Shoulder Impingement Neer s test and Hawkins Kennedy test for impingement used to assess impingement of soft tissue structures 90 degrees of shoulder flexion internal rotation and 30 degrees of horizontal Empty Can Test adduction downward pressure is applied weakness and pain assessed Sternoclavicular Stability stability Acromioclavicular Stability pressure applies superiorly inferiorly and anteriorly to assess for pain and pressure applied to distal end of clavicle in 4 directions 2 Injuries Clavicle Fractures fall on outstretched arm fall on tip of shoulder or direct impact occur primarily in middle third presents with supporting of arm head tilted towards injured side with chin turned away clavicle is lower palpation reveals pain swelling deformity Fracture of the Humerus Sternoclavicular Sprain shaft fractures occur as a result of a direct blow or fall on outstretched arm indirect force