Orthopaedic Upper limb

Question 1

What are the leading cause of shoulder pain?

Answer 1

Rotator cuff disorder

Question 2

Less common shoulder pain

Answer 2

Frozen shoulder (adhesive capsulitis)
Osteoarthritis of the shoulder (glenohumeral)

Question 3

4 muscles of the Rotator cuff

Answer 3

• subscapularis (anterior muscle)
• supraspinatus (posterior muscles)
• infraspinarus (P)
• teres minor (P)

Question 4

What’s the function of rotator cuff

Answer 4

• Glenohumeral stabilisers

- Stabilise the arm in mid range (capsuloligamentous tissues stabilise end range)

Question 5

Ant + Mid deltoid EMG peaks between __ - __ degrees abduction in scapular plane

Answer 5

60 - 90

Question 6

Post operation shoulder rehabilitation (treatment principles)

Answer 6

• Pain must be respected
• Thorough evaluation of the px
• Exercise and techniques are progressively advanced
• Balanced scapula muscle function is integrated into all dynamic exercisses
• Programme is individualised (tissue, personality, surgical concerns)

Question 7

Post operation shoulder rehabilitation (goals)

Answer 7

• Patient education (pathology)
• Anti-inglammation and pain reduction
• Facilitate collagen healing (gentle stress promotes improved collaged alignment and strength)
• Improve ROM
• Strengthen muscle tendon unit (increase motor unit recruitment, hypertrophy)
• Optimise proprioception
• Improve endurance

Question 8

Conservative therapy is dependent on status of the rotator cuff. Intact cuff gives generally greater than __ % satisfactory results. Torn cuff gives generally __ % or worse results.

Answer 8

80, 50

Question 9

Rotator cuff treatment (initial non-operative)

Answer 9

• activity modification
• relieve inflammation - NSAID’s, cortisone
• Physiotherapy … ROM, RC strengthening

Question 10

If rotator cuff tear, what functional movement must be avoided?

Answer 10

Internal rotation (hand to the back)

Question 11

When to start resisted rotator cuff strengthening?

Answer 11

3 months 
(once the collagen lays down load up the tissues)

Question 12

Adhesive Capsulitis is characterised by …

Answer 12

painful restriction of both active and passive shoulder motion that occurs in the absence of a known shoulder disorder.

Question 13

Glenohumeral instability: recurrence rate is highest in aged 20 - 30 yrs. T or F?

Answer 13

False

Recurrence rate is high in the younger age; aged 11-20yrs - 94%, aged 20-30yrs - 79%, aged > 40yrs - 10%

Question 14

why incidence of RC tear in older patient is higher than younger patient?

Answer 14

associated with degeneration, quality of tissue (prone to tear) [30% > 40yrs, 80% > 60yrs]

Question 15

Total shoulder joint replacement post-operation, when lying supine

Answer 15

use of a pillow under the elbow

Question 16

Even minimally displaced anatomical neck of humerus fractures have a significant risk of

Answer 16

avascular necrosis (AVN) of the humeral head
(due to damaged anterior & posteriot circumfles artery)

Question 17

The Open Reduction Internal Fixation (ORIF) of the distal humerus is an operation

Answer 17

that fixes fractures in the humerus that are generally difficult to secure with a cast or splint (external fixation).

Question 18

Shaft of Humerus fracture is usually treated …..

Answer 18

conservatively (with a supportive / hanging cast followed by supportive splint)

Question 19

Distal radius fracture is common in what group.

Answer 19

older, female (Colles fracture … dorsal (posterior) displacement of the wrist)

Question 20

Conservative Treatment of “Distal radius” fracture: __ - __ weeks in Long armed cast. __ - __ weeks in Short armed cast.

Answer 20

2 - 4 weeks (LAC)

4 - 6 weeks (SAC)

Question 21

Palpation of the Scaphoid tubercle and anatomical snuff box is sensitive or specific test?

Answer 21

100% Sensitive test

(Rule out) [74% Specificity]

Question 22

Goal of any rehabilitation programme should be “ _____ ______” of the patient

Answer 22

functional restoration

Question 23

Post-op RC cuff tear: one of the difficulties

Answer 23

weakness with arm elevation

Question 24

Post-op RC cuff tear: most Px encouraged to contimue exercise for at least?

Answer 24

a year
(return to sports = 6-9 months)

Question 25

Rehabilitation of RC should progress from ___=> ____ => ____

Answer 25

Passive => Active => muscle strengthening (resisted)

Question 26

What factors has an impact on the rehabilitaion of RC

Answer 26

• surgical repair (open … deltoid detachment = 6-8weeks of no deltoid use; arthroscopic … no deltoid involvment = less painful)
• size of the tear (>5cm = poor outcome; <1cm = quicker progression)
• quality of the tissue
• age
• comobidities

Question 27

Why avoid IR after RC repair, and how many weeks are necessary to protect the repair of the tendon?

Answer 27

• trying to avoid maximum tension on repaired RC (supraspinatus, infraspinatus, teres minor = ER, so stretch by IR)
• 12 weeks

Question 28

Kellgran Lawrence scale

Answer 28

• grade 0 - no radiographic features of OA are present
• grade 1 - doubtful joint space narrowing (JSN) and possible osteophytic lipping
• grade 2 - definite osteophytes and definite JSN
• grade 3 - multiple osteophytes, definite JSN, sclerosis, possible bony deformity
• grade 4 - large osteophytes, marked JSN, severe sclerosis and definitely bony deformity

Question 29

why Hemiarthroplasty for proximal humeral fracture?

Answer 29

• cost effective
• a less-invasive surgery
• no risk of problems with an artificial socket