MS II Flashcards
Anterior dislocation occurs with ?
external rotation and abduction
Humeral head lies inferiorly and medial to the glenoid ( and anterior ) for what ?
Anterior dislocation dislocation fo shoulder
What is most common shoulder dislocation ?
anterior
- *this does not alway happen but we see this when patients have had dislocations in the past
- *
Hill-Sachs deformity (more common according to sample) ?
Indentation on the posterosuperior portion of the humeral head
** “on top of the hill”
when it goes down and inferior it strikes the glenoid process **
Bankart deformity ?
Bony irregularity or fragment of the glenoid
What is the bets view for shoulder dislocation ?
✪ Best view- transscapular view (“Y” view)
scapula and the humeral head should be in the center of the Y or when the glenoid process, acromiun process ( know the three parts of the Y)
AC separation grades ?
1 - strain
2 - tear
3- dislocation ( complete separation of the clavicle from the acroimun process)
AC separation ?
when someone falls onto a shoulder it is a high impact injury (fall down hard) ATV or dirt bike accident
cartilage and ligament that attack clavicle to acronym and when you tear them then you get separation and cause the clavicle to lie superiorly to the acromium process
weight bearing films ( it pulls down on the humeral head and acromium process and makes the dislocation look more obvious ( weight bearings films are the Gold standard!)
Elbows we want to remember to look for ?
fat pads
sometimes we dont see the fractures so we look for these fat pad signs
fat pad by the posterior part of the distal humorous
fracture causes bleeding in the joint pushes the fat pad out of the joint and we can see it in the fat pad (“ blown out cell”)
xray with no obvious fracture but we see a fat pad sign then we are going to treat it like a fracture and splint it and everything etc .
Elbow: fat pad sign normal location ?
Normally posterior fat pad is tucked into the olecranon bursa
Elbow: fat pad sign occurs cause the fat pad is displaced by ?
bleeding fracture
what is the “sail sign” ?
bowed anterior fat pad
By your elbow the ulna is ___ and the radius is _____
big
small
Bennett fracture occurs in the ?
hand
Bennett fracture occurs where?
Base of the thumb into the carpometacarpal joint.
**fracture at the base of the thumb at the carpal and metacarpal joint - almost always needs surgery cause it goes into the intraacular joint **
Bennett fracture almost always requires ?
surgical fixation
Comminuted bennett fracture ?
Rolando fx.
Mallet Finger is in the ?
hand
Mallet Finger is a ________ injury at the base of the _____ phalanx
Avulsion
distal
Mallet Finger is a ______ tendon injury
extensor
** the extensor tendon is snapped ( jams finger really hard) cant straighten it out ( when it snapped it takes a chunk of bone off the distal phalanx) evulsion injury which sometime fluxation
you need to separate the joints when examine the fingers ( **
Jersey finger is a _______ tendon injury
flexor
** they can keep it in extension but the cannot flex it **
Gamekeeper’s thumb is an ________ on the _____ aspect of the ______ MCP joint
Avulsion
ulnar
1st
***when people used t filed dress a rabbit and peeling the skin back forcefully and get there thumb caught ans snap there thumb back
it creates an injury at the base of the thumb ( it is in evulsionn injury cause the tendon is pulling part of the bone)
aka Skiers thumb**
Boxer’s fracture caused by ?
punching mechanism
Boxer’s fracture is of the ?
4th or 5th metacarpals
- *typically 5th metacarpal distal portion and usually the next ( maybe the 4th )
- *
**look for sissoring of the fingers when the make a fist the pinky moved inward and gets stuck under the ring finger **
Boxer’s fracture can sometimes involve the ?
Sometimes 2nd and 3rd are included in the diagnosis.
Hand bones ?
Trapezium
Trapezoid
Capitate
hamate
triquetrum
lunate
scaphoid
pisiform
Lunate/Perilunate Dislocation occurs when?
ligaments between the lunate and the capitate are disrupted
Lunate/Perilunate Dislocation best view ?
lateral view
Lunate/Perilunate Dislocation different in the way the bone is ?
situated
perilunate - complete dislocation of the capitate off the lunate
lunate - looks like a spilled tea cup
Scaphoid Fracture tx?
clinically
Scaphoid Fracture is frequently missed on ?
XR
Scaphoid Fracture: cast wrist and repeat XR in __ wk?
1
Scaphoid Fracture has a high risk of ?
avascular necrosis
**avascular necrosis and loss of function of the rest ( cause blood supply goes distally and the comes back proximally ) **
Triquetral Fracture best seen on a ?
lateral view XR
Triquetral Fracture is a?
Small chip off of the dorsum of the wrist
What is the most common fracture of the forearm ?
Colles Fracture
What is a Colles Fracture ?
Fracture of the distal radius +/- ulna with dorsal displacement
**dinner fork deformity , dorsally displaced **
** C and D are next to each other in the alphabet ( collet dorsal)**
What fracture of the forearm is less common?
Smith Fracture
Smith Fracture is a ?
Fx of the distal radius +/- ulna with volar displacement
Monteggia Fracture is a fx. of the ____ with ________ radius disolcation
ulna
proximal
big bone breaks and the little bone becomes displace
** the ulna breaks and the radial head displaces
if someone has knee pain look at ankle and hip **
What can be missed if the elbow is not examined ?
Monteggia Fracture
Galeazzi Fracture is a fx. of the ______ with ______ ulna displacement ?
radius
distal
Ulna its little at the wristband is displaced here ,you can have breaks w/o the displacement b
Neck facts ?
vertebral prominences
can see the space when the spine is and if the space is smaller then it could be something wrong with the disc
normal lordosis - straightening of lordosis can be from spasms in the neck on both sides causes the neck to be lordotic
Lateral C-spine XR?
line along the anterior and posterior part of the verterbrae and down the middle
the lines should line up nicely in the lateral view and the lines should not be squiggly
Jefferson fracture involves the ?
C-spine
Jefferson fracture is a split of the bony ring of ?
C1
**breaking one side of a ring bone the other side breaks as well
secondary to a blow to the top of the head
someone who is ina car accident and hits the windshield or falls and hits top of head and they can shatter the C1
lateral displacement of the lateral masses ( the right pic the right mass is more displaced) you know it is broken when you see lateral displacement **
Jefferson fracture is usually a ________ to the top of the head?
2/2 blow
Jefferson fracture view ?
Odontoid view
Jefferson fx. make sure to order a ?
Order CT scan
Clay-shoveler fracture is of the __ or __ spinous processes?
C6
C7
Clay-shoveler fracture is a ________ injury ?
Avulsion
**staining to pull shover out of clay and snap neck back
vertebral process fracture ( not dangerous cause does not involve the cord or disc) it is essential an evulsion fracture **
Hangman fracture caused by ?
hyperextension and distraction
(ie; hitting head on dashboard)
**hyperextended and backwards ,hitting head on dashboard **
Hangman fracture is a fx of ?
the posterior elements of C2
Hangman fracture can also involve ?
+/- displacement of C2 body anterior to C3
Spondylolysis - just the fracture with no _________
Spondylolisthesis ?
slipping
this one moves
**allows slipping forward and backward it is pretty common
when a disc squishes and the caused the disc to bulge and then this cause inflammation and hits a nerve - rediculoapathy (herinated disc)
leg pain - from my but down to my left **
Spondylolysis/Spondylolisthesis views ?
oblique view for this
a scotty dog leg connected to a scotty dogs back
Knee views ?
sunrise view or tunnel view or merchant view on the right - great view of patellar fracture ( if you suspect tendon rupture then you need to get this sunrise view)
AP and lateral view for just normal knee exam
weight bearing views good for arthritis or narrowing of the joint space - helpful cause it can show you a degree of narrowing in a real life situation instead of them lying down and comparing one knee to the other
Osgood-Schlatter is from ? and causes a ?
Patellar tendon pulling on the tibial tubercle
bump
Osgood-Schlatter own notes ?
younger athletes
tibial tubercle is not sealed to the tibia - really active kids get swelling of areas and causes inflammation and pain on the tibial tubercle and the get a bump there
over time may heal and ossify and get a permanent bump
Tibial plateau fracture best view ?
Best seen on lateral but may be difficult to find
**best seen on lateral view and it is difficultt to find *( they are inside the joint) patients do not want to bear weight
this is a surgical knee **
Tibial plateau fracture imaging to better at distinguishing extent ?
CT
MRI
** if they cant bear weight do a CT scan **
Patellar tendon rupture appears as a __________________ on films ?
“high riding patella”
**typically cannot flex **
Patellar tendon rupture results in ?
Unopposed traction on the patella
** the unopposed traction on the patella will cause the patella to get pulled up by the quadriceps tendon **
patella fracture can be missed on a AP view but not so much on a _______ view ?
sunrise
Pronation is ?
inversion
Supination is ?
eversion
Ankle XR viewing ?
important to look at the clear space
clear space on the right pic is from ligamentous fracture and it is unstable and a surgical ankle
the spaces should be less the 5 mm in width indicating a disruption of the ankle mortise
Malleolar Fracture is usually an ________ injury from ________ or inversion of the ankle
avulsion
eversion
“rolling the ankle” injury
**portion of the lateral malleolus the ligament pulled on the end of bone and pulled it off - evulsion injury
this is the most common **
Maissoneuve Fracture ?
proximal fibula fracture
you can have a distal fracture which causes a proximal fracture ( pic on right is the proximal portion - oblique )
if anke is hurt then look at knee and toes ( check neurovascular relfex, cap refill etc of the toes)
Pilon fracture any fracture of the ______ ______ that involves that articular surfaces of the ______ plafond
distal tibial
tibial
**ankle fracture of the distal tibia that involve the plafond which is just the articular surface
pilon means the fracture is communicating with ta articular surface **
Lisfranc fx ?
Medial border of the 2nd metatarsal should align with the medial border of the 2nd cuneiform
Lisfranc own notes ?
a ligamentous disruption with the ligaments int he foot and when they get tore you can have displacement in different ways
know that if you have a widening of the metatarsal it will signify you have a ligamentous disruptions and a lisfranc
jump from a high surface and land on feet and split ligaments - pain will just not go away its for months and months
standing view you can see
Torus fracture aka ?
“buckle” fracture
Torus fracture is from ?
Force causes bowing of the pliable bone
Torus fracture ?
force that cause pliable bone to bow
not unilateral force causing bending it is more falling forward and landing on hands etc and cause compression of hand bones and the y can buckle
lateral view you can deff see the buckling
Pediatric fractures ?
Torus fracture
Greenstick fractures
Salter-Harris
Greenstick fractures is ?
Bowing on one side with an incomplete fracture on the other side
**pliable bone that breaks on one side and bends on the other **
Salter-Harris is a fracture of ?
Epiphyseal plate
Salter-Harris: what are radiopaque ?
Epiphysis
metaphysis
Salter-Harris: what is radiolucent ?
Cartilaginous growth plate
A 12 year old presents to the family practice c/o right knee pain. He is active and plays many sports. On PE, there is a tender raised area near the right tibial tubercle. What is the best diagnostic test to order?
get a xray of knee
osgood slaughter
see the what being pulled away from the tubercle
best seen on lateral view will not see it that much on AP
A 42 year old female presents with neck pain after being falling and striking her forehead against a coffee table. PE shows midline tenderness of the cervical spine. Which cervical spine view will give you the best diagnostic information?
dashboard on she has some extraction and hyper extension and at risk for hang man so the best view is lateral and we will see anterior displacement of C2 from C3
A 17 year old presents with right shoulder pain after falling off of an ATV…while it was moving. PE reveals tenderness along the clavicle and AC joint. What test would you order?
best initial test is xray of shoulder ( AP and lateral views of shoulder )
this is same pic as last slide but this is weight bearing
this is just called AC separation
A 60 year old female FOOSH after slipping on black ice in the parking lot. Now c/o right wrist pain. She has no NV deficit.
fell on outstretched hand
colles
we see fracture of the distal radius that is comminuted with distal displacement of the hand
A 2 year old is brought in by mother with concerns that the patient will not move her left arm and keeps crying. States that it began after she picked her up out of the bath tub by her arms. PE seems to reveal pain at the elbow. What next?
nurse maids elbow
hypersupinate and the flex wth pressure on the radial head and it should pop back into place ( you can try reduction before xray)
dislocate or sublux the radial head ( slips out of the pocket easily)
if the fall or have built trauma then get an xray but if there is a good history and you know it is nuse maids elbow then you dont need xray
Salter Harris own notes ?
fracture of epiphyseal plate and classify them by how the look
above - above the epiphyseal plate
5 types - be careful cause it works when looking at a bone in front of you like tibia, but the wrist when you are talking about above it actually looks below
low goes through the epiphysis and the plate