Shoulder Trauma

Question 1

common U/E fractures, particularly in patients older

than 65 years

Answer 1

Proximal humeral fractures

most are isolated and stable

Question 2

70% of proximal humeral fractures occur in

Answer 2

women due to osteoporosis

Question 3

If displaced fracture is present, it increases chances of

Answer 3

AVN of the Humeral Head

Question 4

used for radiologic-clinical correlation and the severity of

the proximal humeral fractures

Answer 4

Neer classification

Question 5

physeal lines that divide proximal humerus

into four parts:

Answer 5

1) the head
2) the greater tuberosity
3) the lesser tuberosity
4) surgical neck and/or the proximal shaft

Question 6

As defined by Neer in 1970, fragments are considered displaced if there is

Answer 6

> 1 cm of separation and/or >45-degrees of angulation of a fragment

(Most fractures are minimally or un-displaced (80% to 85%)

Question 7

80 % of proximal humeral fractures are

Answer 7

minimally displaced

Question 8

One-part Neer fracture

Answer 8

No fragments displaced (80%)

Question 9

Two-part Neer fracture:

Answer 9

One fragment displaced >1cm or 45-degrees (13%)

Question 10

Three-part Neer fracture:

Answer 10

Displacement of the surgical neck and either the greater

or lesser tuberosity (3%)

Question 11

Four-part Neer fracture:

Answer 11

Typically displaced fractures of both tuberosities and
surgical neck (4%)

Question 12

Un-displaced fractures (Neer one-part) should be treated

Answer 12

conservatively (e.g. sling)

Question 13

lucent line and cortical breach with variable degrees of

cortical off-set, angulation, impaction and displacement

Answer 13

Proximal humeral fractures

Question 14

most common Neer two-part fracture

Answer 14

Surgical neck fracture

Question 15

may occur from

Pectoral pull during surgical neck or proximal metaphysis fractures

Answer 15

medial

displacement of proximal fragment

Question 16

Some sources may refer to greater tuberosity Fx as

Answer 16

“Flap

Fracture”

Question 17

Shoulder dislocations

Answer 17

1) Anterior GH dislocation (most common)
2) posterior GH dislocation
3) inferior GH dislocation (Luxatio Erecta)

Question 18

most common shoulder dislocation

Answer 18

subcoracoid Anterior GH

Question 19

Anterior shoulder dislocation usually results from

Answer 19

forced abduction, external rotation and extension

protective falls

Question 20

inferior GH dislocation, also known as?

Answer 20

Luxatio Erecta

Question 21

anterior shoulder dislocation mostly occur to

Answer 21

young men with high-energy injuries

Question 22

types of Anterior dislocations

Answer 22

subcoracoid: most common
subglenoid
subclavicular
intrathoracic: very rare

Question 23

anterior dislocations of the humeral head comes to lie

Answer 23

anterior, medial and

somewhat inferior to its normal location and glenoid fossa

Question 24

complications of anterior shoulder dislocations?

Answer 24

Hill-Sachs deformity/impaction Fx and Bankart lesion

Question 25

Kocher’s manoeuvre can be | performed by

Answer 25

traction and external rotation and then adduction and | internal rotation.

Question 26

dislocation treatment for patient under 40

Answer 26

3-weeks of collar and a cuff shoulder | immobilization

Question 27

dislocation treatment for older patient

Answer 27

collar and a cuff are applied for 48-hours followed by | some attempts to mobilize the shoulder.

Question 28

Posterolateral humeral head impaction fracture as the humeral head pressed against the antero-inferior part of the glenoid

Answer 28

Hill-Sachs lesion

Question 29

Hill-Sachs lesion is often associated with a

Answer 29

Bankart lesion of the glenoid

Question 30

When a Hill-Sachs lesion is identified careful assessment of the anterior glenoid rim should be performed to search for potential

Answer 30

Bankart lesion

Question 31

Hill-Sachs impaction is best appreciated following relocation of the joint especially on what view?

Answer 31

internal rotation view

Question 32

sclerotic vertical line extending from the top of the humeral head towards the shaft

Answer 32

Hill-Sachs lesion (wedge defect may be noted)

Question 33

the wedge defect sometimes found with Hill-Sachs lesions is also called a?

Answer 33

“hatchet deformity”

Question 34

common complication of anterior shoulder dislocation and | is frequently seen with Hill-Sachs impaction deformity

Answer 34

Bankart lesion (may heal spontaneously)

Question 35

Bankart lesion associated with detachment of the

Answer 35

anterior inferior labrum | from the underlying glenoid

Question 36

bankart lesion, labral only

Answer 36

“cartilagenous Bankart"

Question 37

bony bankart with...

Answer 37

detached fragment of inferior glenoid rim

Question 38

less common than anterior and sometimes hard to identify if only AP projections are obtained

Answer 38

Posterior shoulder dislocation (PSD)

Question 39

Posterior shoulder dislocation (PSD) accounts for what % of all shoulder dislocations?

Answer 39

2-4%

Question 40

mechanism of Posterior shoulder dislocation (PSD)

Answer 40

Humeral head is forced posteriorly in internal rotation whilst the arm is being abducted

Question 41

most common cause of Posterior shoulder dislocation (PSD)

Answer 41

Convulsive disorder (epilepsy)

Question 42

known classic but rare cause of posterior shoulder dislocation

Answer 42

Electrocution

Question 43

the preferred view for diagnosis of posterior shoulder dislocation

Answer 43

axillary view

Question 44

absence of what on radiographs is a major clue to posterior shoulder dislocation?

Answer 44

Absence of external rotation of the humeral head on images in a standard shoulder series

Question 45

internally rotated humeral head takes on a rounded appearance

Answer 45

Light bulb sign

Question 46

vertical dense line in medial humeral head indicating impaction by the posterior glenoid

Answer 46

Trough sign

Question 47

with trough sign there will be Loss of normal

Answer 47

semilunar overlap sign on frontal views

Question 48

widened glenohumeral joint > 6 m (important)

Answer 48

RIM SIGN

Question 49

inferior shoulder dislocation is also known as ________ ,

Answer 49

luxatio erecta

Question 50

inferior shoulder dislocation is also known as luxatio erecta because the arm appears to be

Answer 50

permanently held in fixed in an abducted position

Question 51

inferior shoulder dislocation is caused by a

Answer 51

hyperabduction/inferior push of the arm

Question 52

inferior shoulder dislocation is caused by a

Answer 52

hyperabduction/inferior push of the arm

Question 53

in inferior shoulder dislocation the humeral head is displaced directly below, and a little _____ to the glenoid

Answer 53

medial

Question 54

Inferior dislocations have a high or low complication rate

Answer 54

high

Question 55

ACJ injuries usually occur from a _______ or following a fall onto the shoulder with an _______ arm.

Answer 55

direct blow, adducted

Question 56

ACJ injuries are uncommon. | True or false?

Answer 56

false

Question 57

AP and cephalad angled (10-15 degree) view with and w/o weights (10lb) are obtained for?

Answer 57

ACJ injury

Question 58

Surgical intervention on a grade __ ACJ injury should be considered

Answer 58

lll

Question 59

Features of ACJ injury include:

Answer 59

- soft tissue swelling - widening of the AC joint - increased coracoclavicular (CC) distance - superior displacement of the distal clavicle

Question 60

may be the only finding in grade I ACJ injuries

Answer 60

soft tissue swelling

Question 61

normal ACJ space is?

Answer 61

5-8 mm (narrower in the elderly)

Question 62

normal coracoclavicular (CC) distance is?

Answer 62

10-13 mm

Question 63

Normally the undersurface of the acromion should be leveled with the undersurface of the

Answer 63

clavicle

Question 64

Classification commonly used for the radiographic-clinical grading of ACJ injury?

Answer 64

Rockwood

Question 65

Type I Rockwood ACJ injury

Answer 65

AC ligament is sprained | everything else is normal

Question 66

Type II Rockwood ACJ injury

Answer 66

- AC ligament is RUPTURED - CC ligament: sprain - joint capsule: ruptured - deltoid muscle: minimally detached - trapezius muscle: minimally detached - clavicle elevated but not above the superior border of the acromion

Question 67

Type IIl Rockwood ACJ injury

Answer 67

A- C & CC ligaments are RUPTURED - joint capsule: ruptured - deltoid muscle: detached - trapezius muscle: detached - clavicle elevated above the superior border of the acromion

Question 68

Which types of Rockwood ACJ injuries can be treated conservatively?

Answer 68

1 and 2

Question 69

Humeral shaft fractures account for ____ % of all fractures

Answer 69

3-5

Question 70

2-age groups for humeral shaft fracture?

Answer 70

males in their 30's and patients over 65

Question 71

Direct blow to the upper arm usually causes a?

Answer 71

transverse fractures

Question 72

The most common associated injury during Humeral shaft fractures is damage to the

Answer 72

radial nerve in the spiral groove

Question 73

In some cases of a spiral fracture of the humeral shaft its distal fragment may be displaced in such way that its proximal end will be displaced in what direction?

Answer 73

radially (i.e. | laterally)

Question 74

when spiral fracture of humeral shaft causes radial displacement of proximal end, this is called a?

Answer 74

Holstein-Lewis Fx

Question 75

Holstein-Lewis Fx may lead to damage to the

Answer 75

Radial nerve as it passes in the intermuscular | septum

Question 76

location of 30% of Humeral Shaft Fractures

Answer 76

proximal third

Question 77

60% of Humeral Shaft Fractures occur where?

Answer 77

middle third

Question 78

10% of Humeral Shaft Fractures occur where?

Answer 78

distal third

Question 79

most common humeral shaft fractures occur where?

Answer 79

middle third