Exam 1 Flashcards
(132 cards)
1
Q
Where is the groove for the biceps tendon
A
between the greater and lesser tuberosities of the humerus
2
Q
what are the trauma views of the shoulder
A
AP with external rotation, AP with internal rotation, axillary/scapular Y
3
Q
What does the AP with shoulder in external rotation visualize
A
greater tuberosity in profile
4
Q
What does the AP with shoulder in internal rotation visualize
A
lesser tuberosity in profile
5
Q
what is the axillary view of the shoulder good for diagnosing
A
posterior dislocations
6
Q
What are the 4 sites of proximal humerus fracture
A
Surgical neck, anatomic neck, greater tuberosity, lesser tuberosity
7
Q
which is the most common site of proximal humerus fracture
A
surgical neck
8
Q
describe the location of the anatomical neck of the humerus
A
end of the humeral head cartilage and where the capsule attaches
9
Q
what type of fracture commonly coexists with a humeral anatomical neck fracture
A
surgical neck
10
Q
what are the two mechanisms of injury for a greater tuberosity of the humerus fracture
A
direct blow (young patient) or dislocation (older patient)
11
Q
which type of proximal humerus fracture is rarely found in isolation
A
anatomical neck and lesser tuberosity
12
Q
what two injuries commonly occur with an anterior GH dislocation
A
Fracture of glenoid/labral tear (Bankart), posterolateral fracture of humeral head (Hill Sachs)
13
Q
what is the most common mechanism of injury for a posterior shoulder dislocation
A
Seizure/electrocution
14
Q
what is the radiographic challenge of a posterior GH dislocation
A
the shoulder is locked in internal rotation so it may be missed on AP views; axillary view is needed
15
Q
Bankart fracture AKA
A
glenoid fracture
16
Q
Labral tear aka
A
Bankart tear
17
Q
Hill Sachs fracture
A
posterolateral humeral head
18
Q
Neer classification
A
1-4 part based on number of displaced segments
19
Q
what is the most common shoulder dislocation
A
anterior
20
Q
inferior GH dislocation aka
A
luxatio erecta
21
Q
inferior GH dislocation presentation
A
arm is locked above their head
22
Q
grade 1 AC separation
A
tenderness over the AC joint, normal x-rays
23
Q
grade 2 AC separation
A
AC joint is torn but coracoclavicular ligament is intact (AC joint is separated but clavicle isn’t elevated)
24
Q
grade 3 AC separation
A
AC joint and coracoclavicular ligaments are torn (joint is separated and clavicle is elevated)
25
grade 4 AC separation
something goes posterior
26
grade 5 AC separation
Clavicle is tenting skin
27
common fracture sites of clavicle
mid clavicle, distal, and AC joint
28
what is challenging about a medial third clavicle fracture
difficult to see on x-ray
29
radiograph views for elbow
AP, lateral, oblique
30
which view of elbow is most important
lateral
31
where does the radial head articulate
capitulum
32
what do the fat pads look like in a normal elbow radiograph
anterior is visible but flat and posterior is obscured
33
what do the fat pads look like in an elbow radiograph with effusion
anterior: sail sign, posterior: visible
34
what do signs of an elbow effusion usually mean in an adult
radial head fracture
35
what do signs of an elbow effusion usually mean in a child
supracondylar fracture
36
what is the normal mechanism of injury for an olecranon process fracture
direct blow due to fall
37
why are olecranon process fractures usually displaced
the bone fragment is pulled away by the triceps (olecranon process is attachment point)
38
Nightstick fracture
exception to the ring rule, isolated fracture to distal ulna due to sharp blow
39
If the distal radius is fractured, what is dislocated?
distal radioulnar joint
40
if the proximal ulna is fractured, what is dislocated?
radiocapitular joing
41
if the radial head is comminuted, what is dislocated?
distal radioulnar joint
42
name for proximal ulnar fracture and radiocapitular dislocation
Monteggia
43
name of distal radius fracture and DRUJ dislocation
Galeazzi
44
name for comminuted radial head and DRUJ dislocation
Essex lopresti
45
most common fractures of the wrist
distal radius and ulnar styloid
46
clinical presentation of scaphoid fracture
snuffbox tenderness
47
best view for scaphoid fracture
ulnar deviation (navicular)
48
what can happen if a scaphoid fracture is missed
nonunion, AVN, and arthritis
49
what if scaphoid fracture is suspected but negative x-ray
splint and re-image in 1-2 weeks
50
what is normal position of ulna
slightly negative variance (shorter than radius)
51
what can happen with positive ulnar variance
ulna is longer than radius, can cause triangular fibrocartilage tears with cartilage loss and cystic changes (ulnar impaction into lunate)
52
what can happen with negative ulnar variance
puts stress on lunate and can cause osteonecrosis
53
Keinboch's disease
AVN to lunate caused by negative ulnar variance
54
what is the most common MOI for distal radius injuries
FOOSH
55
method of characterizing distal radius injuries
Fryckman classification
56
Name for a distal radius fracture with dorsal angulation
Colles fracture
57
Name for a distal radius fracture with volar angulation
Smith's fracture
58
which distal radius fracture is more likely to need hardware, Smith's or Colles
Colles
59
What is a Barton fracture
an intraarticular distal radius fracture that only involves a fragment of the bone but can appear as a dislocation on x ray because its displacement drags carpal bones along with it
60
name for radial styloid fracture
Hutchinson/Chauffeurs
61
X-ray finding for scapholunate dissociation
wide gab between scaphoid and lunate (David Letterman sign)
62
major risk with scapholunate dissociation
wrist won't move as a unit (SLAC) wrist and will lead to arthritis if untreated
63
x-ray views for hand
AP/lateral/oblique
64
what is a boxers fracture
5th metacarpal neck
65
what is a Bennett fracture
intraarticular fracture at the base of the first metacarpal (at carpal-metacarpal joint)
66
what is a Rolando fracture
a comminuted fracture at the same location as Bennett fracture
67
what is major sequelae of Rolando fracture
early arthritis
68
what is Gamekeeper's thumb
ulnar collateral ligament tear of first MCP joint
69
imaging considerations for gamekeeper's thumb
may have normal radiograph with or without fracture
70
MOI for gamekeepers thumb
hand stuck on pole plant when skiing, pulling thumb back
71
AVN consideration for scaphoid fracture
in the scaphoid waist, the more proximal the fracture, the more likely to get AVN of the proximal pole and subsequent nonunion
72
Most common carpal fracture
triquetral
73
which view to use to see triquetral fracture
lateral
74
what is a tuft fracture
a blunt crushing injury to the tip of the finger, generally nondisplaced
75
treatment consideration with tuft fracture
if nailbed is injured, it is an open fracture with infection risk
76
distal and middle phalanx lip fractures considerations
flexor/extensor tendons may be avulsed and splinting must take tension off
77
which pathogen is most common in dog bites
pasteurella canis
78
what causes Boutouneirre deformity
PIP flexion and DIP extension, can be caused by laceration involving the tendons, direct blow to DIP joint, osteoarthritis. Proximal phalanx buttonholes between the bands of the extensor tendon
79
combination of what forces to cause an anterior shoulder dislocation
abduction, extension, external rotation
80
combination of what forces to cause a posterior shoulder dislocation
adduction, extension, internal rotation
81
articulation of olecranon process
trochlea and olecranon fossa
82
physical exam findings of Monteggia fracture
radial head displacement into AC space
83
torus/buckling fracture force
compression
84
most common elbow fracture in adults
radial head fracture
85
what view is necessary for triquetral fracture
lateral
86
4 muscles of rotator cuff
supraspinatus, infraspinatus, subscapularis, teres minor
87
radiograph finding of GH arthritis
"goat's beard" osteophyte off inferior humerus
88
presentation of AC arthritis
pain with cross-body adduction, tenderness over AC joint, bony prominences over AC joint
89
operative treatment for AC arthritis
distal clavicle resection
90
presentation of adhesive capsulitis
loss of internal rotation in abduction, gradual loss of flexibility
91
imaging findings of adhesive capsulitis
x-rays are often normal, MRI shows lack of axillary recess and soft tissue scarring and contracture w/o known cause
92
risk factors of adhesive capsulitis
diabetes, thyroid conditions
93
conservative treatment for adhesive capsulitis
PT with elbow at the side, NSAIDs, steroid injections
94
advanced treatment for adhesive capsulitis
manipulation under anesthesia, arthroscopic release
95
imaging findings for rotator cuff tear
x-rays often normal, bright spot in rotator cuff on mri
96
sequelae of rotator cuff tear
cuff tear arthropathy
97
presentation of rc tear
pain with overhead motion and at night
98
post-surgical recovery time of rc tear
8-12 weeks
99
what percentage of rc tear pts improve with PT
75%
100
infraspinatus test
elbows flexed to 90, external rotation
101
subscapularis test
elbows flexed to 90, internal rotation
102
supraspinatus test
Jobe's test
103
supraspinatus tear test
drop-arm test (snow angel, arm will drop)
104
supraspinatus impingement tests
Neers, Hawkins
105
test for biceps tendon or labral pathology
press down on flexed, straight arm while pt tries to bring wrist to shoulder (Speeds test)
106
labral tear test
arm outstretched with thumb down, resist downward pressure, repeat with thumbs up (Obriens)
107
teres minor test
horblowers test
108
imaging finding for calcific tendonosus
fluffy white cloud on x-ray
109
pathology of calcific tendonosus
deposition of calcium in rotator cuff
110
sulcus sign
odd contour of shoulder present with shoulder dislocation
111
significance of continued instability after shoulder dislocation immobilization
likely bankart lesion
112
how long to immobilize dislocated shoulder
several days
113
pathology of multidirectional instability of shoulder
ligament laxity
114
presentation of multidirectional instability of shoulder
anterolateral shoulder pain with clicks and pops
115
imaging of multidirectional shoulder instability
x-rays are usually normal, extra fluid may be seen in joint capsule on MRI
116
treatment for multidrectional shoulder instability
PT (no surgery)
117
Presentation of AC separation
tenderness over AC joint and abnormal shoulder contour
118
treatment for AC separation
if grade 1-2, immobilize in sling for 3 weeks
119
MOI for AC separation
direct blow to shoulder
120
operative treatment for AC separation
grade 3-6, ORIF or ligament reconstruction
121
recovery from AC separation surgery
no ROM for 6 weeks, full use at 6 months
122
imaging for clavicle fracture
AP radiograph
123
treatment for clavicle fracture
sling 2-4 weeks if stable, ORIF if unstable, open, comminuted, displaced
124
Imaging for scapular fracture
AP, scapular, axillary radiographs
125
treatment for scapular fracture
sling for 2 weeks with early ROM
126
nerve damage in proximal humerus fractures
axillary nerve (possibly brachial plexus if high energy)
127
nerve damage in midshaft humeral fractures
radial nerve
128
nerve damage in distal humerus fractures
ulnar nerve
129
tx for proximal humerus fractures
sling and PT
130
tx for midshaft humerus fractures
coaptation splint
131
tx for distal humerus fractures
requires surgery
132
presentation of biceps tendonitis
anterior shoulder pain, tenderness at biceps groove
