Exam 1 Flashcards
Where is the groove for the biceps tendon
between the greater and lesser tuberosities of the humerus
what are the trauma views of the shoulder
AP with external rotation, AP with internal rotation, axillary/scapular Y
What does the AP with shoulder in external rotation visualize
greater tuberosity in profile
What does the AP with shoulder in internal rotation visualize
lesser tuberosity in profile
what is the axillary view of the shoulder good for diagnosing
posterior dislocations
What are the 4 sites of proximal humerus fracture
Surgical neck, anatomic neck, greater tuberosity, lesser tuberosity
which is the most common site of proximal humerus fracture
surgical neck
describe the location of the anatomical neck of the humerus
end of the humeral head cartilage and where the capsule attaches
what type of fracture commonly coexists with a humeral anatomical neck fracture
surgical neck
what are the two mechanisms of injury for a greater tuberosity of the humerus fracture
direct blow (young patient) or dislocation (older patient)
which type of proximal humerus fracture is rarely found in isolation
anatomical neck and lesser tuberosity
what two injuries commonly occur with an anterior GH dislocation
Fracture of glenoid/labral tear (Bankart), posterolateral fracture of humeral head (Hill Sachs)
what is the most common mechanism of injury for a posterior shoulder dislocation
Seizure/electrocution
what is the radiographic challenge of a posterior GH dislocation
the shoulder is locked in internal rotation so it may be missed on AP views; axillary view is needed
Bankart fracture AKA
glenoid fracture
Labral tear aka
Bankart tear
Hill Sachs fracture
posterolateral humeral head
Neer classification
1-4 part based on number of displaced segments
what is the most common shoulder dislocation
anterior
inferior GH dislocation aka
luxatio erecta
inferior GH dislocation presentation
arm is locked above their head
grade 1 AC separation
tenderness over the AC joint, normal x-rays
grade 2 AC separation
AC joint is torn but coracoclavicular ligament is intact (AC joint is separated but clavicle isn’t elevated)
grade 3 AC separation
AC joint and coracoclavicular ligaments are torn (joint is separated and clavicle is elevated)
grade 4 AC separation
something goes posterior
grade 5 AC separation
Clavicle is tenting skin
common fracture sites of clavicle
mid clavicle, distal, and AC joint
what is challenging about a medial third clavicle fracture
difficult to see on x-ray
radiograph views for elbow
AP, lateral, oblique
which view of elbow is most important
lateral
where does the radial head articulate
capitulum
what do the fat pads look like in a normal elbow radiograph
anterior is visible but flat and posterior is obscured
what do the fat pads look like in an elbow radiograph with effusion
anterior: sail sign, posterior: visible
what do signs of an elbow effusion usually mean in an adult
radial head fracture
what do signs of an elbow effusion usually mean in a child
supracondylar fracture
what is the normal mechanism of injury for an olecranon process fracture
direct blow due to fall
why are olecranon process fractures usually displaced
the bone fragment is pulled away by the triceps (olecranon process is attachment point)
Nightstick fracture
exception to the ring rule, isolated fracture to distal ulna due to sharp blow
If the distal radius is fractured, what is dislocated?
distal radioulnar joint
if the proximal ulna is fractured, what is dislocated?
radiocapitular joing
if the radial head is comminuted, what is dislocated?
distal radioulnar joint
name for proximal ulnar fracture and radiocapitular dislocation
Monteggia
name of distal radius fracture and DRUJ dislocation
Galeazzi
name for comminuted radial head and DRUJ dislocation
Essex lopresti
most common fractures of the wrist
distal radius and ulnar styloid
clinical presentation of scaphoid fracture
snuffbox tenderness
best view for scaphoid fracture
ulnar deviation (navicular)
what can happen if a scaphoid fracture is missed
nonunion, AVN, and arthritis
what if scaphoid fracture is suspected but negative x-ray
splint and re-image in 1-2 weeks
what is normal position of ulna
slightly negative variance (shorter than radius)
what can happen with positive ulnar variance
ulna is longer than radius, can cause triangular fibrocartilage tears with cartilage loss and cystic changes (ulnar impaction into lunate)
what can happen with negative ulnar variance
puts stress on lunate and can cause osteonecrosis
Keinboch’s disease
AVN to lunate caused by negative ulnar variance
what is the most common MOI for distal radius injuries
FOOSH
method of characterizing distal radius injuries
Fryckman classification
Name for a distal radius fracture with dorsal angulation
Colles fracture
Name for a distal radius fracture with volar angulation
Smith’s fracture
which distal radius fracture is more likely to need hardware, Smith’s or Colles
Colles
What is a Barton fracture
an intraarticular distal radius fracture that only involves a fragment of the bone but can appear as a dislocation on x ray because its displacement drags carpal bones along with it
name for radial styloid fracture
Hutchinson/Chauffeurs
X-ray finding for scapholunate dissociation
wide gab between scaphoid and lunate (David Letterman sign)
major risk with scapholunate dissociation
wrist won’t move as a unit (SLAC) wrist and will lead to arthritis if untreated
x-ray views for hand
AP/lateral/oblique
what is a boxers fracture
5th metacarpal neck
what is a Bennett fracture
intraarticular fracture at the base of the first metacarpal (at carpal-metacarpal joint)
what is a Rolando fracture
a comminuted fracture at the same location as Bennett fracture
what is major sequelae of Rolando fracture
early arthritis
what is Gamekeeper’s thumb
ulnar collateral ligament tear of first MCP joint
imaging considerations for gamekeeper’s thumb
may have normal radiograph with or without fracture
MOI for gamekeepers thumb
hand stuck on pole plant when skiing, pulling thumb back
AVN consideration for scaphoid fracture
in the scaphoid waist, the more proximal the fracture, the more likely to get AVN of the proximal pole and subsequent nonunion
Most common carpal fracture
triquetral
which view to use to see triquetral fracture
lateral
what is a tuft fracture
a blunt crushing injury to the tip of the finger, generally nondisplaced
treatment consideration with tuft fracture
if nailbed is injured, it is an open fracture with infection risk
distal and middle phalanx lip fractures considerations
flexor/extensor tendons may be avulsed and splinting must take tension off
which pathogen is most common in dog bites
pasteurella canis
what causes Boutouneirre deformity
PIP flexion and DIP extension, can be caused by laceration involving the tendons, direct blow to DIP joint, osteoarthritis. Proximal phalanx buttonholes between the bands of the extensor tendon
combination of what forces to cause an anterior shoulder dislocation
abduction, extension, external rotation
combination of what forces to cause a posterior shoulder dislocation
adduction, extension, internal rotation
articulation of olecranon process
trochlea and olecranon fossa
physical exam findings of Monteggia fracture
radial head displacement into AC space
torus/buckling fracture force
compression
most common elbow fracture in adults
radial head fracture
what view is necessary for triquetral fracture
lateral
4 muscles of rotator cuff
supraspinatus, infraspinatus, subscapularis, teres minor
radiograph finding of GH arthritis
“goat’s beard” osteophyte off inferior humerus
presentation of AC arthritis
pain with cross-body adduction, tenderness over AC joint, bony prominences over AC joint
operative treatment for AC arthritis
distal clavicle resection
presentation of adhesive capsulitis
loss of internal rotation in abduction, gradual loss of flexibility
imaging findings of adhesive capsulitis
x-rays are often normal, MRI shows lack of axillary recess and soft tissue scarring and contracture w/o known cause
risk factors of adhesive capsulitis
diabetes, thyroid conditions
conservative treatment for adhesive capsulitis
PT with elbow at the side, NSAIDs, steroid injections
advanced treatment for adhesive capsulitis
manipulation under anesthesia, arthroscopic release
imaging findings for rotator cuff tear
x-rays often normal, bright spot in rotator cuff on mri
sequelae of rotator cuff tear
cuff tear arthropathy
presentation of rc tear
pain with overhead motion and at night
post-surgical recovery time of rc tear
8-12 weeks
what percentage of rc tear pts improve with PT
75%
infraspinatus test
elbows flexed to 90, external rotation
subscapularis test
elbows flexed to 90, internal rotation
supraspinatus test
Jobe’s test
supraspinatus tear test
drop-arm test (snow angel, arm will drop)
supraspinatus impingement tests
Neers, Hawkins
test for biceps tendon or labral pathology
press down on flexed, straight arm while pt tries to bring wrist to shoulder (Speeds test)
labral tear test
arm outstretched with thumb down, resist downward pressure, repeat with thumbs up (Obriens)
teres minor test
horblowers test
imaging finding for calcific tendonosus
fluffy white cloud on x-ray
pathology of calcific tendonosus
deposition of calcium in rotator cuff
sulcus sign
odd contour of shoulder present with shoulder dislocation
significance of continued instability after shoulder dislocation immobilization
likely bankart lesion
how long to immobilize dislocated shoulder
several days
pathology of multidirectional instability of shoulder
ligament laxity
presentation of multidirectional instability of shoulder
anterolateral shoulder pain with clicks and pops
imaging of multidirectional shoulder instability
x-rays are usually normal, extra fluid may be seen in joint capsule on MRI
treatment for multidrectional shoulder instability
PT (no surgery)
Presentation of AC separation
tenderness over AC joint and abnormal shoulder contour
treatment for AC separation
if grade 1-2, immobilize in sling for 3 weeks
MOI for AC separation
direct blow to shoulder
operative treatment for AC separation
grade 3-6, ORIF or ligament reconstruction
recovery from AC separation surgery
no ROM for 6 weeks, full use at 6 months
imaging for clavicle fracture
AP radiograph
treatment for clavicle fracture
sling 2-4 weeks if stable, ORIF if unstable, open, comminuted, displaced
Imaging for scapular fracture
AP, scapular, axillary radiographs
treatment for scapular fracture
sling for 2 weeks with early ROM
nerve damage in proximal humerus fractures
axillary nerve (possibly brachial plexus if high energy)
nerve damage in midshaft humeral fractures
radial nerve
nerve damage in distal humerus fractures
ulnar nerve
tx for proximal humerus fractures
sling and PT
tx for midshaft humerus fractures
coaptation splint
tx for distal humerus fractures
requires surgery
presentation of biceps tendonitis
anterior shoulder pain, tenderness at biceps groove
