Questions Flashcards
Name 2 ways to decrease scapular notching with RTSA
inferior placement and inferior tilt of the glenoid component
where does the COR move with RTSA and what does this do?
Medial and inferior which tensions the deltoid
- true medial would be medial to the GH joint -lateral placement would be between the GH joint and the COR of the humeral head; this helps to tension the rotator cuff more but doesn’t tension the deltoid as much
with ER lag and teres minor dysfunction, what must the patient have to consider a latissmus dorsi transfer?
subscapularis function
what nerves are at risk with LD transfer for massive irreparable cuff tears?
radial nerve runs along the anterior surface just 2.3 cm medial to the inferior aspect of the humeral insertion; the axillary and lower subscapular nerve are more proximal and medial and at risk with muscle belly mobilization
what are the post operative limitations with TEA?
-lifetime weightbearing restriction of 5 lbs or less; no immediate triceps strengthening
what is the most common complication of interscalene blocks?
-temporary paresthesias to the affected arm
Glenohumeral arthrodesis is a good operation for someone with a ____ shoulder but intact ____ and ____
- flail
- elbow and wrist
- **the goal of fusion is to have the shoulder in a position that the hand can still reach the mouth
what is released with a rotator interval release? what must be seen superiorly to know that you are fully released?
- SGHL and CHL
- CAL
what are 2 situations where you wouldn’t want to use a unstrained compared to a semiconstrained total elbow?
- ligamentous instability
2. rheumatoid arthritis
what is the most common complication of arthroscopic capsular release for adhesive capsulitis? how is this prevented?
- recurrent stiffness
- immediate ROM and PT
in patients with OA, what is a PE finding that is a clue that wear is more posterior than just central?
loss of external rotation
list 4 predictors of humeral head ischemia in order from greatest to least for proximal humerus fractures
- calcar length less than 8 mm
- disrupted medial hinge
- humeral head angulation greater than 45 degrees
- head split fracture
what happens to intra-capsular volume on MRI with adhesive capsulitis?
decreased
what are the 3 components of the medial elbow ligamentous complex? what are the bundles of the anterior band and when are they tight? does the posterior band subdivide?
- anterior, posterior, transverse
- anterior bundle, posterior bundle, oblique
(anterior bundle is isometric while the posterior bundle of the anterior band tightens during flexion) - no
what nerve is most at risk during a laterjet and why is this? what nerve is at risk during graft fixation?
- musculotaneous, as you put retractors around the conjoined tendon
- axillary
where do partial distal bicep tears occur?
radial
what is the order of injuries with terrible triads as far as soft tissues: anterior capsule, MCL, LUCL?
- LUCL, anterior capsule, MCL
with a pec transfer for subscapularis insurrficiency, where is the transfer relative to the conjoint tendon and what nerve can this tether?
- deep
- musculotaneous
what is the position for shoulder fusion?
- 20 abduction 30 FF 40 IR
shoulder hemiarthroplasty indications
- OA in young patient with preserved glenoid
- AVN
- PH fracture in young patient
what is the rate of RCT’s with primary shoulder OA undergoing arthroplasty? what group of patients is this much higher?
- < 10%
- RA
with adhesive capsulitis, what is the MRI finding on the coronal sequences?
- loss of the normal axillary recess
what is the mclaughlin procedure? who might benefit from this?
- transfer of the LT and subscapularis into the reverse hill sachs defect from someone that had a posterior shoulder dislocation
- posterior shoulder dislocation (electric shock or seizure)
what is the cutoff for glenoid retroversion that can be safely eccentrically reamed?
15 degrees
what has more complications, RTSA for cuff tears and cuff arthropathy or converting an ATSA to RTSA?
- ATSA to RTSA
what is the distance from the upper border of the pectoralis major insertion to the top of the humeral head?
- 56 mm
