1st Handout Flashcards
Grade 3 according to ligamentous injury scale?
Tenderness to palpation with significant joint laxity and no end point
In SC joint sprains, 2/3 of the dislocations occurs where? Its causes medial end of the clavicle to become more prominent.
Anteriorly
In SC joint sprains 1/3 of the dislocation occurs where? It has more pain with less prominent medial clavicular end associated with vascular compromise.
Posteriorly
80% of clavicular fx occurs where?
Middle third of the clavicle
Most common cause of clavicular fx
Direct blow to the point of the shoulder
What is the management for clavicular fx with good alignment
Partial immobilization using sling or figure of 8 bandage
Surgical intervention should be considered in clavicular fractures if?
15 to 20mm shortening occurs
Grade 2 according to ligamentous injury scale?
Tenderness to palpation with joint laxity but a good end point
Tenderness to palpation without joint laxity?
Grade 1
It accounts for 9% of all shoulder injuries, are most frequent in males in their 3rd decade of life and usually partial rather than complete
Acromioclavicular joint sprain
MOI of AC joint sprain
Direct trauma from a fall or blow to the acromion
Rockwood classification 1
Mild injury to the AC ligaments, & radiologic evaluation is normal
Rockwood type 2
Torn AC ligaments + intact CC ligaments. Clavicular elevation <25% displacement
Rockwood type 3
Torn AC and CC ligaments, intact deltotrapezial fascia. 25 to 100% increase in the coracoclavicular space
Rockwood type 4
Torn AC and CC ligaments + posterior displacement of the distal clavicle into the trapezius muscle
Rockwood type 5
Torn AC and CC ligaments + rupture of deltotrapezial fascia that will increase in cc interspace >100%
Rockwood type 6
Torn ac and cc ligaments and deltotrapezial muscular attachments; distal of the clavicle below the acromion or the coracoid process
What type of ac joint sprains are usually treated non-operatively
Type 1,2,3
Indications for surgical intervention for type 3 AC CC sprains?
Persistent pain or unsatisfactory cosmetic results
What are the types of sprains that requires surgical treatment
Type 4 ,5,6
It is due to repetitive overload of the distal clavicle
Usually young weight lifters who perform significant amount of bench press and military press.
Osteolysis of the distal clavicle
Often referred as snapping scapula or scapula crepitus
Scapulothoracic crepitus
Three primary types of sounds in scapulothoracic crepitus
Gentle friction
Loud grating sound
Loud snapping sound
Scapulothoracic sound due to physiologic cause
Gentle friction sound
Scapulothoracic creptius; soft tissue disease such as bursitis, fibrotic muscle, muscular atrophy, anomalous muscular insertions, excessive thoracic kyphosis or thoracic scoliosis, scapulothoracic dyskinesis or winging
Loud grating sound
Scapulothoracic crepitus; bony pathology such as osteophyte, a rib or scapular osteochroma, hooked superomedial angle of the scapula, malunion of rib fractures
Loud snapping sound
Repetitive microtrauma and outlet impingement between the acromion and greater tuberosity of the humerus is more common
Rotator cuff tendinitis and impingement
Neer stage 1
Inflammation and edema in the rotator cuff
Neer stage 2
Fibrosis and tendinitis
Neer stage 3
Partial or complete rotator cuff tear
Type 1acromion
Flat
Type 2 Acromion
Curve
Type 3 acromion
Hooked
Internal impingement of rotator cuff is due to what mechanism?
Abducted 90 degrees and maximally externally rotated
Primary impingement of the rotator cuff is due to?
Hooked acromion or thickened acromioclavicular ligament
Rotarorcuff microtrauma is due to?
Eccentric overload of the shoulder external rotators during the deceleration or throwing phase
Define large rotator cuff tears
Usually have acromial distance of less than 7mm and sclerosis on the undersurface of the acromion
Occurs in patients more than 40 years of age with a prolonged history of outlet impingement and rotator cuff disease; “pop” at the time of injury
Long head of the bicipital tendon strains
Rupture of the long head of the biceps brachii tendon will lead to?
Loss of approximately 8% of elbow flexion strength and 21% of supination strength
Best evaluation tool for long head of biceps strain
MRI OR ULTRASOUND
What is the mx for patients who had long head of the biceps strain >40 yrs of age who are relatively sedentary
Sling immobilization for comfort
Mx for patients who had long head of the biceps strain that are young and physically active?
Early surgical intervention
Most commonly seen in athletes who perform shoulder adduction and internal rotation against resistance such as weight lifters and football players
Pectoralis major strain
Humeral head is dissociated from the glenoid fossa and often requires manual reduction
Dislocation
Humeral head translates to the edge of the glenoid beyond normsl physiologic limits, followed by self reduction
Sublaxation
It is due to excessive capsular laxity, is multidirectional, frequently associated with internal impingement of rot cuff
Sublaxation
New injury resulting in sublaxation or dislocation of the gh joint
Acute instability
It is due to repetitive instability episodes
Chronic instability
Gh joint instability resulting from congenital capsular laxity or repetitive microtrauma
Atraumatic instability
Refers to an individual who volitionally subluxes or dislocates hid ot her gh joint
Voluntary instability
Unidirectional instability
Instability only in one direction caused by traumatic event; most frequent type is traumatic anterior instability
Frequently tears the antero inferior gh joint capsule and avulses the inferior glenoid labrum with or without some underlying bone from the glenoid rim
Bankart lesion
Acute anterior gh dislocation associated with fx of the POSTEROLSTERAL apect of the humeral head
Hill-sachs defect
It is due to congenital glenoid hypoplasia or excessive glenoid or humeral RETROVERSION
Posterior gh joint instability
A tear of the posteroinferior glenoid labrum causing separation from the glenoid fossa rim, fx of the posteroinferior glenoid fossa rim
Reverse bankart lesion
It is due to impaction fx of the anterior humeral head
Reverse hill-sachs
Recurrent unilateral joint instability is due to underlying connective tissue disorders such as?
Marfan or Ehlers-Danlos syndrome
Stage 1 of frozen sh
1-3mos; painful shoulder movement minimal restriction in motion
Stage 2 frozen shoulder
3-9mos; painful shoulder movement progressive loss of gh joint motion
Stage 3 of frozen shoulder
9-15mos reduced pain with shoulder movement severely restricted gh joint motion
Stage 4 of frozen shoulder
15-24mos; minimal pain progressive normalization of gh joint motion
Type 1 slap lesion
Fraying injury to the superior labrum without detachment of the biceps tendon
Type 2 slap lesion
The biceps is detached from the supraglenoid tubercle
Type 3 slap lesion
Bucket handle tearing of the superior labrum without detachment of the biceps tendon
Type 4 slap lesion
Tear of the superior labrum that extends to the biceps tendon
Gold standard for diagnosing slap lesions
Arthroscopy
It is used to detect slap lesions
Gadolinium enhanced MRI scans
Entrapment of the post interosseous brach of radial nerve that has tenderness 3 to 4cm distal to the lateral epicondyle
Lateral epicondilitis
Treatment for lateral epicondilitis
Lateral-counterforce strap or neutral wrist splint
In medial epicondilitis, degenerative changes are most frequently found at?
Pronator teres and FCR origins
Acute hemmorhagic bursitis resulting from MACROTRAUMATIC insult of the bursa or chronic bursitis caused by repetitive microtrauma; frequently seen in athletes who participate in football or hockey
Aseptic arthritis
Olecranon bursitis due to localized systemic infection
Septic bursitis
