L4 UE Flashcards
(75 cards)
1
Q
Y view
A
plain film with the patient rotated to look for suspected shoulder dislocations or fractures of scapula
2
Q
Axillary view
A
plain film with arm abducted and beam is focused through the axilla with the film cartiridge on the superior aspect of the shoulder
3
Q
Impingement due to rotator cuff
A
ultrasound is recommended along with plain radiography
MRI is used when ultrasound is not available
4
Q
CT of shoulder is useful for
A
complex fracture dislocation injuries of the shoulder, as pre-surgical tool
5
Q
Plain Radiography for shoulder
A
- initial investigation of choice for all shoulder problems
- can detect most fractures, dislocations, calcific tendonitis, arthritis, tumor
*shoulder trauma should hav ≥ 3 views. Usually axillary, scap, y-view, AP
6
Q
Ultrasoundography for shoulder
A
- best for full thickness rotator cuff, less sensitive in partial thickness
- ultrasound is better than MRI, only if the user is experienced. Still only best for full thickness
- useful for long head of biceps
7
Q
MRI in shoulder
A
- highly accurate with full thickness RCT
- used when further investigation of RCT is needed i.e causes of the impingement
8
Q
MRI Arthrography
A
- involves an MRI following injection of contrast agent
- most accurate for rotator cuff pathology
9
Q
CT for shoulder
A
- better for complex fractures and dislocations
- contrast agent can be used, MRI is now replacing this option
10
Q
Views for shoulder
A
AP–IR/ER
Scapular Y view (Post)
Axillary
West point
Stryker Notch
Zanca view
11
Q
Scapular Y View
A
good for scapular fracture and dislocation
shows posterior view
12
Q
Axillary View
A
best view to determine the direction of dislocation
13
Q
West Point View
A
shoss anterior inferior glenoid. demonstrates bony bakart lesions and hill sachs lesions
individual is in prone, with shoulder abducted to 90°
14
Q
Stryker Notch View
A
- evaluates posterolateral humeral head
- demonstrates hill-sachs lesions
- patient is supine, shoulder flexed above head, x-ray goes through armpit
15
Q
humeral head migration should be less than
A
3 mm
normal is between 7-10 mm
16
Q
Zanca view
A
- 10-15° cephalic tilt
- best to view to evaluate joint displacement and intra-articular fractures of the AC joint and clavicle
- patient is standing , and x-ray comes in at the chest
17
Q
Most common shoulder fractures
A
clavicular
humeral
glenoid
scapular
18
Q
Clavicle Fractures
A
- most common shoulder fractures
- harder to heal in adults
- most occur in the middle 1/3
19
Q
Scapular Fractures
A
- most common are body or spine fx, usually results from a severe direct blow
- other types include acromion, neck, glenoid, coracoid
20
Q
Acromion fracture
A
results from downward blow to the shoulder. superiorly displaced fractures may occur as result of a superior dislocation of shoulder
21
Q
Neck fracture
A
direction anterior or posterior blow to shoulder
22
Q
Glenoid fracture
A
comes from fall onto flexed elbow, direct lateral blow
23
Q
Coracoid Fracture
A
results from direct blow to superior point of shoulder or humeral head. or results from avulsion fracture
24
Q
Humerus Fractures
A
- proximal fractures are common
- MOI = direct trauma to arm or shoulder or axial load transmitted through the elbow
- bruising is common, radial nerve can be damaged if the spiral groove is fractured
- older adults are common because of osteoporosis
- 4-5% of all fractures
- RC attachments influence degree of displacement
25
Anatomical neck
residual epiphyseal plate
26
Surgical Plate
bony constriction at proximal end of shaft of humerus
27
Most fractures through head of humerus are
type 1 or type 2 of salter-harris
28
Shoulder dislocations
* most are anterior from glenoid
*y-view should humeral head dislocation
29
Factors with high SNOUT for fracture + dislocation of shoulder
1. 40 yo+ and humeral ecchymosis
2. 40 yo+ and first episode of dislocation
3. <40 yo and MOI other than fall or atrauma
30
Hill-sachs lesions
* defect in posterio superior humeral head
* chondral or osteochondral
* indentation from where humeral head was resting on anterior rim of glenoid
31
MRI with contrast is done in what view?
anterior approach and arm in moderate external rotation
32
MRI with contrast is done to evaluate
* labral tears
* capsular disruptions
* articular cartilage defects
* proximal biceps tears
33
Signs of RCT
* visualization
* high T2 signal tracking through RC
* injected contrast in subacromial bursa
Indirect: fluid in subacromial bursa, high riding humeral head
34
Bankart Lesion
anterior or anteroinferior labral tear
* acute or chronic
* often assoicated with anterior capsular or IGHL disruption
35
Benign Bone Lesions
* small size
* no periosteal reaction
* sharp zone of transition between bone and lesion
* thin, well-defined sclerotic margin
36
Malignant Bone Lesions
any lytic lesion without sclerotic margin should be considered malignant
often have sunburst view
37
periosteal reaction
* thickening of the periosteum, appears white on x ray
* seen with normal healing fracture, osteomyelitis, tumors
* radiating is worrisome for malignancy
38
Elbow extension test
patients unable to fully extend their elbows indicate that they have a bone injury/fracture
39
Elbow plain film views
* AP view
* Lateral view w/elbow flexed to 90°
40
Lateral view on elbow shows
anterior fat pad may be seen and should be adjacent to the bone
posterior fat pad indicated pathology
41
What nerves and arteries could be injured with elbow fracture?
Brachial, Radial, Ulnar
42
Elbow Trauma
lateral view is best
* displacement of anterior fat pad or presence of posterior fat pad indicates a fracture
43
Elbow ossification sequence
CRITOE --> capitulum, radial head, internal/medial epicondyle, trochlea, olecranon, external/lateral epicondyle
ossification usually complete by mid-teens
44
What is the most common fracture of the elbow?
radial head
45
FOOSH
escessive force in a closed pack position leads to bony failure
46
if FOOSH force is through radius
radial head on capitulum, causing radial head fracture
47
If FOOSH force is through the ulna,
ulna on humerus, fracture of either coronoid or olecranon
48
radial head fractures
* mechanical considerations --> axial loading, valgus impaction, or combo
may need fixation or it is unreconstructable
49
Proximal Radius Fx
* most common elbow fx in adults
* difficult to see a non-displaced radial head, may need oblique view
50
Capitellum Fractures
* mechanical forces = longitudinal foces, valgus impaction
* associated injuries include medial elbow, radial head, distal humerus, wrist
* three different types
51
Supracondylar Fracture
* 60% of all peds elbow fx
* 96% extension injuries, including FOOSH hyperextension
* 10% have a nerve injury (radial >median>ulnar)
52
Subluxation of radial head
* most common traumatic elbow injury in peds population
* results from pull on extended pronated arm
* "nursemaid's elbow)
53
Fractures of the forearm
nightstick
monteggia
galeazzi
greenstick
54
Nightstick fx
fx of midportion of ulna
55
Monteggia Fx
fx of proximal ulna with dislocation of radial head
56
Galeazzi Fracture
fx of distal radius with dislocation of ulnar head from the wrist
57
Greenstick fracture
incomplete fx due to flexibility of young bones
one side of bone breaks from a distraction force and other side bends but stays intact
58
Wrist and Hand plain film views
include AP, lateral, and oblique, scaphoid view
59
Scapholunate Angle
dorsal instability >70
Volar instability < 30
60
The scaphoid lunate gap should be less than
3 MM
61
Terry Thomas Sign
dislocation of scapholunate ligament
62
Colles' fracture
* most common fx of wrist
* fx of distal radius with dorsal angulation of distal fragment
* includes fx of ulnar styloid
* MOI = FOOSH
* dinner fork deformity
* extension fracture of radius
63
Smith Fracture
* reverse of colles' fracture
* distal fragment is angulated towards the palmar surface
* flexion fracture of radius
64
Torus Fracture
* know as buckle fracture
* compression fracture in children, in radius
65
Scaphoid Fracture
* most common fracture of carpals
* often difficult to see on initial plain films
* can lead to avascular necrosis of scaphoid
* CT scan is best, bone scan is also good
66
Screening for scaphoid fracture
* snuff box tenderness
* scaphoid tubercle tenderness
* longitudinal compression
HIGH snout 100%, high spin
67
Common fractures of metacarpals include
boxer's fracture
bennet and rolando's
68
Boxer's fracture
fx of 5th MC
often with displacement or angulation
69
Bennett fracture
fx of the base of the 1st MC, moi is forced abduction
70
Rolando Fracture
MC base fracture with 3 fragments, falling with flexed thumb
71
Common finger fractures
* gamekeeper's fracture
* volar plate freacture
* mallet finger deformity
72
Gamekeeper's fracture
* avulsion fracture of the base 1st phalange
* MOI is HE of thumb
73
Volar plate fracture
avulsion fracture of the base of the palmar surface of a phalange
74
Mallet Finger
avulsion fracture at the base of the DIP or tear of the ED at the DIP
75
Signet Ring Sign
shoes a subluxed scaphoid
