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Ortho > Shoulder, Elbow > Flashcards

Shoulder, Elbow Flashcards

1
Q

Reason for shoulder instability?

A

Shallowness of glenoid fossa of scapula + lack of support of GH joint provided by weak GH Ligs, transverse humeral lig.

Strength mainly depends on rotator cuff

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2
Q

How to diagnose shoulder instability?

A

Clinically with increased anterior and posterior humeral translation, a sulcus sign, and overall increased external rotation.

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3
Q

Mechanism of shoulder instability?

A

Microtrauma from overuse = overhead throwing, volleyball, swimmers etc
General lig laxity = a/w connective tissue disorders: Ehlers-Danlos and Marfan’s

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4
Q

What is primary role of rotator cuff?

A

Stabilize GH joint by compressing humeral head against glenoid

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5
Q

Treatment for shoulder instability?

A

Non-op = Dynamic Stabilization physical treatment
Op = Capsular shift/stabilization procedure

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6
Q

Signs of shoulder instability in PE?

A

Sulcus sign
Apprehension/relocation test
Ant / post load and shift test
Neer/Hawkins test

Must have instability in 2 or more planes for MDI

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7
Q

Another name for Traumatic Anterior Shoulder Instability?

A

Traumatic Unilateral Dislocations with a Bankart lesion requiring Surgery
TUBS!

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8
Q

How do TUBS occur?

A

Result of anterior force to shoulder while abducted + externally rotated

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9
Q

Commonest injury that comes with TUBS?

A

Bankart lesion
2nd: Hill-Sachs defect

Avulsion of ant labrum and ant band of IGHL from ant inf glenoid.

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10
Q

What does AMBRII recurrent shoulder instability stand for?

A

Atraumatic
Multidirectional
Bilateral
Rehabilitation
Inf capsular shift
Interval closure

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11
Q

Why are inferior shoulder dislocations rare?

A

There are no muscles at the bottom, but deltoids hold the muscle up

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12
Q

What is Hill-Sachs defect?

A

Chondral impact injury in posterohumeral head 2° to contact with glenoid rim.

Present in 80-100% of traumatic dislocations.

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13
Q

Associated injuries of Anterior dislocation?

A

Bankart, Bony bankart, Hill-Sachs
Rotator cuff tear
Fracture-dislocation: proximal humerus
Axillary nerve (mainly)
Axillary artery injury

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14
Q

Late complications of anterior shoulder dislocation?

A

Shoulder stiffness
Unreduced dislocation
Anterior instability

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15
Q

How does anterior shoulder dislocation happen?

A

FOOSH.
Head of humerus displaced anteriorly and glenoid labrum avulses

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16
Q

How does Anterior inferior instability occur??

A

Fall on backward stretching arm.
Arm for

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17
Q

How does Acromioclavicular injury occur?

A

Fall on shoulder with arm adducted.
Upward subluxation of clavicle.

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18
Q

Signs of acromioclavicular injury?

A

AC joint tenderness
Prominent “step” deformity
Scarf test

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19
Q

**

What XR view for Acromioclavicular injury?

A

Stress view. Pt stands holding 5kg weight on each hand. Diff in distance btw coracoid and inf border of clavicle >50% means AC dislocation

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20
Q

Rockwood classification for AC tear?

A

Type 3 = both AC and CC ligs torn. Type 3 onwards need surgery.

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21
Q

Presentation of Sternoclavicular injury?

A

Ant dislocation = Deformity with palpable lump
Post = Impingement on medistinal fractures - dysphagia etc

Pain relieved on ipsilateral head rotation

For ant dislocation, lump increases with arm abduction and elevation.

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22
Q

What can cause winged scapula?

A

Weak serratus anterior!
Fairly obvious bump/step over AC joint.

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23
Q

What is Tennis Elbow?

AKA Lateral Epicondylitis!

A

Overuse injury - tendinosis and inflamm of Extensor Carpi Radialis Brevis

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24
Q

What is Golfer’s elbow?

Medial Epicondylitis

A

Overload at origin of flexor-pronator mass. PT, FCP, FDS, palmaris longus, FCU.

Causes tendinosis + inflamm.

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25
Q

Most common cause of Cubitus valgus?

A

Chronic non-union of fractured lateral condyle.
Comp: Delayed/tardy ulnar nerve palsy

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26
Q

Most common cause of Cubitus Varus?

A

Malunion of supracondylar fracture in childhood.
Can cause nerve palsy

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27
Q

Terrible Triad for elbow dislocations?

A

Posterolateral elbow dislocation
Radial head fracture
Coronoid tip fracture

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28
Q

Common site of clavicle injury? Why?

A

**Junction btw middle 1/3. **
Bone transits from tube to flat area, lack of muscle attachment, little cancellous bone

29
Q

Mechanism of clavicle injury?

A

Fall on shoulder or FOOSH

30
Q

Conservative Mx for clavicle healing?

A

Sling immobilization - PT gentle ROM at 2-4 weeks
Strengthening at 6-10 weeks.

Can only be done if :
<2cm shortening+displacement
<1cm displacement of superior shoulder suspensory complex
No neurovascular injury

31
Q

Who commonly gets proximal humerus fractures?

A

Osteoporotic, post-menopausal women

32
Q

What neurovascular injury can come from proximal humerus fracture?

A

Axillary nerve!
Brachial plexus/artery

33
Q

Can humeral head have AVN in proximal humerus fracture?

A

Yes. A/w anatomical neck fractures

34
Q

Rockwood classificaation for AC joint?

A

1 = AC lig stretched
2 = Partial rupture of AC ligs
3 = Full rupture of AC + CC ligs
4 = Clavicle displaced post over acromion
5 = Clavicle displaced just under skin
6 = Clavicle underneath coracoid

35
Q

What is Essex-Lopresti?

A

Radial head fracture with associated injury to the forearm interosseus membrane and longitudinal instability of DRUJ.

36
Q

Weight distribution in axial loading of extended elbow?

A

40% ulnohumeral joint
60% radiohumeral joint

37
Q

Flexors of elbow?

A

Biceps
Brachialis
Brachioradialis.

Extensor is triceps

38
Q

Ligs in radial head fracture?

A

LCL complex - LUCL, RCL, Annular, accessory lateral collateral
MCL - Ant, post, transverse bundle

LUCL = primary stabilizer to varus and hypersupination stress
Ant bundle of MCL = primary stabilizer to valgus stress

39
Q

Mason classification for radial head fracture?

A

1 = Undisplaced or <2mm, no mechanical block to rotation
2 = Displaced >2mm or angulated, possible mechanical block to forearm rotation
3 = Comminuted and displaced, mechanical block to motion
4 = Radial head fracture with associated elbow dislocation

39
Q

Normal angle of ROM in elbow joint?

A

Flexion Extension = 150°
Pronation = 85°
Supination = 75°

40
Q

Principle for distal radius fracture Mx?

A

Mason 1 = Simple short immobilization with early ROM
Mason 2/3 = ORIF
Mason 3 w comminuted >3 segments = radial head arthroplasty

Terrible triad/Monteggia/Essex Lopresti = arthroplasty
Early ROM impt cuz elbow gets stiff super fast

41
Q

What is Monteggia fracture?

A

Proximal 1/3 ulna fracture a/w radial head dislocation

Rare in adults, mostly children

42
Q

What Lig damaged in Monteggia?

A

Annular lig

43
Q

Bado classification for Monteggia?

A

1 = of prox or mid 1/3 of ulna # with Ant dislocation of radial head
2 = prox or mid 1/3 of ulna # with post dislocation of radial head
3 = Fracture of ulnar metaphysis with lateral dislocation of radial head
4 = Frac of prox or mid 1/3 of ulna + radius with dislocation of radial head in any direction

1 most common in children
2 most common in adults

44
Q

What is Galeazzi fracture?

A

Distal 1/3 radial shaft # a/w DRUJ injury

45
Q

How does Galeazzi occur?

A

FOOSH with forearm in pronation

46
Q

OTA classification for Galeazzi?

A

22-A2.3 = diaphyseal, simple # of radius
A3.3 = diaphyseal, simple # of both bones
B2.3 = wedge # of radius
B3.3 = Wedge # of both bones with DRUJ dislocation

Applicable for both Radius/Ulna #

For Galeazzi means mUST have DRUJ dislocation

47
Q

Signs of DRUJ injury on XR?

A

Ulnar styloid #
Widening of joint on AP view
Dorsal or volar displacement on Lat view
Radial shortening of 5mm or more

48
Q

Complication of Monteggia?

A

Neurovascular injury = PIN syndrome
Unreduced dislocation

PIN Syndrome = radial nerve, motor only

49
Q

Complications for Galeazzi?

A

AIN syndrome - median nerve, motor only

50
Q

Anatomical landmark for radius fracture to be called DISTAL?

A

DISTAL 3cm

51
Q

Neers classification for proximal humerus frac?

A

One-part [no displacement]
2-part [1 displaced part]
3-parts [2 displaced parts]
4-parts [3 displaced parts]

52
Q

Predictor of humeral head ischemia in proximal humerus #

Hint: Hertel criteria

A

<8mm calcar length attached to articular segment
Disrupted medial hinge
Increasing # complexity
Displacement >10mm
Angulation >45°

Humeral head ischemia does not confirm mean subsequent AVN

53
Q

Blood supply for proximal humerus?

A

Ant and post humeral circumflex artery.
Post is main blood supply to humeral head.

Ant branch has large anastomosis with other vessels in prox humerus

54
Q

Complications of humeral shaft frac?

A

Early = Radial nerve function

Wrist drop, MCP extensor paralysis, profunda brachii artery

55
Q

What is Holstein Lewis frac?

A

Spiral frac of distal 1/3 of humeral shaft often a/w neuropraxia of radial nerve

When reduced, radial nerve is impinged in frac site

56
Q

What ROM affected in humeral shaft fracture?

Depends on site!

A

STAR!!! Shortening + Translation + Angulation + Rotated
Frac above deltoid insertion = prox fagment adducted by pec major
Frac below deltoid insertion = prox fragment abducted by deltoid

57
Q

Classification for distal humerus fracture?

A

A = extra-articular supracondylar
B = Intra-articuar unicondylar, partial articular
C = Intra-articular. Both columns fracture and no part of joint is contiguous with shaft

58
Q

Complications of distal humerus #?

A

Early = Neurovascular injury - MN/UN. Check brachial pulse
Late = Elbow stiffness, heterotrophic ossification

59
Q

when to do total elbow arthroplasty in distal humerus frac?

A

Communited articular fracs in osteoporotic bone
Inflammatory conditions e.g. RA

60
Q

What is adhesive capsulitis?

Frozen shoulder

A

Inflammatory process causes fibroblastic proliferation of joint capsule causing thickening, fibrosis and adherence of capsule to itself and humerus

61
Q

What is Frozen shoulder a/w

A

DM
Thyroid disorders (Autoimmune)
Dupuytren’s disease
Atherosclerotic disease
Cervical disc disease

62
Q

Mechanism of Frozen shoulder injury?

A

Idiopathic
Post-trauma
Post-surgical

63
Q

What does frozen shoulder cause?

A

Functional loss of both passive and active shoulder motion

64
Q

Acute calcific tendinitis pathophysiology and symptom?

A

Deposition of calcium crystals in supraspinatus tendon.
Intensely painful but rapidly better

65
Q

Epidemiology of Rotator cuff tendinitis pathos?

Acute calcific tendinitis [ACT] vs Chronic tendinitis [CT]

A

ACT = Young adults <40yo
CT = adults 40-60yo

66
Q

Presentation of chronic tendinitis?

A

Worse at night, cannot lie on affected side

67
Q

Treatment of Frozen shoulder?

A

PT usu enough
NSAIDs + intra-articular steroid injections
Manipulation under anaesthesia [op]
Arthroscopic/open capsular release [op]

68
Q
A

Ortho (11 decks)

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