MSK 4 with pictures Flashcards
Where do the pectoralis major and deltoid muscles attach to the humerus?
Pectoralis major inserts on the proximal shaft and deltoid muscle attaches to the midshaft
What 2 branches of the axillary artery does the proximal humerus receive blood supply from?
Anterior and posterior humeral circumflex arteries
What is the blood supply of the humeral shaft?
Axillary and brachial arteries
What nerve should you be concerned about with a displaced mid-distal humeral shaft fracture?
Radial nerve→ check function (wrist extension)
What are the 4 rotator cuff muscles and what is the function of each?
1) Supraspinatus: initiates and acts throughout abduction cycle 2) Infraspinatus: external rotation with arm in neutral 3) Teres minor: external rotation in 90 degrees of abduction 4) Subscapularis: main internal rotator of the shoulder
What are the 2 suggested x-ray views of the AC joint?
AP with and w/o weights
What are the 2 suggested x-ray views of the chest?
PA, lateral (full inspiration)
What are the 2 suggested x-ray views of the clavicle?
AP, axial (20 degrees cephalad)
What are the 2 suggested x-ray views of the humerus?
AP, lateral
What are the 2 suggested x-ray views of the SC joint?
AP, obliques (bilat)
What are the 3 suggested x-ray views of the shoulder?
AP, Grashey, Y-scapular view
What is the most common location of a clavicle fracture?
Middle 3rd (80%)
What motions will be painful with clavicle fractures?
Active/passive ROM w/abduction/flexion of the shoulder
How are most clavicle fractures treated?
Sling to start→ initiating glenohumeral ROM w/in 1 week
What are 5 components of clavicle fx tx with ORIF?
(1) ORIF w/plate and screws (2) sling to prevent excessive motion (3) ROM to start as soon as tolerated (4) analgesics (5) physical therapy
What is the etiology of AC joint injuries?
Usually occurs from direct force to lateral aspect of shoulder w/arm adducted→ drives acromion forcibly inferiorly and medially w/respect to the clavicle
Describe grades I, II, and III AC joint injuries.
Grade I: sprain of AC ligament Grade II: tear of AC ligament→ CC ligaments still intact, but will see some migration w/weights in hand Grade III: tear of AC and coracoclavicular ligaments
What test do you perform to test the AC joint and what is a positive finding?
Cross arm test: pt elevates the affected arm to 90 degrees, then actively adducts it; (+) finding= pain in AC joint
How are grades I and II AC joint injuries tx?
Grades I and II are treated conservatively
How are grades III AC joint injuries tx?
Grade III injuries are variably treated
How are grades IV, V, and VI AC joint injuries tx?
Grade IV, V, and VI are treated surgically
A sternoclavicular joint dislocation is only emergent requiring surgical repair if dislocated in which direction?
Posterior: requires repair if there is damage to neurovascular structures
What pt population is a proximal humerus fx most common in?
Elderly, w/> 70% occurring in pts over 60 yrs
What is the most common mechanism of injury of proximal humerus fractures?
fall from standing
What are 4 findings to look for on clinical presentation of a proximal humerus fx?
(1) moderate/severe shoulder pain that inc w/shoulder movement (2) swelling and ecchymosis may be apparent soon after injury (3) pt holds affected arm adducted against side (4) suspect in elderly pts who have fallen and present with: focal tenderness at the proximal humerus and motor function limited d/t pain
What are the 2 most important things to check for with proximal humerus fx of the shaft?
Radial nerve and vascular integrity
When do you begin gentle ROM of the shoulder after proximal humerus fx?
2 weeks after injury
When do you begin ROM of the elbow/wrist after proximal humerus fx?
As soon as pain tolerates (move all the way up, and all the way back down)
What are the 4 major segments of the proximal humerus?
(1) anatomic neck (2) surgical neck (3) greater tuberosity (4) lesser tuberosity
According to neer classification, displacement exists when a segment is angulated _____ or ____ from anatomic position.
According to neer classification, displacement exists when a segment is angulated >45 degrees or >1 cm from anatomic position.
What 2 conditions might be suspected if a person has frequent shoulder dislocations?
(1) Ehlers-danlos (2) Marfan syndrome
How long after reduction of a dislocated shoulder will a pt continue to have limited ROM and pain?
4-6 weeks
What are AP and axillary scapula Y views used to determine in shoulder dislocations?
The relationship of the humerus and glenoid, and to r/o fx
What is the orthogonal view used to identify in a shoulder dislocation?
Identifies if there is a posterior shoulder dislocation
What are the 3 steps of tx of acute shoulder dislocations?
(1) reduce ASAP (2) sling immobilization for 2 weeks + pendulum exercises (3) early PT to maintain ROM and strengthen rotator cuff muscles
What is impingement syndrome also known as?
Rotator cuff tendonitis
What does the short head of the biceps attach to?
Coracoid process
Where does pain originate from in impingement syndrome?
Pain originates from compression of tissues b/w the humeral head and coracoacromial arch
In impingement syndrome, there is decreased ____ ROM, but preserved ____ ROM.
In impingement syndrome, there is decreased active ROM, but preserved passive ROM.
What is one of the most common reasons for impingement syndrome?
Partial rotator cuff tears
What test do you use to determine impingement syndrome, how is it performed, and what are positive findings on it?
Test: Hawkin’s impingement test Used to evaluate impingement of RC and subacromial bursa Maneuver: Pt seated or standing w/shoulder forward flexed to 90 degrees and elbow flexed to 90 Stabilize top of the shoulder while internally rotating the arm at the forearm Positive findings: pain in the anterior shoulder or reproduction of the pt’s symptoms w/the test