Wrists: Physical Exam
– Hand: Physical Exam Flex Ext R/Dev. U/Dev. Pro Sup Radial-Ulnar Art. 75 70 25 45 60 60 5/5 5/5 2+ … Read more
Elbow
Wrist Arthrodesis
– Indications: – painful or unstable wrist joint w/ advanced destruction due to OA, RA, post traumatic arthritis, SLAC wrist, spastic flexion contracture, degenerative scaphoid non-union, unsuccessful wrist arthroplasty, and Keinbock’s dz; – this procedure is more beneficial for young, active pts or middle aged pts, but not for elderly pts; … Read more
Wrist Arthrography
– Discussion: – arthrography may be used in diagnosis of carpal instability because it is technically easy & is only minimally invasive; – normally there should be no communication between the radiocarpal, mid-carpal, and distal radial-ulnar joints; – it is noteworthy that in normal wrists there may be communications … Read more
Wrist Arthroscopy
– Positioning and Preparation: – joint is distended w/ finger traps (to index and long fingers) w/ about 10 lbs, using a pulley system; – counter traction is applied to the arm w/ use of a second 10 lb pulley – this allows the elbow to be flexed 90 deg; – gravity assistant inflow; – initially … Read more
Wrist Disarticulation
– Discussion: – wrist disarticulation: include the removal of the radius and ulna to styloid processes; – shape of stump remains bulbous, thus permitting prosthetic attachment, leaving the elbow free and preserving full pronation & supination; – wrist disarticulation retains distal radio-ulnar joint preserves more forearm rotation, & retaining distal radial flare dramatically … Read more
Work Up for Shoulder Dislocation
– Discussion: – consequences of anterior instability include Bankart lesion, Hill Sachs lesion, erosion of the anterior glenoid, loose body formation, and stretching of the joint capsule; – features: – degree of trauma involved – distinguish between traumatic dislocations and recurrent … Read more
Work Up for Brachial Plexus Injuries
– See: brachial plexus – Discussion: – hx: persistant pain > 6 months: (poor prognosis); – diff dx: – breast cancer (lower plexus and painful) – radiation therapy (upper plexus and painless) – … Read more
Volkmann’s contracture
– See: Compartment Syndrome – Discussion: – type of forearm ischemic contracture resulting from brachial artery injury usually associated w/ supracondylar frx of humerus; – may see loss of motor & sensory function, however, classic involvment is w/ anterior interosseous branch of median nerve; – pathology: … Read more
Vastus Medialis
– See quadriceps muscle; Origin: Lower 1/2 of the intertrochanteric lines, medial lip of linea aspera, upper part of medial supracondylar line, medial intermuscular septum tendons of adductor magnus and adductor longus; Insertion: Medial border of the patella by the ligamentum patella into the tibia tuberosity; Action: Extends the leg at the knee … Read more