Orthopaedics

Question 1

A pt. comes into the ER complaining of pain at the shoulder after a FOOSH. On PE you note a loss of shoulder ROM, decreased strength and a step deformity at the AC joint. What is your most likely diagnosis? What is the treatment?

Answer 1

Acromioclavicular joint sprain = Separated Shoulder

• Type 1-3: manage non-operatively, physio
• Type 4-6 (displaced clavicle): manage surgically, physio

Question 2

A pt comes into the ER carrying their arm. They were skiing through the trees when they were pulled backwards by their arm which got stuck on a tree. The patient is in significant pain. It sounds to you like the MOI included abduction and external rotation. With this in mind, in addition to the anterior dislocation, what other injuries might this patient have sustained? What nerve is at risk? What is the treatment?

Answer 2

Anterior Glenohumeral Joint Dislocation

• 95% of shoulder dislocations are anterior
• Most result in a Bankart lesion (injury to the glenoid labrum)
• Some also result in a Hill-Sach’s lesion (humeral head compression fracture due to hitting glenoid)
• Axillary n. is at risk of injury
• Recurrent injury can cause pain and arthritis
• Treatment: reduce
  
  • Non-operative trtmnt: immobilization for 3 wks, early ROM exercises, gradually add strengthening exercises (physio)
  • Consider surgery if you can’t maintain reduction or if <20 yrs and high performance athlete

Question 3

What are the MOIs for a posterior shoulder dislocation?

Answer 3

MOI of Posterior Dislocation: 3 E’s (or seizures)

• EtOH (withdrawal)
• Epilepsy
• Electrocution
• Forward fall on elbow, contracting anterior shoulder muscles
• Do not reduce

Question 4

What muscles make up the rotator cuff?

Answer 4

SITS

• Supraspinatus: most commonly injured
• Infraspinatus
• Teres minor
• Subscapularis: least commonly injured

Question 5

If the long head tendon of the biceps is ruptured what movement(s) is the patient unlikely able to do?

Answer 5

Long Head Rupture

• Pop or pain
• Bruising down the arm
• Supination weakness > elbow flexion weakness
• Tendon is intraarticular
• MOI: eccentric contraction
• Manage non-surgically

Question 6

What are the potential causes for carpal tunnel syndrome?

Answer 6

Causes of carpal tunnel syndrome:

• Idiopathic
• Swelling
• Hemorrhage
• Scarring
• Exertional/work
• Pregnancy
• Thyroid disease

Question 7

A pt. presents with numbness in digits 4&5 that becomes worse with elbow flexion. On PE you notice that the hypothenar muscles have wasted and the pt. has weakness with finger abduction. What nerve do you think has been implicated in this injury?

Answer 7

Ulnar N. Compression

• Numbness in D5 & D4
• Worse with elbow flexion
• Hypothenar and interosseous wasting
• Weakness in muscles innervated by ulnar n.
• Compression of the ulnar n. at the elbow
• +Froment sign, +Wartenburg sign, + Duschenne’s sign
• Trtmnt: splint at night, activity modification, surgery (decompression and transposition)

Question 8

What are you looking for the history/MOI of an ACL tear?

Answer 8

ACL = VERPS

• Valgus force
• External rotation
• Pop
• Swell
• ACL tear often happens as the unhappy triad: ACL, MCL, medial meniscus

Question 9

What are the Ps of Compartment Syndrome?

Answer 9

Compartment Syndrome

• Pain on passive stretch
• Pain out of proportion
• Parasthesia
• Paralysis
• Pulselessness
• Pallor
• Poikilothermia