Upper limb surgical repair Flashcards
(140 cards)
1
Q
Bone on bone contact in the shoulder can lead to (2)
A
osteophytes and osteoarthritis
2
Q
Muscle released in shoulder replacement (tendon)
A
subscapularis
3
Q
muscle released in reverse shoulder replacement
A
deltoid
4
Q
Plane between deltoid and pectoralis major
A
anterior inter nervous plane
5
Q
Deltoid nervous supply
A
axillary nerve
6
Q
Pectoralis major nervous supply (2)
A
medial and lateral pectoral nerves
7
Q
vein in deltopectoral groove
A
cephalic vein
8
Q
groove between deltoid and pectoralis major
A
deltopectoral groove
9
Q
proximal end of deltopectoral groove
A
coracoid process
10
Q
deltopectoral groove is infero lateral to what
A
clavicle
11
Q
what is between cephalic vein, deltoid and pectoralis major (2)
A
fascia over deltoid and pectoralis major
12
Q
once deltopectoral groove is incised what is retracted
A
deltoid
13
Q
once deltoid is retrancted what is incised
A
subscapularis tendon
14
Q
what is inferior to subscapularis tendon
A
vessels
15
Q
where is a drill hole placed when subscapularis is released
A
coracoid process
16
Q
conjoint tendon (2)
A
short head of biceps brachii and coracobrachialis
17
Q
what happens to conjoint tendon
A
released with tip of coracoid process
18
Q
what is between the subscapularis and teres major
A
vessels
19
Q
what happens to vessels inferior to subscapularis
A
clamped
20
Q
once subscapularis is incised what happens to it (2)
A
reflected and sutures put in place
21
Q
once subscapularis is reflected what is incised
A
joint capsule
22
Q
joint capsule is incised to reveal (3)
A
head of humerus, glenoid fossa, posterior glenoid labrum
23
Q
what runs medial to coracoid process
A
axillary sheath
24
Q
what is in the axillary sheath (2)
A
axillary vessels and brachial plexus
25
when is axillary sheath pulled closer to coracoid process
abducted shoulder
26
nerve closest to area of shoulder replacement
musculocutaneous nerve
27
what nerve lies inferior to subscapularis
axillary nerve
28
muscles inferior to axillary nerve (superficial to deep 2)
latissimus dorsi and teres major
29
what moves the area of work away from axillary nerve
shoulder external rotation
30
rotator cuff tears which muscle contracts strongly to attempt abduction
deltoid
31
deltoid contraction but rotator cuff tear what happens (3)
humerus pulled superiorly towards acromion, scapula externally rotated, clavicle elevated
32
what angle allowed in abduction with rotator cuff tear
45 degrees
33
what happens to abduction at 90 degrees with partial rotator cuff tear
unable to hold resistance
34
what can communicate in rotator cuff tear
shoulder joint and subdeltoid bursa
35
what can occur in rotator cuff tear (3)
thickened edematous biceps brachii tendon, retracted tendon, needs to be repaired with surgery
36
bicep brachii tendon repair if edges fresh (3)
notch made in humerus, attach with drill holes, strong sutures
37
Open acromioplasty removes (2)
tip of acromion and most of coracoacromial ligament
38
where is incision made to inspect rotator cuff for tears in acromioplasty
T incision in deltoid
39
what portion of acromion removed in acromioplasty
anterolateral inferior
40
what tool used in acromioplasty
osteotome
41
deltoid reattachment acromioplasty suture origin
acromioclavicular joint capsule
42
deltoid reattachment acromioplasty suture insertion (2)
fibrous stump of coracoacromial ligament or wires and small drill holes in acromion
43
Arthroscopic acromioplasty setup (6)
lateral decubitus position, hips stabilised, padding between knees and ankles, arm extended and abducted, skin traction, screen visualisation
44
what is inserted from arthroscopic acromioplasty (3)
arthroscope, cannula, suction drain
45
where is burr placed
with cannula
46
where is arthroscope placed
below posterior angle of acromion
47
where is the burr and suction drain placed
through cannulas in anterior incision
48
tool used in arthroscopic acromioplasty
power burr
49
how is acromion portion removed arthroscopically
cannula, releasing coracoacromial ligament
50
What is done to observe bursa
burscopy
51
what can burscopy reveal
bursitis
52
inflamed bursa
bursitis
53
subacromial impingement diagnostic features (5)
pain at night, pain with activity, MRI, positive impingement test, weakness
54
no subacromial impingement arthroscopic view (medial to lateral 3)
rotator cuff, biceps tendon, top of humerus
55
what can bone spurs cause (3)
bursitis, tendonitis, rotator cuff tears
56
what happens when bone spur is removed
pressure on rotator cuff released
57
how is rotator cuff attached in arthroscopic rotator cuff repair
sutures and anchors to humerus
58
normal gleno humeral arthroscopic view
biceps tendon
59
abnormal gleno humeral arthroscopic view
torn biceps tendon
60
how are loose bodies from torn biceps tendon removed
grabber
61
average width of sternal end of clavicle
22.6 mm
62
average width of acromioclavicular end of clavicle
21.1 mm
63
at risk average width of clavicle
12.0 mm
64
average at risk length of clavicle
138.4 mm
65
subclavian artery average width
0.42 mm
66
subclavian vein average width
0.33 mm
67
safe trajectory through clavicle
superiorly
68
dangerous trajectory through clavicle
anteriorly
69
dangerous clavicular trajectory at risk elements (superficial to deep)
subclavian vein, scalenus anterior, subclavian artery, brachial plexus
70
what could lead to a proximal humeral fracture
fall
71
what is one way of fixing proximal humeral fracture
plate and screws
72
which nerve runs around the humerus
axillary nerve
73
what is important to do before proximal humeral fracture surgery (2)
measuring and marking nerve
74
At what angle is the nerve felt deep to deltoid, run along the bone
Cobb
75
What is one way to visualise the axillary nerve
arthroscope
76
for proximal humeral fracture repair where is the plate slipped
deep to deltoid
77
where are K wires positioned for proximal humeral fracture repair (2)
top and bottom
78
what is used to reduce shaft to plate in proximal humeral fracture repair
screws
79
Once screws are in place for proximal humeral fracture repair what is done
screws are locked
80
How many screws at top and bottom of plate in proximal humeral fracture repair
4 each
81
In proximal humeral fracture repair what arteries need to be avoided (3)
posterior and anterior humeral circumflex. arcuate
82
Which artery runs in the intertubecular groove of the humerus
anterolateral branch of anterior humeral circumflex
83
what is between the greater and lesser tubercles of the humerus
intertubecular groove
84
which is bigger anterior or posterior humeral circumflex arteries
posterior
85
which artery does the anterior and posterior humeral circumflex arteries branch from
axillary
86
types of proximal humeral fracture repair (3)
3 part, 4 part, valgus 4 part
87
chance of 3 part proximal humeral fracture repair
12-25%
88
chance of 4 part proximal humeral fracture repair
21-75%
89
chance of valgus 4 part proximal humeral fracture repair
8-26%
90
Predictors of humeral head ischaemia (3)
metaphyseal head extension calcar less than 8 mm (97% PPV), loss of integrity of medial hinge, fracture pattern (anatomic neck)
91
When is the humeral head likely not viable for proximal humeral fracture repair
lateral head displacement
92
When will a longer plate be required
proximal and shaft fracture
93
what is a SLAP lesion
superior labral anterior posterior
94
grades of SLAP lesion
I-IV
95
How can SLAP be diagnosed
MRI
96
Paralabral cysts (4)
superior, posterior, inferior, anterior
97
what can be involved with paralabral cysts (2)
suprascapular notch extension, spinoglenoid notch involvement
98
How can paralabral cysts be diagnosed
MRI
99
what is released to reveal spinoscapular nerve
TSL
100
types of clavicular dislocation
I-VI
101
type I clavicular dislocation
acromion inferior
102
type II clavicular dislocation
acromioclavicular ligament torn
103
type III clavicular dislocation
acromioclavicular and coracoclavicular ligaments torn
104
type IV clavicular dislocation
coracoclavicular ligament torn
105
type V clavicular dislocation
acromioclavicular and coracoclavicular ligaments torn, clavicle shifted superiorly
106
type VI acromioclavicular and coracoclavicular ligaments torn
acromioclavicular and coracoclavicular ligaments torn, clavicle shifted inferiorly, distal clavicle behind tendons of biceps brachii and coracobrachialis
107
fixing clavicular dislocation (2)
screw through clavicle and coracoid process
108
Where does the clavicle normally fracture
lateral 1/3
109
What produces a popeye arm
proximal long head of biceps tendon tear
110
What indicates proximal long head of biceps tendon tear
active flexion of elbow
111
what is another name for a torn tendon
avulsed
112
what needs to be reflected for proximal long head of biceps tendon tear repair (2)
deltoid and pectoralis major
113
where are stitches placed for proximal long head of biceps tendon tear repair
biceps tendon and acromion
114
what technique is used for bicep brachii insertion tear repair
pullout wire trapdoor technique
115
where is a trapdoor placed for insertion of biceps tendon repair
radius
116
who came up with pullout wire trapdoor technique
Bunnell, Bovd, Anderson
117
what sutures are used for bicep brachii belly tear
mattress sutures
118
what is a distal humeral fracture called
Holstein Lewis humeral fracture
119
What is at risk with a Holstein Lewis humeral fracture (2)
lateral intermuscular septum and radial nerve
120
Which shoulder dislocation occurs 30% of the time
anterior inferior
121
dislocated shoulder can result in
proximal humeral fracture
122
what happens secondary to axillary nerve injury
deltoid wasting and weakness
123
Hilton's law (3)
nerves supply a muscle moving a joint, nerves supply articular branches to joint, nerves supply skin overlying muscle insertion
124
Axillary nerve roots
C5-C6
125
dorsal scapular nerve roots
C5
126
Subclavius nerve roots
C5-C6
127
Suprascapular nerve roots
C5-C6
128
Lateral pectoral nerve roots
C5-C7
129
Musculocutaneous nerve roots
C5-C7
130
Radial nerve roots
C5-T1
131
Median nerve roots
C5-T1
132
Ulnar nerve roots
C7-T1
133
Upper subscapular branch nerve roots
C5-C6
134
medial antebrachial cutaneous nerve roots
C8-T1
135
lower subscapular nerve roots
C5-C6
136
thoracodorsal nerve roots
C6-C8
137
medial brachial cutaneous nerve roots
T1
138
medial pectoral nerve roots
C8-T1
139
long thoracic nerve roots
C5-C7
140
to longius colli and scalene nerve roots
C5-C8
