Elective Upper Limb Surgery Flashcards
Outline the anterior (deltopectoral) approach to the shoulder
- 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
Applications of anterior approach to the shoulder
- Anterior stabilisation
- Joint replacement
- Fracture fixation
What are the 2 x-ray views required to image the shoulder
- AP
- Lateral
- Axillary
Which rotator cuff is most commonly torn
Supraspinatus
What is involved in supraspinatus repair
- Coracoacromial ligament excision to decompress rotator cuff
- Tendon repair if <65
Surgical intervention for ACJ arthritis
Distal clavicle osteotomy in severe cases
What is the first movement to be restricted in frozen shoulder
External rotation
How long does frozen shoulder take to completely resolve
Up to 2 years
What are the 3 phases of frozen shoulder
- Painful
- Frozen
- Thawing
Neurovascular relationships of the surgical neck of the humerus
- Axillary nerve
2. Circumflex humeral vessels
Neurovascular relationships of the spiral groove
- Radial nerve
2. Profunda brachii vessels
Neurovascular relationships of the posterior aspect of he medial epicondyle
Ulnar nerve
List the 3 joints forming the elbow
- Ulnohumeral
- Radiohumeral
- Proximal radioulnar
List the 6 ossification centres of the elbow in order
- Capitulum (3 months)
- Radial head (5 years)
- Internal (medial) epicondule (7 years)
- Trochlea (9 years)
- Olecranon (11 years)
- Lateral epicondyle (13 years)
Describe the relationship of the median nerve and brachial artery to the biceps tendon at the elbow joint
Median nerve and brachial artery lie medial to the biceps tendon and superficial to brachialis
Which approach to the humerus is most commonly used for ORIF (especially if radial nerve already injured)
Posterior approach
Outline the posterior approach to the humerus
- Extensile incision
- Split triceps (lateral and long heads superficially, medial head deep)
- Identify radial nerve
Define tennis elbow
Common extensor tendinopathy
What causes cubitus varus
Supracondylar fracture or other elbow fracture in childhood
List the 3 sites of potential ulnar compression
- Medial epicondyle
- Between the two heads of flexor carpi ulnaris
- Ulnar tunnel of the hand
How does a ‘pulled elbow’ present
- Child aged 2-5
- Limited supination
- Tenderness over the radial head
Describe Verden flexor tendon zone 1
- Between DIP and PIP joint creases distal to the insertion of FDS
- Contains FDP tendon within the distal flexor sheath
Describe Verden flexor tendon zone 2
- Between distal palmar crease and midpoint of middle phalanx
- Corresponds to proximal part of flexor tendon sheath
Describe Verden flexor tendon zone 3
- Between distal margin of carpal tunnel and distal palmar crease
- Contains both FDS and FDP tendons but are unsheathed
Describe Verden flexor tendon zone 4
- Area of the carpal tunnel
- Contains both FDP and FDS tendons
Describe Verden flexor tendon zone 5
Area of wrist and forearm up to carpal tunnel
Outline the anterior (Henry’s) approach to the radius
- Extensile approach incision in line of lateral epicondyle to styloid process
- Develop plane between brachioradialis (overlying superficial branch of radial nerve) and FCR
- Elevate insertion of supinator to protect posterior interosseous nerve (exposes proximal 1/3rd)
- Elevate insertion of pronator teres and origin of FDS (exposes middle 1/3rd)
- Elevate radial border of pronator quadratus (exposes distal 1/3rd)
Outline the approach to the ulnar shaft
- Subcutaneous border of the ulna is palpable along its entire length
- Exposed by reflecting ECU and FCU
Describe the management of extensor tendon injuries of the hand
- Primary suture
- Splintage in extension for 6 weeks
- Hand physiotherapy
What causes mallet finger
Disruption of the extensor tendon of the distal phalanx from forced flexion of an extended finger
Treatment of mallet finger
6 weeks of splintage with DIP hyperextension and PIP flexion
What causes mallet thumb
Delayed rupture of EPL following Colles’ fracture or in RA
How is mallet thumb managed
Tendon transfer of extensor indices
Describe Boutonniere deformity
Lateral bands of the extensor expansion sublux volarly
Describe Paronychia
Infection between the side of the nail and the lateral pulp of the finger
What is the most common cause of Paronychia
Staphylococcus aureus
Define a felon
Abscess in the pulp of the finger
What are the risks of pulp infections
Distal phalanx destruction
