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Musculoskeletal > Elective Upper Limb Surgery > Flashcards

Elective Upper Limb Surgery Flashcards

1
Q

Outline the anterior (deltopectoral) approach to the shoulder

A
  • 10-15cm incision over deltopectoral groove
  • Split deltoid and pec major (retracting cephalic vein)
  • Retract short head of biceps medially
  • Divide subscapularis between stay sutures with arm externally rotated
  • Longitudinal capsulotomy
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2
Q

Applications of anterior approach to the shoulder

A
  • Anterior stabilisation
  • Joint replacement
  • Fracture fixation
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3
Q

What are the 2 x-ray views required to image the shoulder

A
  1. AP
  2. Lateral
  3. Axillary
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4
Q

Which rotator cuff is most commonly torn

A

Supraspinatus

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5
Q

What is involved in supraspinatus repair

A
  1. Coracoacromial ligament excision to decompress rotator cuff
  2. Tendon repair if <65
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6
Q

Surgical intervention for ACJ arthritis

A

Distal clavicle osteotomy in severe cases

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7
Q

What is the first movement to be restricted in frozen shoulder

A

External rotation

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8
Q

How long does frozen shoulder take to completely resolve

A

Up to 2 years

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9
Q

What are the 3 phases of frozen shoulder

A
  1. Painful
  2. Frozen
  3. Thawing
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10
Q

Neurovascular relationships of the surgical neck of the humerus

A
  1. Axillary nerve

2. Circumflex humeral vessels

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11
Q

Neurovascular relationships of the spiral groove

A
  1. Radial nerve

2. Profunda brachii vessels

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12
Q

Neurovascular relationships of the posterior aspect of he medial epicondyle

A

Ulnar nerve

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13
Q

List the 3 joints forming the elbow

A
  1. Ulnohumeral
  2. Radiohumeral
  3. Proximal radioulnar
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14
Q

List the 6 ossification centres of the elbow in order

A
  1. Capitulum (3 months)
  2. Radial head (5 years)
  3. Internal (medial) epicondule (7 years)
  4. Trochlea (9 years)
  5. Olecranon (11 years)
  6. Lateral epicondyle (13 years)
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15
Q

Describe the relationship of the median nerve and brachial artery to the biceps tendon at the elbow joint

A

Median nerve and brachial artery lie medial to the biceps tendon and superficial to brachialis

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16
Q

Which approach to the humerus is most commonly used for ORIF (especially if radial nerve already injured)

A

Posterior approach

17
Q

Outline the posterior approach to the humerus

A
  1. Extensile incision
  2. Split triceps (lateral and long heads superficially, medial head deep)
  3. Identify radial nerve
18
Q

Define tennis elbow

A

Common extensor tendinopathy

19
Q

What causes cubitus varus

A

Supracondylar fracture or other elbow fracture in childhood

20
Q

List the 3 sites of potential ulnar compression

A
  1. Medial epicondyle
  2. Between the two heads of flexor carpi ulnaris
  3. Ulnar tunnel of the hand
21
Q

How does a ‘pulled elbow’ present

A
  • Child aged 2-5
  • Limited supination
  • Tenderness over the radial head
22
Q

Describe Verden flexor tendon zone 1

A
  • Between DIP and PIP joint creases distal to the insertion of FDS
  • Contains FDP tendon within the distal flexor sheath
23
Q

Describe Verden flexor tendon zone 2

A
  • Between distal palmar crease and midpoint of middle phalanx
  • Corresponds to proximal part of flexor tendon sheath
24
Q

Describe Verden flexor tendon zone 3

A
  • Between distal margin of carpal tunnel and distal palmar crease
  • Contains both FDS and FDP tendons but are unsheathed
25
Q

Describe Verden flexor tendon zone 4

A
  • Area of the carpal tunnel

- Contains both FDP and FDS tendons

26
Q

Describe Verden flexor tendon zone 5

A

Area of wrist and forearm up to carpal tunnel

27
Q

Outline the anterior (Henry’s) approach to the radius

A
  1. Extensile approach incision in line of lateral epicondyle to styloid process
  2. Develop plane between brachioradialis (overlying superficial branch of radial nerve) and FCR
  3. Elevate insertion of supinator to protect posterior interosseous nerve (exposes proximal 1/3rd)
  4. Elevate insertion of pronator teres and origin of FDS (exposes middle 1/3rd)
  5. Elevate radial border of pronator quadratus (exposes distal 1/3rd)
28
Q

Outline the approach to the ulnar shaft

A
  • Subcutaneous border of the ulna is palpable along its entire length
  • Exposed by reflecting ECU and FCU
29
Q

Describe the management of extensor tendon injuries of the hand

A
  • Primary suture
  • Splintage in extension for 6 weeks
  • Hand physiotherapy
30
Q

What causes mallet finger

A

Disruption of the extensor tendon of the distal phalanx from forced flexion of an extended finger

31
Q

Treatment of mallet finger

A

6 weeks of splintage with DIP hyperextension and PIP flexion

32
Q

What causes mallet thumb

A

Delayed rupture of EPL following Colles’ fracture or in RA

33
Q

How is mallet thumb managed

A

Tendon transfer of extensor indices

34
Q

Describe Boutonniere deformity

A

Lateral bands of the extensor expansion sublux volarly

35
Q

Describe Paronychia

A

Infection between the side of the nail and the lateral pulp of the finger

36
Q

What is the most common cause of Paronychia

A

Staphylococcus aureus

37
Q

Define a felon

A

Abscess in the pulp of the finger

38
Q

What are the risks of pulp infections

A

Distal phalanx destruction

Musculoskeletal (5 decks)

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