Musculoskeletal conditions wk3

• unique to children
• one side of the bone bends, microfractures, no break
• falling on outstretched arms

• distal end of radius
• falling on outstretched arms

• most common carpal fracture
• falling injury
• tenderness over snuffbox area
• people will think wrist is sprained
• Delay of treatment -> OA, decreased wrist strength
• more common in young adult athletes

• aka boxer's fracture
• collateral ligaments become slack

acute event or overuse/physical abuse

• significant soft tissue injury
• slammed finger, sports injury

• partial dislocation of proximal radioulnar joint
• annular ligament slides over the head of the radius and becomes entrapped
• 1-3YO, child may avoid use of arm
• Tenderness over elbow joint
• Reduce joint dislocation: supinate and flex forearm until "click" is heard/felt
• may have recurrence, no long term effects

• MCP joints most affected
• Ulnar deviation @MCPs
• hyperextension of PIPs w/flexion of DIPs (swan-neck)
• flexion of PIPs w/hyperextension of DIPs (boutonniere deformity)
• Symmetrical joint swelling, rheumatoid nodules, fusion of carpal bones
• NSAIDs/antirheumatic agents

• Narrowed joint spaces @ PIP, DIP, & CMC joint of thumb (most affected)
• Bony deformity and bony nodules @ PIP (Bouchard's nodes) & DIP (Heberden's nodes), osteophytes
• Localized pain, gradual onset
• Accelerated cartilage degeneration if joint is overused
• Atrophy, decreased ROM due to pain/stiffness
• NSAIDs, corticosteriods, paraffin wax and contrast baths, protective equipment

• acute or gradual onset
• intermittent -> constant pain sensation
• injury, chronic repetitive movement
• weak wrist, swelling, clicking wrist
• limited ROM @ wrist
• gap of >2mm
• NSAIDs, surgery, temporary immobilization

• overuse of wrist flexors/pronators
• "golfer's elbow"
• increasing w/lifting or wrist flexion, radiating pain to forearm
• passive ROM normal, active ROM limited
• Tenderness on exam
• Normal xray unless calcified
• NSAIDs, ice, corticosteroids, rarely surgery
• good prognosis

• overuse of wrist extensors/supinator muscles
• common extensors (usually extensor carpi radialis brevis), "tennis elbow"
• aching pain, increases w/lifting or wrist extension
• passive ROM normal, active ROM limited
• NSAIDs, ice, rest, corticosteriod, rarely surgery

• acute/repetitive trauma (resting elbows on the desk)
• usually gradual onset of moderate/severe pain w/elbow motion
• if acute, may radiate to posterior forearm
• localized swelling/erythema
• ROM may be limited
• NSAIDS, PRICE, aspiration if septic bursitis is suspected
• good prognosis

• Inflammation of extensor pollicis brevis and abductor pollicis longus tendon
• Repetitive trauma, tendon sheath produces a dense fibrous tissue
• Often confused w/OA @ CMC joint
• mild/moderate pain on radial side of wrist
• Finkelstein's test, tenderness over radial styloid process and CMC joint of thumb, crepitus
• NSAIDS, PRICE, surgery/corticosteriods
• good prognosis

• palpable/audible snapping when flexing & extending fingers
• inflammation of flexor digitorum superficialis/profundus tendon sheath (tenosynovitis)
• gradual onset, mild to moderate pain
• pain increases w/inactivity or repeated activity
• swelling, small nodule @ MCP joint
• extension limited due to pain (locked fingers)
• NSAIDS, PRICE, corticosteriods, surgery can widen tunnel to slide more easily
• good prognosis

• median nerve is compressed beneath transverse carpal ligament
• Dull, aching pain @wrist, can extend up forearm to arm
• paresthesias in thumb and index finger, may worsen @ night due to flexed wrist when sleeping
• decreased sensation @volar pads of thumb, index, middle fingers
• in chronic conditions: atrophy of pollicis brevis muscle
• Tinel's sign and Phalen's test, electrodiagnostic
• NSAIDS, opioids, PRICE, corticosteriod, surgery

ulnar nerve in cubital tunnel w/in aponeurosis or between proximal heads of flexor carpi ulnaris

• aka posterior interosseous syndrome
• compression of radial nerve near lateral elbow
• weakness during elbow supination and finger extension
• no sensation changes except dull, aching pain over lateral elbow

• ulnar nerve compressed in ulnar tunnel
• bifurcation into sensory (superficial) and motor (deep) branches
• either both are affected, or just motor