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MSK > Other Common Problems > Flashcards

Other Common Problems Flashcards

1
Q

Proximal humeral fx more common in what population

A

> 40yr

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2
Q

Distal humeral fx more common in what populatioon

A

younger

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3
Q

Treatment if undisplaced or minimally displaced

A

immob for 2 wks, then PROM.

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4
Q

Treatment if 2-part fx

A

Surgical: ORIF, total shld replace.
Conservative: sling.

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5
Q

Hill-Sachs Lesion

A

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.

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6
Q

Hill-Sachs: instability w/ % of articular surface affected

A

<20% HH affected: not significant factor for stability.
20-40% HH affected: varies.
>40% HH affected: significant decrease in stability.

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7
Q

Hill-Sachs treatments

A

<20% HH: conservative tx, immob.
20-40% HH: may require bone-graft.
>40% HH: hemiarthroplasty.

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8
Q

Engaging Hill-Sachs

A

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.

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9
Q

Reverse Hill-Sachs

A

ant HH affected from post dislocation.

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10
Q

GH static stability

A

GH congruence, labrum, ligs, jt capsule, (-) intra-artx pressure.

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11
Q

GH dynamic stability

A

RC, BLH tdn, scapular musc.

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12
Q

Traumatic anterior/inferior dislocation

A

MOI: ABD + ER force (e.g. FOOSH).
Damage to mid/ant IGHL.
May cause Hill-Sachs or Bankart lesion.

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13
Q

Bankart lesion

A

labral tear to ant/inf glenoid rim.
Avulsion fx of ant/inf glen rim may occur.
Occurs in 90% of anterior dislocations.

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14
Q

Traumatic posterior dislocation MOI

A

ADD + IR force (seizures, fall from height, MVA).

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15
Q

Traumatic posterior dislocation risk factors

A 
General lig laxity
Inadequate glenoid concavity
Musc imbalance
Poor neuromusc ctrl
Glenoid hypoplasia (rim slopes posteriorly)
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16
Q

Other structures that may be injured w/ dislocations

A

Brachial plexus
Vascular
RC
Fracture

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17
Q

Tx for GH instability

A

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.

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18
Q

SLAP types (1-4)

A

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.

19
Q

SLAP acute traumatic MOI

A

FOOSH, GH traction injury.

20
Q

SLAP chronic repetitive MOI

A

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.

21
Q

SLAP conservative tx

A

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.

22
Q

SLAP surgical tx

A

Type 1 & 3: debride

Type 2 & 4: repair

23
Q

AC separation MOI

A

direct blow to top of shld w/ arm ADD

FOOSH.

24
Q

AC separation types 1-3

A
  1. AC sprain
  2. AC torn
  3. AC + CC both torn
25
Q

AC separation types 4-6

A

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.

26
Q

AC separation tx for type 1-2

A

conservative

27
Q

AC separation tx for type 3

A

start w/ conservative, may need surg

28
Q

AC separation tx for type 4-6

A

surgery

29
Q

AC separation surgery

A

AC reduction with Hook Plates (cannot be left in permanently, must be removed).
Reconstruct CC lig.

30
Q

Long Thoracic Nerve - level & invx

A

C5-7

serratus anterior

31
Q

Long Thoracic Nerve common injury

A

neurapraxia after blunt or stretch injury.

32
Q

Long Thoracic Nerve MOI

A

fall from height, MVA, athletics, sudden shld depress + neck twist, posn during surgery.

33
Q

Long Thoracic Nerve presentation

A

winging w/ flex, not much w/ ABD.

34
Q

Long Thoracic Nerve Tx

A

scap stabilization, strengthen serratus (but avoid over-fatiguing), address c-spine if involved.

35
Q

Suprascapular nerve - level & invx

A

C5-6

supra/infrascapular

36
Q

Suprascapular Nerve common injury

A

compression or distraction.

37
Q

Suprascapular Nerve MOI

A

OH throwing, entrapment at suprascap notch or spinoglenoid notch, compression from bone tumor.

38
Q

Suprascapular Nerve presentation

A

pain/weakness in flex & ER.
May cause impingement.
Alters SH rhythm.

39
Q

Suprascapular Nerve tx

A

estim, treat weaknesses.

40
Q

Axillary nerve - level & invx

A

teres minor
deltoid
C5-6

41
Q

Radial nerve - level & invx

A

C5-6: triceps, anconeus

C5-7: brachioradialis

42
Q

Subscapular nerve - level & invx

A

C5-6
subscapularis
teres major

43
Q

Differences btwn cervical radiculopathy & peripheral neuropathy

A

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

MSK (8 decks)

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