ED 2 Upper Extremity Flashcards
(33 cards)
where do most clavicle fractures occur? what is the typical MOI?
distal 1/3 of clavicle
“shoulder first” injuries
what carries the worst prognosis in terms of clavicle fractures?
tenting – can convert to open fracture (push that thing down)
if you note pain at the SC joint in your patient with a clavicle fracture, what do you worry about?
additional, deeper injury – it takes a LOT of force to dislocate there
management of clavicle fractures? what will your patient typically have following healing process?
sling and ortho referral
bayonette deformity following healing process
what should you advise your patient to do for the first few nights following clavicle fracture?
sleep upright
your patient presents to your office with a “low hanging” shoulder. he says he fell on his shoulder. what do you suspect?
AC separation
how do we manage AC separations?
sling them
should heal on their own
in which population is a shoulder fracture most common? what is the typical MOI?
elderly, osteoporotic
fall with arm locked, driving humeral head straight up into glenoid
if you notice a scapular fracture on your patient’s x-ray, what should you be thinking?
consider other fractures and injuries, it takes a LOT to fracture a scapula
treatment for shoulder fractures?
sling, refer to ortho (don’t do much for them)
which way do shoulders typically dislocate? in which two circumstances would we see the other direction?
typically anterior
posterior = electrocution, epilepsy
MC mechanisms of shoulder dislocation?
FOOSH, abduction and external rotation (reaching backward in car)
what special test will be positive on PE of a shoulder dislocation?
+ sulcus sign
what might you notice on x-ray of patient who has had multiple shoulder dislocations?
hill-sach’s deformity
what x-ray view must your order to see a shoulder dislocation?
lateral (y view) x-ray
4 reduction techniques for shoulder dislocation? what must you always ensure pre and post-reduction?
1) traction/countertraction
2) stinsons
3) scapular manipulation
4) external rotation
ensure neurovascular fxn intact
when do we get post-reduction films with shoulder dislocations?
for the first dislocation or with obvious trauma
management of shoulder dislocations?
sling and swath
ortho FU
patient presents with very little ROM of their arm, with the inability to bring arm above their head while held out anteriorly. DX?
rotator cuff injury
sling em
which elbow injury carries the worst prognosis due to risk of malalignment?
supercondylar elbow fracture
most common type of elbow injury?
radial head fracture; usually a FOOSH
most common direction of elbow dislocation? how do we reduce?
posterior
pull lower arm towards you while pts arm is flexed and you are pushing back on their humerus
why are elbow injuries a real concern?
BIG risk of neurovascular injury, don’t tolerate abuse well
even if you can’t see a break on x-ray, what may you notice that will clue you into presence of a fracture?
sail sign, posterior fat pad
