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Diagnostic Imaging II Exam Two > AC joint to Elbow > Flashcards

AC joint to Elbow Flashcards

1
Q

What are the 3 grades for an AC joint injury?

A

Grade I = mild sprain
Grade II = moderate sprain
Grade III = severe sprain

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2
Q

What is the most common mechanism of injury for an AC joint injury?

A

Landing on top of shoulder

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3
Q

Which AC joint sprain grade appears radiographically normal?

A

Grade I

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4
Q

A Grade III AC joint sprain involves the tearing of which two ligaments?

A

Acromioclavicular and coracoclavicular ligaments

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5
Q

A Grade II AC joint sprain involves the tearing of which ligament?

A

Acromioclavicular

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6
Q

What is the normal range for the space at the distal end of the clavicle (AC joint)?

A

0-5mm

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7
Q

What is the normal range of the space between the clavicle and coracoid process?

A

0-11mm

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8
Q

What special X-ray view of the shoulder can help assess AC join separation?

A

Y-view

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9
Q

How is a severe AC joint sprain treated?

A

Screw through clavicle into coracoid process with resection of clavicle

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10
Q

What is the most common fracture in infants/kids?

A

Middle third clavicle

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11
Q

Which third of the clavicle is least likely to fracture?

A

Medial third

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12
Q

Posterior dislocation of which clavicular joint can be potentially life threatening and why?

A

Sternoclavicular; compression of great vessels

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13
Q

What anatomical structure is pulled up and which is pulled down following a clavicle fracture?

A

SCM pulled up, shoulder droops

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14
Q

How can callus formation following a clavicular fracture lead to a complication?

A

Neurovascular ocmpromise

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15
Q

Which artery is especially at risk of complication following a clavicle fracture?

A

Subclavian (also brachial plexus)

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16
Q

What is the name of the classifications system for humeral fractures?

A

Neer Classification

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17
Q

What is the most common direction for a shoulder dislocation?

A

Anterior (97%)

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18
Q

What is the most common type of anterior shoulder dislocation?

A

Subcoracoid

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19
Q

What are the three subcategories of anterior shoulder dislocations?

A

Subcoracoid, subglenoid, intrathoracic

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20
Q

The type of anterior shoulder dislocation is assessed relative to the position of which bone?

A

Resting place of humerus after dislocation

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21
Q

Does the humeral head usually move inferior or superior with an anterior shoulder dislocation?

A

Inferior

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22
Q

In which direction does the humeral head usually move with a posterior shoulder dislocation?

A

Either stays the same or superiorly

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23
Q

A Bankart lesion is associated with what injury?

A

Anterior shoulder dislocation

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24
Q

Where does the Bankart lesion occur?

A

Inferior aspect of the labrum (avulsion fracture)

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25
Q

What is the name of the injury that results from an anterior shoulder dislocation that is a cortical depression in the posterolateral head of the humerus results from forceful impaction of the head against the anterioinferior glenoid rim?

A

Hill-Sachs lesion (appears as “V” shape depression)

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26
Q

What is a flap fracture (type 4 Neer)?

A

Avulsion of the greater tuberosity by retraction of the rotate cuff

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27
Q

What are the 3 possible mechanisms of injury for a posterior shoulder dislocation?

A

1 direct blow to arm
2 electrical shock
3 convulsive seizures

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28
Q

What is the name of the sign that appears with a posterior shoulder dislocation that is analogous to the Hill-Sachs lesion of an anterior dislocation?

A

Trough sign

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29
Q

What is the different of location between the trough sign and Hill-Sachs lesion?

A

Trough sign = anterior medial surface

Hill-Sachs = posterolateral head

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30
Q

What is the name of the shoulder dislocation where the humerus is dislocated anteriorly and inferiorly with the arm hyperabducted and locked above the head?

A

Luxatio erecta

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31
Q

Why is a luxatio erecta dislocation particularly serious?

A

Increased potential for neurovascular issues

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32
Q

What four muscles make up the rotator cuff?

A

Supraspinatus, infraspinatus, teres minor, and subscapularis

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33
Q

Which muscle is most commonly injured in a rotator cuff injury?

A

Supraspinatus

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34
Q

What is unique about the anatomy of the subscapularis compared to the other rotator cuff muscles?

A

Subscapularis inserts on the lesser tuberosity instead

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35
Q

What is the location of the “critical zone” in reference to a rotator cuff injury?

A

1 cm proximal to supraspinatus insertion at greater tuberosity

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36
Q

Why is the critical zone called that?

A

Area of least vascularization aka most susceptible to tear

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37
Q

The acromiohumeral joint space is narrowed to how many millimeters with a rotator cuff tear seen on X-ray?

A

Less than 6mm

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38
Q

How does a rotator cuff injury change the acromion process?

A

Erosion of the inferior aspect

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39
Q

How does a rotator cuff injury change the greater tuberosity?

A

Flattening and atrophy

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40
Q

What is the best imaging procedure to asses for a rotator cuff tear?

A

MRI (soft tissues)

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41
Q

How does a rotator cuff tear appear on MRI?

A

Area of increased signal intensity (white) between the tendon (aka fluid disrupting continuity)

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42
Q

What is the name for a rotator cuff tear that doesn’t go completely through the tendon but is still visible upon MRI?

A

Intrasubstance tear

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43
Q

What is usually the cause of a scapular fracture?

A

Direct trauma from a fall (also MVA…hard to break scapulas)

44
Q

When a scapular fracture is known, what other anatomy should be assessed for fracture?

A

Ribs (located just anterior to the scapula)

45
Q

What type of fracture is usually seen at either the medial or lateral condyle of the distal humerus in children?

46
Q

What kind of fracture usually causes Volkman’s ischemic contracture?

A

Midshaft humeral fractures due to callus formation leading to neuromuscular issues

47
Q

What are the usual signs and symptoms of Volkman’s ischemic contracture?

A

Cold hands or altered sensation

48
Q

What is the most common elbow injury in children?

A

Supracondylar

49
Q

What is the most common elbow injury in adults?

A

Radial head fracture

50
Q

What is the second most common elbow injury in adults?

A

Olecranon process

51
Q

Why don’t olecranon process fractures occur in children?

A

Aren’t present until teenage years

52
Q

Which elbow fracture sign is only present in adults?

53
Q

Which elbow fracture signs/tools can be used in kids?

A

Positive fat pad sign, radio-capitellar line, anterior humeral line, hockey stick appearance

54
Q

The tools to find elbow fractures are visualized on which X-ray view?

A

Lateral (90 degrees)

55
Q

Which fat pat about the elbow should be able to be seen normal and without fracture?

56
Q

How sensitive is a posterior fat pad sign to an elbow fracture?

57
Q

The anterior humeral line and radio-capitellar lines should intersect what piece of anatomy?

A

Middle 1/3 of the capitellum

58
Q

What is the sail sign?

A

Anterior and posterior fat pad signs visible in elbow region

59
Q

When the radio-capitellar line is projecting into the shaft of the humerus, what is the overall injury?

A

Anterior radial dislocation

60
Q

What is the most common kind of radial head fracture?

A

Vertical fracture without displacement (type 1)

61
Q

What are the types of radial head fractures?

A 
1 = vertical fracture without displacement 
2 = vertical fracture with displacement
3 = comminuted fracture
4 = fracture and dislocation
62
Q

What is another name for a radial head fracture?

A

Chisel fracture

63
Q

Olecranon fractures are usually what kind of fracture due to the mechanism of injury being a fall to the elbow?

A

Comminuted

64
Q

What is the acronym to remember the order in which the parts of the elbow ossify?

65
Q

What is the easiest way to tell if an ossification center is displaced?

A

One part of every growth center MUST be touching the parent bone - if not, then displaced

66
Q

Nursemaid’s elbow usually affects what age group?

A

Toddlers ages 2-5

67
Q

What is the mechanism of injury for a nursemaid’s elbow?

A

Sudden jerk or pull on the hand resulting gin entrapment of the annular ligament by the radial head

68
Q

In which direction is the forearm held in with a nursemaid’s elbow injury?

69
Q

How is reduction accomplished for a nursemaid’s elbow?

A

Supinating the forearm

70
Q

How does the radiograph appear for a nursemaid’s elbow?

A

Normal (reduction is usually the quick fix)

71
Q

What are the 3 most common areas of dislocation in adults?

A

1 shoulder MC
2 interphalangeal
3 elbow

72
Q

What is the most common area of dislocation in children?

73
Q

What is the most common direction for an elbow dislocation?

A

Posterior (90%)

74
Q

What is the most common injury to the forearm?

A

Fracture of both radius and ulna

75
Q

What is a Galeazzi injury?

A

Distal radial fracture with distal radioulnar joint dislocation (ulna remains intact)

76
Q

What is a parry fracture?

A

Ulna fracture (usually in self defense)

77
Q

What is a Monteggia fracture?

A

Fracture of proximal third of the ulna with dislocation of the head of the radius

78
Q

What is usually the mechanism of injury for a Monteggia fracture?

A

FOOSH with forearm in excessive pronation

79
Q

In which direction does the radius usually dislocate?

A

Anteriorly

80
Q

What type of injury is also considered the adult version of Nursemaid’s elbow?

A

Monteggia fracture

81
Q

Greenstick fractures usually occur in what age group?

A

Less than 10 years of age

82
Q

Which has a greater force involved: torus or greenstick fracture?

A

Greenstick

83
Q

Does the concave or the convex side of the bone usually result in the greenstick fracture?

A

Convex (concave is maintained)

84
Q

What is the term for the combination of a greenstick and torus fracture?

A

Lead pipe fracture

85
Q

What is the most common forearm fracture in a child?

A

Torus (6-10 years of age)

86
Q

What is the most common location for a torus fracture of the forearm?

A

Posterior surface of radius

87
Q

What is the “trick” to guessing a child’s age based on presence of carpals on X-ray?

A

Number of carpals minus 1

88
Q

What type of fracture is also known as a reverse Colle’s?

A

Smith’s fracture

89
Q

Which involves the hand extending outward: Colle’s or Smith’s?

90
Q

Which involves the hand flexing inward: Colle’s or Smith’s?

91
Q

Which fracture is also known as the dinnerfork deformity?

92
Q

What is the most common mechanism of injury for a Colle’s fracture and which population does it most commonly affect?

A

FOOSH; elderly

93
Q

What is a Colle’s fracture?

A

Fracture of the distal radius about an inch and a half above the carpals with posterior displacement of the distal fragment

94
Q

What other fracture is often associated with a Colle’s fracture?

A

Ulnar styloid fracture

95
Q

What is the normal degree of palmar angulation seen that is disrupted with a Colle’s fracture?

A

10-15 degrees

96
Q

What is another name for the dinnerfork deformity?

A

Garden spade deformity

97
Q

Which X-ray view is most definitive for a Colle’s fracture?

A

Lateral (view of posterior dislocation)

98
Q

What is a Smith’s fracture?

A

Fracture of the radius one and a half inches from the carpals with volar angulation of the distal fragment (toward the palm)

99
Q

Which involves the hand being displaced anteriorly: Colle’s or Smith’s fracture?

100
Q

Which is more common: Colle’s or Smith’s?

101
Q

What is the mechanism of injury for a Smith’s fracture?

A

Fall onto back of the hand

102
Q

What type of fracture is one of the anterior or posterior rim of the radius with accompanying carpal dislocation?

A

Barton’s fracture

103
Q

What is the mechanism of injury for a Barton’s fracture?

A

FOOSH in the elderly

104
Q

What usually causes a Barton’s fracture in the younger population?

A

Motorcycle accidents

105
Q

Barton’s fractures are best depicted on what X-ray view?

106
Q

What is the location of a Hutchinson’s or Chauffer’s fracture?

A

Radial styloid process

107
Q

On which X-ray view is a Chauffer’s fracture best seen?

Diagnostic Imaging II Exam Two (4 decks)

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