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Netter's Orthopaedics > Shoulder/Arm > Flashcards

Shoulder/Arm Flashcards

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1
Q

Lateral vs medial winging?

A

Trapezius - lateral winging (spinal accessory n)

Serratus anterior - medial winging (long thoracic n)

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2
Q

Clavicle fracture groups?

A

Group 1 - Middle 1/3 (most common, 80%)
Group 2 - Distal 1/3
Type 1 - lateral to CC ligaments
Type 2a - medial to CC ligaments
Type 2b - between CC ligaments (conoid torn, trapezoid intact)
Type 3 - fracture into into AC joint
Group 3 - Proximal 1/3

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3
Q

Associated injury with scapula fracture?

A

(85% have associated injuries) - Rib fx #1, pulmonary contusion, pneumothorax, brachial plexus injury

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4
Q

Ideberg classification

A

Glenoid fracture:
Type I: anterior avulsion fracture
Type II: transverse/oblique fx through glenoid, exit inferiorly
Type III: oblique fracture through glenoid, exits superiorly
Type IV: transverse f exits through scapular body
Type V: type II + type IV

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5
Q

Rockwood classification

A

AC separation
I: Sprain
II: AC tear, CC intact
III: AC+CC tears

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6
Q

Hill-Sachs lesion

A

Posterolateral humeral head compression fracture often secondary to multiple anterior shoulder dislocations

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7
Q

Glenohumeral dislocation, most common and associations?

A

Anterior more common (>90%) >90% recurrence if

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8
Q

Neer classifications

A

Proximal humerus fracture

Based on number of free fragments (head, greater/lesser tuberosity, shaft), must be >1cm displaced

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9
Q

Buford complex?

A

Thickened MGHL and absent anterior/superior labrum

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10
Q

Significance of SGHL?

A

resists inferior translation and ER in shoulder abduction

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11
Q

Significance of MGHL?

A

resists AP translation in 45° of abduction

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12
Q

Significance of IGHL (and components)

A

MOST IMPORTANT LIGAMENT
Anterior band of IGHL - resists anterior and infection translation in abduction and ER
Posterior band of IGHL - resists posterior translation in IR and 90o flexion

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13
Q

Superior transverse scapular related nerve/artery?

A

Suprascapular nerve travels UNDER it, suprascapular artery travels OVER it

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14
Q

Impingement sign test

A

Impingement: forward flexion more than 90°, pain=positive

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15
Q

O’brien’s (active compression)

A

O’Brien’s: FF 90°, adduct 10°, resist FF in pronation then supination. More pain with pronation = SLAP tear (or AC)

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16
Q

Apprehension test (shoulder)

A

Apprehension: pain or apprehension on abduction and ER = anterior instability

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17
Q

Cross body adduction

A

Cross body adduction: adduct arm across body. Pain at AC joint = AC joint path

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18
Q

Proximal humerus insertions

A

PLT medial to lateral

Pec major, lat dorsi, teres major

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19
Q

Quadrangular space, triangular space, triangular interval. Borders and contents

A

Quadrangular space: Humerus, teres major, teres minor, long head of triceps. Transmits Posterior circumflex humeral artery and axillary nerve
Triangular space: Teres major and minor, long head of triceps. Transmits circumflex scapular artery
Triangular interval: long and lateral heads, teres major. Transmits radial nerve and profunda brachii (deep artery of arm)

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20
Q

Muscle at risk from anterior approach to shoulder?

A

Subscapularis

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21
Q

Which muscle protects what nerve in posterior approach to shoulder?

A

Teres major protects radial nerve

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22
Q

Draw the brachial plexus

A

do it

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23
Q

Dorsal scapular nerve runs through which muscle

A

middle scalene

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24
Q

Long thoracic nerve travels on which muscle

A

serratus anterior

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25
Which muscles does brachial plexus travel between
between anterior and middle scalene
26
What nerve is at risk in lateral shoulder approach
Axillary nerve
27
What runs in the deltopectoral groove?
Cephalic vein
28
Subdivision of brachial plexus?
``` Roots Trunks Divisions Cords Branches ```
29
Branches off of subclavian
``` VITC,D Part 1) Vertebral a Internal thoracic a Thyrocervical a (Inferior thyroid a., transverse cervical a., suprascapular a.) Part 2) Costocervical a Dorsal scapular a ```
30
When does the subclavian change name
After 1st rib, becomes the Axillary artery
31
Branches of axillary artery
Sixties Teens Love Sex And Pot 1) Superior thoracic 2) Thoracoacromial (Cadavers are dead people = clavicular, acromial, deltoid, pectoral) Lateral thoracic 3) Subscapular - circumflex scapular, thoracodorsal Anterior circumflex humeral (main supply to humeral head) posterior circumflex humeral
32
Artery at risk in subacromial decompression
Acromial branch of the thoracoacromial
33
When does axillary artery name change?
Brachial at the lower border of teres major
34
Defining characteristic of adhesive capsulitis?
decreased active AND passive ROM
35
Bankart lesion?
Anterior inferior labral detachment from glenoid
36
Glenohumeral instability, two types
TUBS trauma, unilateral, Bankart lesion, surgery AMBRI atraumatic, multidirectional, bilateral, rehab, inferior capsular shift helpful.
37
SLAP lesion
Superior labrum (biceps anchor) from anterior to posterior
38
Sprengel's deformity
Small scapula, omovertebral bone connects c-spine to scapula. Associated with Klippel-Feil syndrome, scoliosis, kidney disease
39
``` Anterior (deltopectoral) shoulder approach internervous planes dangers protect nerve with? Complications ```
IN planes: Deltoid, pectoralis major dangers: MC nerve, (retraction of conjoined tendon), cephalic vein, axillary nerve protect axillary nerve with adduction and ER Subscapularis rupture
40
6 portals for shoulder arthroscopy + dangers
``` Posterior - posterior capsule/labrum Anterior superior - CA ligament/artery Anterior inferior - MC nerve Lateral - axillary nerve Wilmington - safe Neviaser (supraspinatus) - Rotator cuff ```
41
Tennis vs golfers elbow
Tennis lateral, golf medial epicondyle
42
What runs in spiral groove?
Radial n
43
Holstein-Lewis fracture? Nerve entrapped?
Distal 1/3 humerus fracture, radial n
44
Supracondylar process ligament entrapping nerve
Ligament of Struthers, entrapping Median n
45
Most susceptible part of radial head + why?
Anterolateral portion of radial head, less subchondral bone
46
Humerus shaft fracture?
Descriptive
47
Distal humerus fracture?
Descriptive (uni/bicondylar, T/y/lambda)
48
Gartland classification
Extension type supracondylar humerus fracture (Posterior displacement, common in peds) I: nondispaced II: partially displaced (post. ctx intact) III: displaced (no ctx intact)
49
Colton classification
Olecranon fracture I: nondisplaced (2mm) + description (avulsed, transvers/oblique, comminuted, displaced) II: Displaced: avulsion, transverse/oblique, comminuted, displaced fx-dx
50
Mason classification
Radial head fx | I: nondisplaced (
51
Risk with olecranon fracture?
ulnar nerve injury
52
Essex-Lopresti fracture?
Comminuted radial head with dislocation of distal RU joint, proximal migration of radius, and tear of IO membrane.
53
Terrible triad of elbow
Elbow dislocation, radial head fx, coronoid fx
54
Most common elbow dislocation?
posterolateral
55
Nursemaid's elbow
Radial head subluxation from annular ligament
56
Bundles of medial ulnar collateral ligament, most important?
Anterior (most important against valgus stress) | posterior, transverse
57
What compresses ulnar n in cubital tunnel?
Arcuate (Osbourne's) ligament
58
Sail sign?
displaced fat pads seen on XR when fracture causes hematoma
59
Ligament of Struthers can compress
Median nerve proximally
60
Arcade of Struthers can comress
Ulnar nerve proximal to cubital tunnel
61
Leash of Henry can compress
radial n/PIN
62
C5, C6, C7 reflexes?
C5 - biceps C6 - brachioradialis C7 - triceps
63
Tennis elbow test
TET: make fist, pronate, extend wrist and fingers against resistance. pain @ lateral condyle = positive
64
Conjoined tendon components (on coracoid process)
Short head biceps, coracobrachialis, pec minor
65
Course of MC nerve in arm
Pierces coracobrachialis, then travels between biceps and brachilais muscles.
66
Course of radial n in arm
Starts medial, spirals posteriorly, and laterally around the humerus in spiral groove and emerges between brachialis and brachioradialis.
67
Course of ulnar n in arm
In medial arm from anterior to posterior compartment across the IM septum into cubital tunnel
68
course of median n in arm
In anteromedial arm, lateral to brachial artery but crosses to become medial.
69
Course of brachial artery in arm
runs with median nerve, then crosses under it to become more midline in distal arm.
70
Innervation of brachialis
Medial is MC nerve, lateral is radial n
71
Where are the 4 places the ulnar nerve can get trapped
IM septum Arcade of Struthers Cubital tunnel FCU fascia
72
Osteochondritis dissecans of elbow, XR findings?
vascular insufficiency to capitellum. Lucency of capitellum
73
Humerus anterior approach. IN plane, dangers
Proximal planes: deltoid, pec major Distal planes: brachialis (radial n lateral and MC nerve medial) Dangers: proximal - axillary n, humeral circumflex artery Distal: radial n, MC n
74
Kocher approach to elbow
Lateral IN planes: anconeus, ECU Dangers: PIN, radial n Keep arm pronated
75
Posterior approach to elbow
No IN plane, olecranon is osteotomizes. | Dangers ulnar n.
76
Bryan/Morrey approach to elbow
Posterior approach. Same as other posterior approach, but leave olecranon, triceps is partially reflected. Dangers: ulnar n.
77
Elbow arthroscopy portals (5) - dangers
Proximal anteromedial - ulnar nerve, MAC Proximal anterolateral - radial nerve Posterocentral - safe (thru tendon) Posterolateral - med and post antebrachial cutaneous n Direct lateral - posterior antebrachial cutaneous n
78
Hawkins test
Hawkins: ff shoulder 90° then IR pain=positive impingement
79
Empty can test
Empty can: pronate arm, resist FF weakness/pain=SS tear or RC tear
80
Drop arm test
Drop arm: FF shoulder 90o, hold. drop=SS tear
81
ER lag sign
ER lag sign: ER shoulder, patient holds. weakness = IS tear
82
Horn blower's test
Horn blower's: ER shoulder in slight abduction. weakness = IS tear
83
Lift off/lag/belly press:
Lift off/lag/belly press: lift hand off back, press on belly. weakness = subscap tear
84
Crank test
Crank: abduct, axial load, rotate. pain = SLAP
85
Speed's test
Speed's: resisted FF of shoulder, pain = biceps lesion
86
Yergason's test
Yergason's: elbow 90o, resist supination and ER, feel biciptal groove. Pain = biceps tendinits
87
Relocation (shoulder)
Relocation: abduct and ER with posterior force to arm. Relief from apprehension = anterior instability
88
Load and shift
Load and shift: axial load with AP translation. increased translation = anterior or posterior instability
89
Jerk test
Jerk: supine, adduct, FF90o, push posterior. pain/apprehension/translation = posterior instability
90
Sulcus test
Sulcus: pull down on adducted arm. Sulcus under lateral acromion = inferior instability
91
Scapular winging
Scapular winging: Push against wall, winging = LTN/serratus anterior weakness, or trap for lateral winging
92
Adson's test
Adson's: Palpate pulse, rotate neck. Numbness/tingling suggests thoracic outlet syndrome (TOS)
93
Wright's test
Wright's: Extend arm, rotate neck away, Numbness/tingling suggests thoracic outlet syndrome (TOS)
94
Spurling's test
Spurling's: lateral flex/axillary compress neck. symptoms = cervical neck pathology
95
Golfer's elbow test
GET: supinate arm, extend wrist and elbow. pain @ medial epicondyle = positive
96
Ligament instability
Ligament instability: 25° flexion, apply varus/valgus stress. Pain or laxity = positive
97
Pivot shift shoulder
Pivot shift: supine, extend elbow, flex shoulder above head, supinate, axial load, valgus and flex elbow. Apprehension, palpable subluxation of the radial head or skin dimpling = positive.
98
Tinel's arm
Tinel's: tap in ulnar groove. Numbness/tingling=positive | Elbow flexion: maximal elbow flexion for 3 mins. Tingling = positive
99
Pinch grip
Pinch grip: pinch thumb and index. Pinching pads = AIN pathology.

Netter's Orthopaedics (7 decks)

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