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CT.MS > Orthopedics: Shoulder and knee > Flashcards

Orthopedics: Shoulder and knee Flashcards

1
Q

What are the four main joints of the shoulder?

A
  1. Acromioclavicular joint
  2. Glenohumeral joint
  3. Scapulothoracic joint
  4. Sternoclavicular joint
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2
Q

Which joints are responsible for shoulder abduction?

A

2/3 is glenohumeral abduction

1/3 is scapulothoracic abduction

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3
Q

What are the components of shoulder stability?

A

Bone conguity
ligamentous stability
muscular stability
–>most of support is from the soft tissues

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4
Q

Which types of acromioclavicular joint injuries are operative?

A

Types IV, V, VI. Excise the distal clavicle and repair the coracoclavicular ligaments.

If not operable, just stabilize.

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5
Q

What is the most common type of acute glenohumeral instability?

A

Anterior dislocation: 98%

Posterior dislocation: 2%

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6
Q

How does the recurrence rate of glenohumeral dislocations vary with age?

A

Younger people have higher rates of recurrence. In contrast, older pts ahve rotator cuff tears

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7
Q

How do you treat glenohumeral anterior dislocations?

A

Reduction and sling immobilization

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8
Q

What nerve is injured in glenohumeral instability?

A

axillary nerve

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9
Q

What is tricky about posterior dislocations?

A

Most are missed at initial presentation. Need an axillary x ray to diagnose

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10
Q

How do you treat a posterior dislocation of glenohumeral joint?

A

Closed reduction and immobilization in external rotation

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11
Q

What’s difficult about young pts with recurrent subluxations of glenohumeral joint?

A

More difficult to diagnose. Less obvious

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12
Q

Bankart lesion

A

When labrum of glenoid is torn from recurrent anterior dislocations

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13
Q

Hill Sachs lesion

A

Lesion of posterior head of humerus from recurrent posterior dislocations

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14
Q

Physical findings of glenohumeral disloations

A

Apprehension sign

Sulcus sign

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15
Q

How do you treat recurrent anterior glenohumeral dislocations?

A

Physical therapy

Operation to stabilize (arthroscopic or open)

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16
Q

How do you treat recurrent posterior glenohumeral dislocations?

A

Aggressive physical therapy, cause surgery is not as successful

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17
Q

What are the sx of rotator cuff disorders?

A
  1. night pain
  2. painful arc of motion
  3. restriction of motion
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18
Q

What is impingement syndrome?

A

coracoacromial arch compresses the rotator cuff muscles

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19
Q

What are the treatments for impingement syndrome?

A
  1. Removing a piece of the acromion surgically

2. Conservative therapy

20
Q

What is calcific tendinitis?

A

Tendinitis in pts with calcium deposits. Consider needle aspiration

21
Q

What is adhesive capsulitis?

A

Thickened capsule around humeral head. Results in limited ROM. Treat with PT, and failure if not working

22
Q

What is your typical pt for rotator cuff tears?

A

Elderly pt after anterior shoulder dislocation

23
Q

What are the sx of acute rotator cuff tears?

A
  1. Normal passive ROM

2. Limited active ROM

24
Q

How do you treat chronic rotator cuff tears?

A

Surgical repair

25
Q

How do you treat biceps tendon ruptures of the long head?

A

No surgery! Because the short head is still holding on…even tho the bulge looks weird

26
Q

First/2nd/3rd degree ligament injury

A
  1. Only tenderness
  2. Joint opens on stress, palpable endpoint
  3. Joint opens on stress, no endpoint. No “stop” to where you would expect ROM to end.
27
Q

Valgus stress causes

A

MCL injry. Common

28
Q

How do you treat MCL?

A

Grade I: symptomatic
Grade II: knee brace
Grade III (completely torn): Brace vs surgery

29
Q

Varus stress causes

A

LCL injury. Less common. Doesn’t heal as well.

30
Q

What is the other common knee injury?

A

ACL. Healing capabilities are poor. Little blood supply

31
Q

Who is at higher risk of ACL injury?

A

Females. Caused by rapid deceleration on a planted foot.

32
Q

Sx of ACL

A

“heard it pop”
Lots of swelling
limited ROM

33
Q

What is the most sensitive test for ACL injury?

A

Lachman test (also known as anteriordrawer test) Can also use pivot shift test

34
Q

What do you see on Xray of an ACL injury?

A

lateral capsular sign

35
Q

How do you treat ACL?

A

Don’t need an ACL unless you are an athlete with rotational movement. MAY prevent future osteoarthritis? Tx based on PATIENT GOALS

36
Q

How do you get PCL injury?

A

Usually a car crash, not thru sports. Operate if multiple ligamentous tears, not if only PCL

37
Q

Definition of knee dislocation

A

Disruption of both cruciate ligaments and at least one collateral ligament

38
Q

When would you get an arteriogram for a knee dislocation?

A

Always. Worry about nerve or arterial injuries

39
Q

What are the PE findings in meniscal injury?

A
  1. Joint tenderness
  2. Effusion
  3. Incomplete extension
  4. Positive McMurray
40
Q

How do you treat patellofemoral syndrome?

A

Quadriceps strengthening exercises.

41
Q

What is patellofemoral syndrome?

A

increased or misdirected mechanical forces between the kneecap and femur

42
Q

What are the sx of patellofemoral disorders?

A

“giving way” of knee
pain on incline/prolonged flexion
Swellin

43
Q

How do you tx patellar dislocation?

A
  1. Reduce. If first time, just immobilize afterwards

2. If recurrent, think about surgery

44
Q

What is patellar tendinitis?

A

Pain at inferior patella. Repetitive stress injury

45
Q

What is osteochondritis dissecans?

A

Separation of bone/cartilage from normal bone. Usually medial femoral condyle

46
Q

What is osgood-schlatter’s disease?

A

Patellar tendon pulls and fragments off a piece of the tibial tubercle

47
Q

What is Sinding-Larsen-Johansson disease?

A

“reversed” osgood-schlatter’s disease. Fragmentation of inferior pole of patella

CT.MS (13 decks)

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