[AC] Orthopaedics Upper Limb

Question 1

The rotator cuff functions as two muscles divided by the biceps tendon

1) Anterior .. ?
2) Poster … ?

Answer 1

1) Anterior - Subscapularis

2) Posterior - Supraspinatus , infraspinatus, teres minor

Question 2

With rotator cuff dysfunction (infero-medial pull of humerus), the superior directed pull of the deltoid predominates which can lead to:

Answer 2

1) Cuff fatigue
2) Tendinopathy
3) Partial tears
4) Full thickness tears

Question 3

Post op rehabilitation principles remain constant regardless of whether the patient has had post injury or post surgery with specific focus on what areas (for shoulder surgery) ?

Answer 3

1) Rotator cuff
2) Biceps
3) Deltoid
4) Capsuloligamentous complex (CLS)
5) Scapulothoracic muscles (serratus anterior, rhomboids, trapezius etc)

Question 4

Pre-requisites for post op rehabilitation of shoulder?

Answer 4

1) Patient must be compliant with program
2) Surgeon must provide therapist with surgical findings, modifications and precautions
3) Therapist must interact with surgeon regarding patients progress

Question 5

Isometric short arc to long arc; sub maximal to maximal are some ideas of progression of exercises for

Answer 5

post op shoulder rehabilitation

Question 6

Rehabilitation program is individualised based on what for post - op shoulder?

Answer 6

• Tissue reactivity / elasticity
• Personality / goals
• Surgical concerns / complications

Question 7

Results of conservative therapy is dependent on the status of cuff:

Answer 7

1) Cuff intact gives generally greater than 80% satisfactory results
2) Cuff torn generally 50% or worse results

Question 8

With rotator cuff tears, most patients are encouraged to continue exercises for at least how long?
How long is recommended for return to sports?

Answer 8

Continue exercise for at least a year

Return to sports 6-9 months

Question 9

What is the recurrence rate following shoulder dislocations? (ACC Shoulder Guidelines)

What does this mean?

Answer 9

Aged 11 - 20 years = 94%
Aged 20 - 30 years = 79%
Aged >40 years = 10%

So recurrence rate is much higher for those aged under 20 and thus we may refer for stabilisation surgery

Question 10

What is the predominant clinical feature of glenohumeral arthritis?
What is the primary indication for surgery?

Answer 10

Pain

….Pain

Question 11

Comment on the prevalence of total shoulder placement surgery in comparison to knee and hip?

Answer 11

Shoulder joint replacement surgery is NOT common but we will encounter it

Question 12

After total shoulder joint surgery patients are usually in a

Answer 12

polyswing; which limits arm movement away from the body

Question 13

What is the common cause of an olecranon fracture?

Answer 13

Fall and land on point of elbow

Question 14

What is a complication of a shaft of humerus fracture?

Answer 14

Radial nerve palsy; as it wraps around the humerus.

Results in loss of wrist extension

Question 15

diagnosis of a scaphoid fractures can involve?

Answer 15

1) Compression test
2) Anatomical snuff box tenderness
3) Scaphoid tubercle tenderness

Question 16

A rupture of extensor pollicis longus resulting in a loss of thumb extension can be associated with what kind of fracture?

Answer 16

Distal radius fracture as it wraps around listers tubercle before turning 45 degrees towards the thumb

Question 17

What patient group would a distal radius fracture be more common in?

Answer 17

Elderly…more common in women

Question 18

Quality of bone stock…

Answer 18

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