Orthopedics

Question 1

What is the most common type of shoulder dislocation and what is the mode of injury for this typically?

Answer 1

anterior dislocation

REMEMBER: ARM = ANTERIOR

fall on an outstretched arm (contact sports in younger patients and falls in older patients)

Question 2

Only 2 - 4% of shoulder dislocations are posterior. What type of occurrence is this most commonly seen with?

Answer 2

seizures

Question 3

What is the presentation for a patient with anterior shoulder dislocation?

Answer 3

abducted and externally rotated

“squaring” of the shoulder: loss of rounded appearance (humeral head) and sharp prominence of the acromion

Question 4

What is a Bankart Lesion and what kind of injury is it associated with?

Answer 4

fracture of the anterior inferior glenoid following impaction of the humeral head against the glenoid (anterior shoulder dislocation)

Question 5

What are some conditions associated with a shoulder dislocation?

Answer 5

1. Bankart Lesion: fracture of glenoid cavity
2. Hill-Sachs Lesion: dent in the humeral head
3. axillary nerve injury
4. rotator cuff tear: (MC in older patients)
5. labral tear: labrum is the cartilage that surrounds the glenoid

Question 6

What is a Hill-Sachs lesion?

Answer 6

dent in the humeral head

compression chondral injury of the posterior superior humeral head following impaction against the glenoid

Question 7

Sometimes with a shoulder injury, a patient can have axillary nerve damage. What are symptoms of this?

Answer 7

transient neurapraxia present in 5% of shoulder dislocations

can present with numbness or tingling over the lateral shoulder

Question 8

Treatment for shoulder dislocations:

Answer 8

reduce

post-reduction films

sling and swath

physical therapy

Question 9

what part of the clavicle is most often fractured?

Answer 9

middle third

Question 10

What is the treatment for a clavicle fracture?

Answer 10

simply arm sling or figure 8 sling: 4 - 6 weeks in adult, ortho consult if proximal 1/3

begin PT after 4 wks with light strengthening after 6 wks

Question 11

What is a step off deformity and what injury would you see it with?

Answer 11

elevation of the clavicle

AC joint separation

Question 12

How do you appropriately grade acromioclavicular separations?

Answer 12

XRAY is taken with the person holding a weight to assess the level of injury to the joint

Question 13

A patient with shoulder separation (AC joint separation) will have pain with what kind of test?

Answer 13

cross-chest testing

Question 14

Management of AC joint separation

Answer 14

Conservative management is possible for mild to moderate injuries because they can be managed with sling and analgesia

more severe injuries will require operative repair