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CT.MS > Orthopedics: Shoulder and knee > Flashcards

Orthopedics: Shoulder and knee Flashcards

1
Q

What are the four main joints of the shoulder?

A
  1. Acromioclavicular joint
  2. Glenohumeral joint
  3. Scapulothoracic joint
  4. Sternoclavicular joint
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2
Q

Which joints are responsible for shoulder abduction?

A

2/3 is glenohumeral abduction

1/3 is scapulothoracic abduction

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3
Q

What are the components of shoulder stability?

A

Bone conguity
ligamentous stability
muscular stability
–>most of support is from the soft tissues

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4
Q

Which types of acromioclavicular joint injuries are operative?

A

Types IV, V, VI. Excise the distal clavicle and repair the coracoclavicular ligaments.

If not operable, just stabilize.

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5
Q

What is the most common type of acute glenohumeral instability?

A

Anterior dislocation: 98%

Posterior dislocation: 2%

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6
Q

How does the recurrence rate of glenohumeral dislocations vary with age?

A

Younger people have higher rates of recurrence. In contrast, older pts ahve rotator cuff tears

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7
Q

How do you treat glenohumeral anterior dislocations?

A

Reduction and sling immobilization

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8
Q

What nerve is injured in glenohumeral instability?

A

axillary nerve

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9
Q

What is tricky about posterior dislocations?

A

Most are missed at initial presentation. Need an axillary x ray to diagnose

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10
Q

How do you treat a posterior dislocation of glenohumeral joint?

A

Closed reduction and immobilization in external rotation

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11
Q

What’s difficult about young pts with recurrent subluxations of glenohumeral joint?

A

More difficult to diagnose. Less obvious

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12
Q

Bankart lesion

A

When labrum of glenoid is torn from recurrent anterior dislocations

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13
Q

Hill Sachs lesion

A

Lesion of posterior head of humerus from recurrent posterior dislocations

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14
Q

Physical findings of glenohumeral disloations

A

Apprehension sign

Sulcus sign

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15
Q

How do you treat recurrent anterior glenohumeral dislocations?

A

Physical therapy

Operation to stabilize (arthroscopic or open)

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16
Q

How do you treat recurrent posterior glenohumeral dislocations?

A

Aggressive physical therapy, cause surgery is not as successful

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17
Q

What are the sx of rotator cuff disorders?

A
  1. night pain
  2. painful arc of motion
  3. restriction of motion
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18
Q

What is impingement syndrome?

A

coracoacromial arch compresses the rotator cuff muscles

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19
Q

What are the treatments for impingement syndrome?

A
  1. Removing a piece of the acromion surgically

2. Conservative therapy

20
Q

What is calcific tendinitis?

A

Tendinitis in pts with calcium deposits. Consider needle aspiration

21
Q

What is adhesive capsulitis?

A

Thickened capsule around humeral head. Results in limited ROM. Treat with PT, and failure if not working

22
Q

What is your typical pt for rotator cuff tears?

A

Elderly pt after anterior shoulder dislocation

23
Q

What are the sx of acute rotator cuff tears?

A
  1. Normal passive ROM

2. Limited active ROM

24
Q

How do you treat chronic rotator cuff tears?

A

Surgical repair

25
How do you treat biceps tendon ruptures of the long head?
No surgery! Because the short head is still holding on...even tho the bulge looks weird
26
First/2nd/3rd degree ligament injury
1. Only tenderness 2. Joint opens on stress, palpable endpoint 3. Joint opens on stress, no endpoint. No "stop" to where you would expect ROM to end.
27
Valgus stress causes
MCL injry. Common
28
How do you treat MCL?
Grade I: symptomatic Grade II: knee brace Grade III (completely torn): Brace vs surgery
29
Varus stress causes
LCL injury. Less common. Doesn't heal as well.
30
What is the other common knee injury?
ACL. Healing capabilities are poor. Little blood supply
31
Who is at higher risk of ACL injury?
Females. Caused by rapid deceleration on a planted foot.
32
Sx of ACL
"heard it pop" Lots of swelling limited ROM
33
What is the most sensitive test for ACL injury?
Lachman test (also known as anteriordrawer test) Can also use pivot shift test
34
What do you see on Xray of an ACL injury?
lateral capsular sign
35
How do you treat ACL?
Don't need an ACL unless you are an athlete with rotational movement. MAY prevent future osteoarthritis? Tx based on PATIENT GOALS
36
How do you get PCL injury?
Usually a car crash, not thru sports. Operate if multiple ligamentous tears, not if only PCL
37
Definition of knee dislocation
Disruption of both cruciate ligaments and at least one collateral ligament
38
When would you get an arteriogram for a knee dislocation?
Always. Worry about nerve or arterial injuries
39
What are the PE findings in meniscal injury?
1. Joint tenderness 2. Effusion 3. Incomplete extension 4. Positive McMurray
40
How do you treat patellofemoral syndrome?
Quadriceps strengthening exercises.
41
What is patellofemoral syndrome?
increased or misdirected mechanical forces between the kneecap and femur
42
What are the sx of patellofemoral disorders?
"giving way" of knee pain on incline/prolonged flexion Swellin
43
How do you tx patellar dislocation?
1. Reduce. If first time, just immobilize afterwards | 2. If recurrent, think about surgery
44
What is patellar tendinitis?
Pain at inferior patella. Repetitive stress injury
45
What is osteochondritis dissecans?
Separation of bone/cartilage from normal bone. Usually medial femoral condyle
46
What is osgood-schlatter's disease?
Patellar tendon pulls and fragments off a piece of the tibial tubercle
47
What is Sinding-Larsen-Johansson disease?
"reversed" osgood-schlatter's disease. Fragmentation of inferior pole of patella

CT.MS (13 decks)

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