Podcast: Play in new window | Download
For musculoskeletal questions pulled straight from The Final Step click here www.physicianassistantexamreview.com/msk
Shoulder Separation (AC joint sprain)
- A partial or complete disruption of the ligaments at the AC joint
- Causes
- Direct blow
- Falling on an outstretched hand
Clinical Presentation
- Shoulder pain following trauma
- Tenderness over the AC joint
- My shoulder is drooping
Labs, Studies and Physical Exam Findings
- Tenderness over AC joint
- Deformity of AC joint especially with shoulder distraction
- Crossover test (squeezes AC joint) causes pain in the AC joint
- Pain relief with an injection of lidocaine into the AC joint
- X-ray of the shoulder showing th separation
Treatment
- Rest
- Ice
- Sling
- Physical therapy
- Severe cases require surgical correction
Shoulder Dislocation
- Powerful abduction or extreme rotation may cause a shoulder dislocation (think of a spiking a volleyball or blocking a shot in basketball)
- Shoulder dislocation involves the humerus and the glenoid
- 95% are anterior dislocations
Clinical Presentation
- Shoulder pain!
- Limited range of motion
Labs, Studies and Physical Exam Findings
- Obvious deformity
- Patient will not allow any motion of the shoulder
- x-ray showing dislocated joint
Treatment
- Manual reduction
Nursemaid’s elbow
- This is a subluxation of the radial head
- Occurs with pulling of the extended arm of a child
- Typically occurs in a child under 4 years
Clinical Presentation
- My child isn’t using his arm. Though he isn’t really complaining of pain.
Labs, Studies and Physical Exam Findings
- Child will not use affected arm
- They will allow passive motion of the arm
- X-ray will be normal
Treatment
- Treatment is by manual reduction
- Supinate the wrist and extend the elbow while applying pressure over the radial head
Elbow fracture
- Radial head fractures are fairly common
Clinical Presentation
- Elbow pain and stiffness following trauama
Labs, Studies and Physical Exam Findings
- Patien will not allow movement of the elbow
- X-ray – Fat pad sign indicate an occult fracture
Treatment
- Treatment – open reduction and internal fixation
Colles Fracture
- This is the most common wrist fracture
- Results from a fall onto a dorsiflexed hand
- Dorsal angulation of the hand and wrist
Clinical Presentation
- I fell on my hand it now it hurts
Labs, Studies and Physical Exam Findings
- X-ray shows a silver fork or dinner fork deformity
Treatment
- Closed reduction and immobilization
- Surgical correction if unable to achieve a stable satisfactory reduction
Gamekeeper’s Thumb (Skier’s thumb)
- Game here refers to hunted animals. A gamekeeper would break the necks of small animals like rabbits after they had been trapped. The method over time may result in this particualr injury
- Injury to the ulnar collateral ligament of the thumb
- Usually this is an tear or avulsion at the insertion site of the proximal phalanx
Clinical Presentation
- I fell on my hand and now I can’t hold a coffee cup
Labs, Studies and Physical Exam Findings
- Instability of the metacarpal joint of the thumb
- Weak pinch or grasp
- Swelling or bruising of the thenar eminence
Treatment
- Minor tears may be treated in a thumb spica splint
- More significant tears may require surgical repair
Scaphoid Fracture
- The most commonly fractured carpal bone
- Be sure to consider this in clinical practice
- These have a high rate of nonunion
Clinical Presentation
- Pain after a fall on an outstretched hand
- Pain with use of the thumb
Labs, Studies and Physical Exam Findings
- Pain with palpation of the anatomical snuffbox
- May be missed on x-ray
- MRI
Treatment
- Cast
- Thumb spica splint
- Surgical correction
Boxer’s Fracture
- Fracture of the 4th and possibly 5th metacarpal neck
Clinical Presentation
- I punched a wall and now my hand really hurts
Labs, Studies and Physical Exam Findings
- Knuckles may no longer be prominent
- Obvious deformity may be present
- X-ray to visualize the fracture
Treatment
- Splinting
- Closed reduction pinning
- Open reduction and internal fixation
Chest and Ribs
Costocondritis- inflammation of the cartilage that connects the ribs to the sternu. It is also known as chest wall pain or costosternal syndrome.
Rib Fractures
Flail Chest: This condition occurs when multiple ribs are fractured in two or more places, causing a segment of the chest wall to become detached from the rest. It is typically a result of severe trauma and can lead to paradoxical chest wall movement during breathing.
**
Shoulder Separation (AC joint sprain)
- A partial or complete disruption of the ligaments at the AC joint
- Causes
- Direct blow
- Falling on an outstretched hand
Clinical Presentation
- Shoulder pain following trauma
- Tenderness over the AC joint
- My shoulder is drooping
Labs, Studies and Physical Exam Findings
- Tenderness over AC joint
- Deformity of AC joint especially with shoulder distraction
- Crossover test (squeezes AC joint) causes pain in the AC joint
- Pain relief with an injection of lidocaine into the AC joint
- X-ray of the shoulder showing th separation
Treatment
- Rest
- Ice
- Sling
- Physical therapy
- Severe cases require surgical correction
Shoulder Dislocation
- Powerful abduction or extreme rotation may cause a shoulder dislocation (think of a spiking a volleyball or blocking a shot in basketball)
- Shoulder dislocation involves the humerus and the glenoid
- 95% are anterior dislocations
Clinical Presentation
- Shoulder pain!
- Limited range of motion
Labs, Studies and Physical Exam Findings
- Obvious deformity
- Patient will not allow any motion of the shoulder
- x-ray showing dislocated joint
Treatment
- Manual reduction
Nursemaid’s elbow
- This is a subluxation of the radial head
- Occurs with pulling of the extended arm of a child
- Typically occurs in a child under 4 years
Clinical Presentation
- My child isn’t using his arm. Though he isn’t really complaining of pain.
Labs, Studies and Physical Exam Findings
- Child will not use affected arm
- They will allow passive motion of the arm
- X-ray will be normal
Treatment
- Treatment is by manual reduction
- Supinate the wrist and extend the elbow while applying pressure over the radial head
Elbow fracture
- Radial head fractures are fairly common
Clinical Presentation
- Elbow pain and stiffness following trauma
Labs, Studies and Physical Exam Findings
- Patient will not allow movement of the elbow
- X-ray – Fat pad sign indicate an occult fracture
Treatment
- Treatment – open reduction and internal fixation
Colles Fracture
- This is the most common wrist fracture
- Results from a fall onto a dorsiflexed hand
- Dorsal angulation of the hand and wrist
Clinical Presentation
- I fell on my hand it now it hurts
Labs, Studies and Physical Exam Findings
- X-ray shows a silver fork or dinner fork deformity
Treatment
- Closed reduction and immobilization
- Surgical correction if unable to achieve a stable satisfactory reduction
Gamekeeper’s Thumb (Skier’s thumb)
- Game here refers to hunted animals. A gamekeeper would break the necks of small animals like rabbits after they had been trapped. The method over time may result in this particular injury
- Injury to the ulnar collateral ligament of the thumb
- Usually this is an tear or avulsion at the insertion site of the proximal phalanx
Clinical Presentation
- I fell on my hand and now I can’t hold a coffee cup
Labs, Studies and Physical Exam Findings
- Instability of the metacarpal joint of the thumb
- Weak pinch or grasp
- Swelling or bruising of the thenar eminence
Treatment
- Minor tears may be treated in a thumb spica splint
- More significant tears may require surgical repair
Scaphoid Fracture
- The most commonly fractured carpal bone
- Be sure to consider this in clinical practice
- These have a high rate of nonunion
Clinical Presentation
- Pain after a fall on an outstretched hand
- Pain with use of the thumb
Labs, Studies and Physical Exam Findings
- Pain with palpation of the anatomical snuffbox
- May be missed on x-ray
- MRI
Treatment
- Cast
- Thumb spica splint
- Surgical correction
Boxer’s Fracture
- Fracture of the 4th and possibly 5th metacarpal neck
Clinical Presentation
- I punched a wall and now my hand really hurts
Labs, Studies and Physical Exam Findings
- Knuckles may no longer be prominent
- Obvious deformity may be present
- X-ray to visualize the fracture
Treatment
- Splinting
- Closed reduction pinning
- Open reduction and internal fixation
Costochondritis
- Inflammation of the cartilage that connects the ribs to the sternum
- Also known as chest wall pain or costosternal syndrome
- Pain is reproducable with deep inspiration or palpation
- Self limiting. Ibuprofen PRN
Flail Chest
This condition occurs when multiple ribs are fractured in two or more places, causing a segment of the chest wall to become detached from the rest. It is typically a result of severe trauma and can lead to paradoxical chest wall movement during breathing.