Other Common Problems Flashcards
Proximal humeral fx more common in what population
> 40yr
Distal humeral fx more common in what populatioon
younger
Treatment if undisplaced or minimally displaced
immob for 2 wks, then PROM.
Treatment if 2-part fx
Surgical: ORIF, total shld replace.
Conservative: sling.
Hill-Sachs Lesion
Compression fx to post-sup-lat HH w/ ant instability
Impression defect associated w/ ant-inf dislocation.
Rim of glenoid presses into post-lat HH, creating depression force on HH.
Hill-Sachs: instability w/ % of articular surface affected
<20% HH affected: not significant factor for stability.
20-40% HH affected: varies.
>40% HH affected: significant decrease in stability.
Hill-Sachs treatments
<20% HH: conservative tx, immob.
20-40% HH: may require bone-graft.
>40% HH: hemiarthroplasty.
Engaging Hill-Sachs
back of HH catches & drops off rim of glenoid w/ ER.
Medial portion of defect extends outside glenoid track.
No engagement = defect stays within glen track.
Risk for engagement depends on location, size, & orientation of defect.
Reverse Hill-Sachs
ant HH affected from post dislocation.
GH static stability
GH congruence, labrum, ligs, jt capsule, (-) intra-artx pressure.
GH dynamic stability
RC, BLH tdn, scapular musc.
Traumatic anterior/inferior dislocation
MOI: ABD + ER force (e.g. FOOSH).
Damage to mid/ant IGHL.
May cause Hill-Sachs or Bankart lesion.
Bankart lesion
labral tear to ant/inf glenoid rim.
Avulsion fx of ant/inf glen rim may occur.
Occurs in 90% of anterior dislocations.
Traumatic posterior dislocation MOI
ADD + IR force (seizures, fall from height, MVA).
Traumatic posterior dislocation risk factors
General lig laxity Inadequate glenoid concavity Musc imbalance Poor neuromusc ctrl Glenoid hypoplasia (rim slopes posteriorly)
Other structures that may be injured w/ dislocations
Brachial plexus
Vascular
RC
Fracture
Tx for GH instability
Maintain ROM
RC strengthening
Muscle balance
SH rhythm: rhomboids, up/low traps, serratus ant, levator.
Neuromusc ctrl: PNF, closed-chain ex, rhythmic stabilization.
Avoid stress in direction of instability: if ant-inf, avoid full ER.
SLAP types (1-4)
Type 1: fraying & degeneration, biceps intact.
Type 2: labrum & biceps detached (most common).
Type 3: “bucket handle” tear.
Type 4: type 3 extends up into biceps tdn.
SLAP acute traumatic MOI
FOOSH, GH traction injury.
SLAP chronic repetitive MOI
OH throwing, high eccentric activity of biceps.
“Peel back” mechanism - labrum peels during late cocking phase (ABD + ER) of throw due to torsional force on bi tdn insertion.
SLAP conservative tx
Often unsuccessful, esp w/ instability or RC tear.
Protection - avoid aggs.
Restore motion - esp GH IR defecit (GIRD).
Strengthen - RC, scap, trunk, core.
Return to throwing after 3mo.
SLAP surgical tx
Type 1 & 3: debride
Type 2 & 4: repair
AC separation MOI
direct blow to top of shld w/ arm ADD
FOOSH.
AC separation types 1-3
- AC sprain
- AC torn
- AC + CC both torn
AC separation types 4-6
Type 3 + some other issue:
Type 4: clavicle disloc post.
Type 5: deltotrap fascia torn, causing scap to droop inf.
Type 6: clavicle disloc inf to coracoid.
AC separation tx for type 1-2
conservative
AC separation tx for type 3
start w/ conservative, may need surg
AC separation tx for type 4-6
surgery
AC separation surgery
AC reduction with Hook Plates (cannot be left in permanently, must be removed).
Reconstruct CC lig.
Long Thoracic Nerve - level & invx
C5-7
serratus anterior
Long Thoracic Nerve common injury
neurapraxia after blunt or stretch injury.
Long Thoracic Nerve MOI
fall from height, MVA, athletics, sudden shld depress + neck twist, posn during surgery.
Long Thoracic Nerve presentation
winging w/ flex, not much w/ ABD.
Long Thoracic Nerve Tx
scap stabilization, strengthen serratus (but avoid over-fatiguing), address c-spine if involved.
Suprascapular nerve - level & invx
C5-6
supra/infrascapular
Suprascapular Nerve common injury
compression or distraction.
Suprascapular Nerve MOI
OH throwing, entrapment at suprascap notch or spinoglenoid notch, compression from bone tumor.
Suprascapular Nerve presentation
pain/weakness in flex & ER.
May cause impingement.
Alters SH rhythm.
Suprascapular Nerve tx
estim, treat weaknesses.
Axillary nerve - level & invx
teres minor
deltoid
C5-6
Radial nerve - level & invx
C5-6: triceps, anconeus
C5-7: brachioradialis
Subscapular nerve - level & invx
C5-6
subscapularis
teres major
Differences btwn cervical radiculopathy & peripheral neuropathy
Neck pain (CR) vs no neck pain (PN)
Worse w/ valsalva (CR) vs no change w/ Valsalva (PN)
Myo/dermotome patterns (CR) vs musc/sens changes at nerve branch (PN)
Reflexes reduced/absent (CR) vs no change in reflex (PN)
(+) tests for CR: Spuring, Distraction
(+) tests for PN: Tinel, Phalen
