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CORE: MSK > Shoulder > Flashcards

Shoulder Flashcards

1
Q

AC joint injury grading

A

downward blow to lateral shoulder

ligament sprain –> disruption of AC joint capsule and coraclavicular ligaments

  • Grade I: AC ligament sprain. Radiographs are normal.
  • Grade II: Disruption of the AC ligament with intact CC ligaments.
  • Grade III: AC joint and CC ligamentous disruption. CC interspace is widened 25–100% relative to the contralateral side.
  • Grade IV: Distal clavicle displaced posteriorly into trapezius (seen on CT or axillary view).
  • Grade V: Severe grade III injury, with >100% displacement relative to the other side.
  • Grade VI: Inferior dislocation of the distal clavicle.
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2
Q

normal AC joint space , CC joint space

A

< 5 mm, 11-13 mm

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3
Q

MOA anterior shoulder dislocation? posterior?

A

direct force on arm; antero-inferior direction

severe muscle spasm (seizure/electrocution)

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4
Q

best view for anterior shoulder dislocation? posterior?

A

anterior: axillary view
posterior: transscapular Y view or axillary view ; overlap on Grashey vew

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5
Q

site of impaction fracture on humerus head/glenoid

A

anterior inferior glenoid

posterolateral humeral head

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6
Q

Hill sachs lesion, bankart, reverse bankart? ?

A

Hillsachs: compression fracture of humerus
Bankart: anterior inferior glenoid rim
Reverse bankart: posterior glenoid (posterior dislocation)

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7
Q

lightbulb sign? trough sign?

shoulder dislocation

A
  • The lightbulb sign describes the appearance of the humeral head due to the fixed internal rotation of the arm often seen in posterior dislocation.
  • The trough sign describes a compression fracture of the anteromedial aspect of the humeral head, also known as a reverse Hill–Sachs, from impaction of the humeral head on the posterior glenoid rim upon recoil.
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8
Q

luxatio erecta

A

inferior dislocation of shoulder from direct force on abducted arm

asociated with rotator cuff tear, greater tuberosity fracture; injury to axillary nerve/artery

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9
Q

do subacromial and subdeltoid bursa communicate? communicate with glenohumeral joint?

clinical impact?

A

yes, no

arthrogram fluid will extend from glenohumeral joint into bursa with rotator cuff tear

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10
Q

impingement syndrome

A

chronic compression/irritation of structures that pass through the coracoacromial arch (supraspinatus/biceps tendon, subacromial-subdeltoid bursa)

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11
Q

extrinsic impingement shoulder

A

-primary external impingement: variant coracoacromial arch (subacromial enthesiophyte, hooked acromion, ac joint osteophyte, thickened coracromial ligament, os acromiale)

subcoracoid impingement: coracohumeral distance narrows

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12
Q

intrinsic impingement shoulder

A

glenohumeral instability; abnormalities of the rotator cuff/joint capsule

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13
Q

types of acromion shapes, classification

A

Borliani

type I: flat
type II: curved
III: hooked
IV: convex undersurface

III/IV may cause external impingement –> rotator cuff tear

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14
Q

frequency of os acromiale

A

15%; best seen axial view

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15
Q

rotator cuff muscles

A

SITS: supraspinatus, infraspinatus, teres minor, subscapularis

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16
Q

insertion site of SITS

A

SIT: body of scapula and insert on greater tuberosity

subscapularis: anterior to scapula; lesser tuberosity

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17
Q

mucoid degeneration of tendon; without inflammation

A

tendinosis/tendinopathy

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18
Q

MR signal of tendinosis

A

thickening; T1/T2 intermediate signal

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19
Q

magic angle appears on what sequences?

A

short TE sequences (T1, PD, GRE)

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20
Q

what happens to bursa/joint in shoulder with complete tear

A

suacromial-subdeltoid bursa and glenohumeral joint communicate

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21
Q

what is the footprint? critical zone?

A

attachment of tendons at greater tuberosity

potential undervascularized portion of distal supraspinatus tendon (1 cm proximal to insertion on footprint)

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22
Q

most commonly injured rotator cuff muscles?

A

supraspinatus > infraspinatus &raquo_space; teres minor

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23
Q

best way to diagnose partial thickness tear?

A

MR arthrography to show communication of fluid between glenohumeral/subacromial-subdeltoid bursa

partial thickness tear shows abnormal signal in muscle/tendon that does not extend through entire thickness

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24
Q

types of partial tears? most common type?

A

bursal, articular, intrasubstance tear

articular surface

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25
Q

most common type of partial tear?

A

rim rent or PASTA (partial thickness articular supraspinatus tendon avulsion)

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26
Q

what is PAINT tear?

A

partial articular tear with intratendinous extension; partial rotator cuff tear at articular surface that also extends into tendon

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27
Q

most common full thickness tear? associated tear?

A

supraspinatus

30-40% supraspinatus tears associated with infraspinatus

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28
Q

rheumatoid arthritis rotator tuff tear ?

A

migrated superiorly; acromion articulation

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29
Q

classification of full thickness tears?

A

length of tendon affected

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30
Q

Goutallier classification?

A

rotator cuff atrophy; degree of fatty replacement in the SITs muscles

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31
Q

how quickly does rotator cuff atrophy occur?

A

within 4 weeks of injury, usually irreversible

extent correlates with outcome following surgical repair

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32
Q

association with denervation atrophy?

A

paralabral cyst

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33
Q

frozen shoulder?

A

adhesive capsulitis; thickening/contraction of glenohumeral joint capsule due to inflammation of the joint capsule/synovium

34
Q

MR findings of adhesive capsulitis

A

joint capsule/synovial thickness >4mm at the axillary pouch

35
Q

what is the rotator interval?

A

triangular region that allows rotational motion around coracoid process

borders: supraspinatus and subscapularis

36
Q

contents of rotator interval?

A

coracohumeral ligament (CHL), long head bicepts tendon, superior glenohumeral ligament

37
Q

what is biceps pulley?

A

intraarticular biceps tendon + CHL + superior glenohumeral ligament (SGHL)

38
Q

is CHL internal or external to joint capsul?

A

external?

39
Q

connection of SGHL?

A

lesser tuberosity to supraglenoid tubercle of scapula

40
Q

connection of MGHL? always present?

A

lesser tuberosity to supraglenoid tubercle of scapula

congenitally absent 30% pts

41
Q

association with tear of MGHL?

A

superior labral tear

42
Q

connection of IGHL? role?

A

anatomical neck of humerus to inferior glenoid labrum.

important for stability in abduction/external rotation

43
Q

components of IGHL

A

anterior band, axillary pouch, posterior band (seen on sagittal)

44
Q

connection of LHBT

A

anterosuperior glenoid rim along with the SGHL and MGHL

45
Q

biceps tendon origin

A

superior labrum along intertubercular groove; communicates with glenohumeral joint

46
Q

capsuloligamentous complex that stabilizes the biceps tendon?

A

biceps pulley; SGHL, CHL, subscapularis tendon

47
Q

biceps tendon tear association?

A

supraspinatus tear

48
Q

complication in biceps with supraspinatus tear?

A

impingement

49
Q

association with biceps tendon subluxation?

A

injury to transverse ligament (which insert at greater/lesser tuberosities to hold tendon in place)

50
Q

best view biceps tendon dislocation?

association with biceps tendon dislocation?

A

axial MRI –bicipital groove is empty

injury to subscapularis tendon; injury of transverse ligament/pulley

(bicep tears associated with supraspinatus injury)

51
Q

shoulder instability types

A

atraumatic: AIOS (acquired, instability, overstress, surgery) OR AMBRI (atraumatic, multidirectional, bilateral, rehabilitation, inferior capsule shift) congenital joint laxity
traumatic: TUBS, (traumatic, unidirectiona, bankart, surgical)

52
Q

most common instability of the shoulder?

A

anterior instability

53
Q

classification of labral injury

A

using sextants or clock face

54
Q

role of the labrum?

A

fibrocartilage that surrounds glenoid and increases surface/depth of glenoid cavity (suction effect)

55
Q

labral variants

A

sublabral foramen: anterosuperior segment is not attached to the bony glenoid.

Buford complex : ormal variant where a cord-like middle glenohumeral ligament is seen in combination with an absent anterosuperior labrum.

56
Q

bankart lesion vs osseous bankart location

A

anteroinferior labral injury from anterior glenohumeral dislocation; stripping of scapular periosteum

fracture of anterior-inferior glenoid rim; predisposition to recurrent dislocation

57
Q

GLOM sign

A

glenoid labrum ovoid mass sign; labrum migrates superiorly

58
Q

ddx for black intraarticular mass

A

GLOM sign, dislocated biceps tendon, air bubble if MR arthrogram

59
Q

Hill sachs location

A

posterolateral humeral head; anterior dislocation

60
Q

How to find a hill sachs lesion

A

axial images; normal humeral head is round on 3 consecutive slices

posterolateral notch in humeral head, bone marrow edema

61
Q

what does ALPSA stand for?

A

anterior labro-ligamentous periosteal sleeve avlusion; Bankart variant from anterior-inferior labral injury

scapular periosteal is intact

62
Q

which way is labrum displaced in ALPSA?

A

inferomedially; GLOM sign is superiorly displaced

63
Q

What is perthes lesion?

A

avulsion of anterioinferior labrum; labrum attached to scapular periosteum

64
Q

best view for perthes lesion?

A

ABER: abduction, external rotation

65
Q

HAGL? opposite what lesion?

A

humeral avulsion of the inferior glenohumeral ligament at attachment of IGHL

opposite to Bankart, ALPSA, Perthes

66
Q

BHAGL?

A

bony HAGL from avulsion of anatomic neck of humerus

67
Q

posterior instability lesions

A

posterior HAGL (PHAGL), reverse bankart, reverse Hill Sachs/trough sign

68
Q

what muscle tears associated with posterior injuries?

A

infraspinatus, teres minor (insert on posterior aspect of greater tuberosity)

69
Q

congenital cause for posterior instability?

A

hypoplastic posterior glenoid

70
Q

thrower’s exostosis

A

extra-articular posterior ossification associated with posterior labral injury (Bennet lesion)

71
Q

SLAP lesion acronym

A

superior labrum anterior posterior tear; AP oriented tear of the superior labrum centered at biceps tendon

72
Q

SLAP classification, most frequent type ?

A

4 originally, now up to 10

I: fraying of superior portion of labrum ,no frank tear, biceps intact
II: most frequent ; labray fraying with stripping of superior labrum (repetitive microtruam)
III: bucket handle tear
IV: buket handle tear with extension into biceps tendon

73
Q

GLAD

A

glenoid labral articular disruption; superficial tear of anterior inferior labrum

74
Q

complications of GLAD

A

posttraumatic arthritis, intra-articular bodies

75
Q

GLAD occurs at same site as?

A

anterior inferior labrum

same as Bankart, ALPSA, perthes

76
Q

paralabral cysts cause? complication?

A

labral tears; soft tissues adjacent the labrum but may extend into bone

specific finding for labral tear; may cause entrapment neuropathy if they cmopress a nerve

77
Q

quadrilateral space syndrome?

A

posterior aspect of axilla, can result in axillary nerve entrapment –> teres minor paresthesi and atrophy; deltoid can be involved

78
Q

borders of quadrilateral space ? contains?

A

humerus, triceps, teres minor, teres major

contains the axillary nerve, posterior humeral circumflex artery

79
Q

innervation to supraspinatus and infraspinatus muscle

A

proximal suprascapular nerve; distal suprascapular nerve provides motor innervation to infraspinatus muscle only

80
Q

where does suprascapular nerve get entraped? cause?

A

suprascapular notch; entrapment commonly from paralabral cyst with superior labral tear

81
Q

innervation to infraspinatus muscle?

A

distal supraspinatus nerve

82
Q

isolated atrophy of infraspinatus, cause?

A

entrapment of distal suprascapular nerve at spinogelnoid notch

CORE: MSK (13 decks)

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