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Y3(S) - T & O > Shoulder + Humeral Fractures > Flashcards

Shoulder + Humeral Fractures Flashcards

(59 cards)

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1
Q

What is the most common shoulder dislocation?

A

Anterior (95%)

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2
Q

How does a shoulder dislocation present?

A

Loss of normal shoulder contour
Squaring of shoulder
Trauma

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3
Q

What imaging views do you get to assess a shoulder dislocation?

A

X-ray AP, lateral and scapula Y

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4
Q

What is the best radiological image to assess whether a shoulder is anterioly or posteriorly dislocated?

A

Scapula Y view

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5
Q

What nerve is most at risk in a shoulder dislocation?

How is it assessed?

A

Axillary nerve

Regimental badge. Region

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6
Q

What usually causes posterior shoulder dislocations?

A

Seizures
Electrocutions

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7
Q

How does a posterior shoulder dislocation appear on x-ray?

What does the limb look like on examination?

A

Light bulb sign

Internally rotated upper limb

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8
Q

How do you manage a shoulder dislocation?

A

Analgesia
Reduce shoulder
Immobilise in a sling
Physio

Take post reduction imaging and re assess neurovascular status

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9
Q

What are some techniques of shoulder relocation?

A

Kochers
Hippocratic manouvre

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10
Q

What are some complications of shoulder dislocations and relocations?

A

Bony bankart lesions
Hillsacks lesions

Recurrent dislocations
Axillary nerve palsy
Rotator cuff injury
Adhesive capsulitis

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11
Q

What is a bankart lesion?
Bony and non bony

A

Bony = Fracture of anteroinferior glenoid

Usually following shoulder relocation

Non bony = avulsion/damage to anterior glenoid labrum

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12
Q

What is a Hillsachs lesion?

A

H for humeral head

Posterolateral fracture of Humeral Head due to Impaction

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13
Q

What is considered an acute rotator cuff injury?

A

Less than 3 months

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14
Q

What is considered a chronic rotator cuff injury?

A

More than 3 months

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15
Q

What are the 4 rotator cuff muscles?

A

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

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16
Q

What is the function of each of the rotator cuff muscles?

A

Supraspinatus = abduction
Infraspinatus = external rotation
Teres minor = external rotation and Adduction
Subscapularis = internal rotation

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17
Q

What test assess the function of Supraspinatus?

A

Empty can test

(Painful arc test for impingement)

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18
Q

What test assess the function of infraspinatus and teres minor?

A

Arms flexed at 90 degrees with elbow tucked at side and externally rotate against examiner

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19
Q

What test assess the subscapaularis muscle?

A

Hands behind back and patient pushes against examiners hand

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20
Q

What is the pathophysiology of chronic rotator cuff tears?

A

Long term progressive micro tears

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21
Q

What are the risk factors for rotator cuff injuries?

A

Repetitive over the head movements
Old
Trauma
Obesity
Smoking

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22
Q

How do rotator cuff tears present on examination?

A

Unable to abduct past 90 degrees
Tenderness over greater tuberosity
Sometimes Supraspinatus and Infraspinatus atrophy

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23
Q

What imaging is done if a rotator cuff injury is suspected?

A

Urgent plain radiograph to exclude bony involvement

Then US to confirm presence and size of tear

MRI also can be used

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24
Q

When are rotator cuffs managed conservatively?

Study These Flashcards
A

If present within 2 weeks of injury

Not limited by pain or loss of function

Significant co-morbidity

25
What is the conservative managemtn of rotator cuff tears?
Analgesia Physio Activity modification
26
When are rotator cuff tears managed surgically?
Present after 2 weeks since injury occured Too painful Tear to large Conservative failed Can be arthroscopic or open repair
27
What is adhesive capsulitis?
When the Glenohumeral joint capsule becomes adherent to the humeral head causing a frozen shoulder
28
What causes adhesive capsulitis?
Primary = idiopathic Secondary = rotator cuff tendinopathy, subacromial impingement, biceps tendinopathy, previous. Surgery or trauma
29
What is the most common presentation of adhesive capsulitis?
Woman 40-70 Deep constant shoulder pain Reduced ROM Deltoid atrophy Loss of arm swing
30
What are the 3 stages of adhesive capsulitis?
Freezing Frozen Thawing
31
What is the timeline for the 3 stages of adhesive capsulitis?
Freezing (2-9months) Frozen (4-12months) Thawing (12-24months)
32
What is the presentation at each stage of adhesive capsulitis?
Freezing (constant increasing pain with decreasing movement) Frozen (extremely painful cant move) Thawing (pain relieving and movement increasing)
33
What imaging can be used for adhesive capsulitis?
X-ray to rule out ACJ involvement or atypical fracture presentations MRI is good however imaging is not actually required since its a clinical diagnosis
34
What imaging can be used for adhesive capsulitis?
X-ray to rule out ACJ involvement or atypical fracture presentations MRI is good however imaging is not actually required since its a clinical diagnosis
35
What diseases is adhesive capsulitis common with so what can you measure when investigating?
Diabetes (HbA1c) Autoimmune thyroid disease (TSH)
36
What is the managemtn for adhesive capsulitis?
Physio during thawing phase Analgesia Intra-articular corticosteroid injections Surgical =manuipulation under anaesthesia
37
What is the subacromial space?
Space between coracoacromial arch/ligament, humeral head and greater tuberosity of the humerus
38
What causes subacromial impingement syndrome?
Repetitive shoulder movements leading to micro traumas to the rotator cuff tendons Bursitis Degenerative tendiopathy Muscular weakness leading humerus to shift medially
39
Who does subacromial impingement syndrome occur most commonly in?
Active individuals Manual professions
40
How does a subacromial impingement present?
Progressive pain ini anterior superior shoulder Pain exacerbated by abduction
41
What test can be used to check for subacromial impingement?
Hawkins test
42
How do you manage subacromial impingement syndrome?
Analgesia, physio, NSAIDS, corticosteroid joint injections Surgery
43
When is subacromial impingement syndrome managed surgically? What can be done?
If persists 6months after conservative management tried Direct repair of Muscularis tears Remove subacromial bursa Remove section of acromion
44
How does an ACJ dislocation present?
Pain over the AC joint Can have skin tenting
45
What test is positive in ACJ dislocation?
Scarf test
46
What is the scarf test?
Hand on opposite shoulder and you push the elbow back
47
How is ACJ dislocation managed?
Briefly immobilise Want to mobilise again ASAP ORIF for skin tenting or. Failed conservative management
48
What are the risk factors of humeral shaft fractures?
Osteoporosis Increasing age female Previous fractures
49
What nerve is at risk in a humeral shaft fracture?
Radial nerve
50
How can you assess radial nerve damage with humeral shaft fractures?
Finger extension against resistance Dorsum 1st web space
51
How do you manage a humeral shaft fracture?
Reduce fracture Brace Surgical: ORIF (with plate) Or IM nail
52
What age group are supracondylar humeral fractures most common in?
Young children
53
What is the method of injury that usually leads to a supracondylar fracture?
FOOSH with extended elbow
54
What nerves and artery are at risk with a supracondylar humeral fracture?
Anterior interosseous nerve of median nerve (most common) Radial and ulnar nerve Brachial artery
55
How does a patient with a supracondylar fracture present?
Pain Deformity Bruising Swelling Nerve palsy.
56
What imaging is required to assess a supracondylar fracture?
Plain radiograph AP and lateral CT may be required if comminuted or Intra articular fractures suspected
57
What sign is often seen on plain radiograph of supracondylar fractures?
Posterior fat pad sign
58
Why does the anterior interosseous nerve get damaged in a supracondylar humerus fracture despite itts branch being given off more distal?
The AIN fibres are arranged posteriorly within the the median nerve
59
How are supracondylar fractures managed?
Immediate closed reduction if NV status compromised Closed reduction and K wire fixation Above elbow cast

Y3(S) - T & O (7 decks)

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