1st Handout

Question 0

Grade 3 according to ligamentous injury scale?

Answer 0

Tenderness to palpation with significant joint laxity and no end point

Question 1

In SC joint sprains, 2/3 of the dislocations occurs where? Its causes medial end of the clavicle to become more prominent.

Answer 1

Anteriorly

Question 2

In SC joint sprains 1/3 of the dislocation occurs where? It has more pain with less prominent medial clavicular end associated with vascular compromise.

Answer 2

Posteriorly

Question 2

80% of clavicular fx occurs where?

Answer 2

Middle third of the clavicle

Question 3

Most common cause of clavicular fx

Answer 3

Direct blow to the point of the shoulder

Question 3

What is the management for clavicular fx with good alignment

Answer 3

Partial immobilization using sling or figure of 8 bandage

Question 5

Surgical intervention should be considered in clavicular fractures if?

Answer 5

15 to 20mm shortening occurs

Question 6

Grade 2 according to ligamentous injury scale?

Answer 6

Tenderness to palpation with joint laxity but a good end point

Question 8

Tenderness to palpation without joint laxity?

Answer 8

Grade 1

Question 9

It accounts for 9% of all shoulder injuries, are most frequent in males in their 3rd decade of life and usually partial rather than complete

Answer 9

Acromioclavicular joint sprain

Question 10

MOI of AC joint sprain

Answer 10

Direct trauma from a fall or blow to the acromion

Question 11

Rockwood classification 1

Answer 11

Mild injury to the AC ligaments, & radiologic evaluation is normal

Question 12

Rockwood type 2

Answer 12

Torn AC ligaments + intact CC ligaments. Clavicular elevation <25% displacement

Question 13

Rockwood type 3

Answer 13

Torn AC and CC ligaments, intact deltotrapezial fascia. 25 to 100% increase in the coracoclavicular space

Question 14

Rockwood type 4

Answer 14

Torn AC and CC ligaments + posterior displacement of the distal clavicle into the trapezius muscle

Question 15

Rockwood type 5

Answer 15

Torn AC and CC ligaments + rupture of deltotrapezial fascia that will increase in cc interspace >100%

Question 16

Rockwood type 6

Answer 16

Torn ac and cc ligaments and deltotrapezial muscular attachments; distal of the clavicle below the acromion or the coracoid process

Question 17

What type of ac joint sprains are usually treated non-operatively

Answer 17

Type 1,2,3

Question 18

Indications for surgical intervention for type 3 AC CC sprains?

Answer 18

Persistent pain or unsatisfactory cosmetic results

Question 19

What are the types of sprains that requires surgical treatment

Answer 19

Type 4 ,5,6

Question 20

It is due to repetitive overload of the distal clavicle

Usually young weight lifters who perform significant amount of bench press and military press.

Answer 20

Osteolysis of the distal clavicle

Question 21

Often referred as snapping scapula or scapula crepitus

Answer 21

Scapulothoracic crepitus

Question 22

Three primary types of sounds in scapulothoracic crepitus

Answer 22

Gentle friction
Loud grating sound
Loud snapping sound

Question 23

Scapulothoracic sound due to physiologic cause

Answer 23

Gentle friction sound

Question 24

Scapulothoracic creptius; soft tissue disease such as bursitis, fibrotic muscle, muscular atrophy, anomalous muscular insertions, excessive thoracic kyphosis or thoracic scoliosis, scapulothoracic dyskinesis or winging

Answer 24

Loud grating sound

Question 25

Scapulothoracic crepitus; bony pathology such as osteophyte, a rib or scapular osteochroma, hooked superomedial angle of the scapula, malunion of rib fractures

Answer 25

Loud snapping sound

Question 26

Repetitive microtrauma and outlet impingement between the acromion and greater tuberosity of the humerus is more common

Answer 26

Rotator cuff tendinitis and impingement

Question 27

Neer stage 1

Answer 27

Inflammation and edema in the rotator cuff

Question 28

Neer stage 2

Answer 28

Fibrosis and tendinitis

Question 29

Neer stage 3

Answer 29

Partial or complete rotator cuff tear

Question 30

Type 1acromion

Answer 30

Flat

Question 31

Type 2 Acromion

Answer 31

Curve

Question 32

Type 3 acromion

Answer 32

Hooked

Question 33

Internal impingement of rotator cuff is due to what mechanism?

Answer 33

Abducted 90 degrees and maximally externally rotated

Question 34

Primary impingement of the rotator cuff is due to?

Answer 34

Hooked acromion or thickened acromioclavicular ligament

Question 35

Rotarorcuff microtrauma is due to?

Answer 35

Eccentric overload of the shoulder external rotators during the deceleration or throwing phase

Question 36

Define large rotator cuff tears

Answer 36

Usually have acromial distance of less than 7mm and sclerosis on the undersurface of the acromion

Question 37

Occurs in patients more than 40 years of age with a prolonged history of outlet impingement and rotator cuff disease; "pop" at the time of injury

Answer 37

Long head of the bicipital tendon strains

Question 38

Rupture of the long head of the biceps brachii tendon will lead to?

Answer 38

Loss of approximately 8% of elbow flexion strength and 21% of supination strength

Question 39

Best evaluation tool for long head of biceps strain

Answer 39

MRI OR ULTRASOUND

Question 40

What is the mx for patients who had long head of the biceps strain >40 yrs of age who are relatively sedentary

Answer 40

Sling immobilization for comfort

Question 41

Mx for patients who had long head of the biceps strain that are young and physically active?

Answer 41

Early surgical intervention

Question 42

Most commonly seen in athletes who perform shoulder adduction and internal rotation against resistance such as weight lifters and football players

Answer 42

Pectoralis major strain

Question 43

Humeral head is dissociated from the glenoid fossa and often requires manual reduction

Answer 43

Dislocation

Question 44

Humeral head translates to the edge of the glenoid beyond normsl physiologic limits, followed by self reduction

Answer 44

Sublaxation

Question 45

It is due to excessive capsular laxity, is multidirectional, frequently associated with internal impingement of rot cuff

Answer 45

Sublaxation

Question 46

New injury resulting in sublaxation or dislocation of the gh joint

Answer 46

Acute instability

Question 47

It is due to repetitive instability episodes

Answer 47

Chronic instability

Question 48

Gh joint instability resulting from congenital capsular laxity or repetitive microtrauma

Answer 48

Atraumatic instability

Question 49

Refers to an individual who volitionally subluxes or dislocates hid ot her gh joint

Answer 49

Voluntary instability

Question 50

Unidirectional instability

Answer 50

Instability only in one direction caused by traumatic event; most frequent type is traumatic anterior instability

Question 51

Frequently tears the antero inferior gh joint capsule and avulses the inferior glenoid labrum with or without some underlying bone from the glenoid rim

Answer 51

Bankart lesion

Question 52

Acute anterior gh dislocation associated with fx of the POSTEROLSTERAL apect of the humeral head

Answer 52

Hill-sachs defect

Question 53

It is due to congenital glenoid hypoplasia or excessive glenoid or humeral RETROVERSION

Answer 53

Posterior gh joint instability

Question 54

A tear of the posteroinferior glenoid labrum causing separation from the glenoid fossa rim, fx of the posteroinferior glenoid fossa rim

Answer 54

Reverse bankart lesion

Question 55

It is due to impaction fx of the anterior humeral head

Answer 55

Reverse hill-sachs

Question 56

Recurrent unilateral joint instability is due to underlying connective tissue disorders such as?

Answer 56

Marfan or Ehlers-Danlos syndrome

Question 57

Stage 1 of frozen sh

Answer 57

1-3mos; painful shoulder movement minimal restriction in motion

Question 58

Stage 2 frozen shoulder

Answer 58

3-9mos; painful shoulder movement progressive loss of gh joint motion

Question 59

Stage 3 of frozen shoulder

Answer 59

9-15mos reduced pain with shoulder movement severely restricted gh joint motion

Question 60

Stage 4 of frozen shoulder

Answer 60

15-24mos; minimal pain progressive normalization of gh joint motion

Question 61

Type 1 slap lesion

Answer 61

Fraying injury to the superior labrum without detachment of the biceps tendon

Question 62

Type 2 slap lesion

Answer 62

The biceps is detached from the supraglenoid tubercle

Question 63

Type 3 slap lesion

Answer 63

Bucket handle tearing of the superior labrum without detachment of the biceps tendon

Question 64

Type 4 slap lesion

Answer 64

Tear of the superior labrum that extends to the biceps tendon

Question 65

Gold standard for diagnosing slap lesions

Answer 65

Arthroscopy

Question 66

It is used to detect slap lesions

Answer 66

Gadolinium enhanced MRI scans

Question 67

Entrapment of the post interosseous brach of radial nerve that has tenderness 3 to 4cm distal to the lateral epicondyle

Answer 67

Lateral epicondilitis

Question 68

Treatment for lateral epicondilitis

Answer 68

Lateral-counterforce strap or neutral wrist splint

Question 69

In medial epicondilitis, degenerative changes are most frequently found at?

Answer 69

Pronator teres and FCR origins

Question 70

Acute hemmorhagic bursitis resulting from MACROTRAUMATIC insult of the bursa or chronic bursitis caused by repetitive microtrauma; frequently seen in athletes who participate in football or hockey

Answer 70

Aseptic arthritis

Question 71

Olecranon bursitis due to localized systemic infection

Answer 71

Septic bursitis