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Sports injury anatomy > radiology: shoulder, arm, elbow, forearm > Flashcards

radiology: shoulder, arm, elbow, forearm Flashcards

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1
Q

what are the joints of the shoulder?

A

sternoclavicular, scapulothoracic, acromioclavicular, glenohumeral

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2
Q

name the ligaments of the shoulder joint.

A

costoclavicular (medial clavicle), anterior sternoclavicular, coracoclavicular (conoid, trapezoid), acromioclavicular, transverse scapular, coracoacromial, coracohumeral, coracoglenoid

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3
Q

why do shoulder dislocations have a high recurrence rate>

A

damage to glenoid labrum

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4
Q

which type of shoulder dislocation is most common and why?

A

anterior (90%): very common in sport. usually due to impact on shoulder, less stable anteriorly
posterior dislocation: epileptic fit, electric shock. all muscles contract leading to strong internal roation leading to posterior dislocation

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5
Q

what other injuries are associated with shoulder dislocation?

A

bankart lesion, bony bankart lesion, hills-sachs defect, greater tuberosity fracture, axillary nerve injury, rotator cuff tears

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6
Q

what are the symptoms of axillary nerve injury?

A

transient neuropraxia of the axillary nerve, present in up to 5% patients with dislocation, weakness of deltoid and loss sensation in regimental badge area

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7
Q

what is a bankart lesion and how is it repaired?

A

anterior labrum and anterior band IGHL avulse off the anterior inferior glenoid. the lesion is on the glenoid
in 80-90% with shoulder dislocation
surgical repair-anchoring sutures

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8
Q

what is a hills-sachs lesion and mx?

A

corresponding lesion on humerus to bankart lesion. chondral impaction injury in the posterosuperior humeral head secondary to contact with the glenoid rim
in 80% traumatic dislocations
not clinically significant unless it engages glenoid

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9
Q

what is a bony bankart lesion and how is it managed?

A

piece of bone pulled of with labrum, fracture of anterior inferior glenoid
49% patients with recurrent dislocation
requires bony procedure to restore bone
defect >20-25% considered critical bone loss

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10
Q

when does dislocation and greater tuberosity fracture occur?

A

in older people due to force of dislocation and inflexible muscles

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11
Q

what is the common MOI acromioclavicular joint separation and what imaging is used?

A

falling onto shoulder

XR: give weight to hold and look for shpulder depression

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12
Q

what is a grade 3 acromioclavicular joint separation?

A

all 3 ligaments damaged (conoid, trapezoid, acromioclavicular)

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13
Q

what rotator cuff injuries are common in overhead sports?

A

sub acromial bursitis, rotator cuff tendonitis, rotator cuff tear

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14
Q

what is the mechanism of injury of a superior labrum from anterior to posterior tear and imaging?

A

aka SLAP tear
may occur as an isolated lesion or associated with rotator cuff tear or instability
repetitive overhead activities, fall on outstretched arm withtensed biceps, traction on arm
MRI

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15
Q

how does a sternoclavicular fracture dislocation occur and who is it common in?

A

“rugby players fracture”
clavicle fracture at proximal end, moves posteriorly
common if younger as weak place due to growth plate which closes at 21/22, impact on shoulder can cause fractue through weak growth plate

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16
Q

why is a sternoclavicular fracture dislocation life threatening?

A

can pierce brachiocephalic trunk and indent trachea

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17
Q

what clavicle fractures are common in children?

A

greenstick

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18
Q

what is the MOI scapula fractures and the imagin used

A

high energy e.g. motorsport

hard to see on XR, need CT

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19
Q

what is a proximal end of humerus fracture an dits mx

A

tend to fracture into 4 fragments, head collapses and moves up. can get avascular necrosis
surgery: screws or replace shoulder. poor outcomes.career ending

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20
Q

what is adhesive capsulitis and the imaging used?

A 
aka frozen shoulder
capsule becomes thick and inflamed
passive an dactive loss of movement
often as a complication during rehab
UR and MRI: thiickened capsule, absent axillar recess
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21
Q

what are the symptoms of long head of biceps rupture?

A

“pop-eye” muscle: lump on arm as bunches up
function often still quite good as short head still intact
US or MRI

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22
Q

which nerve us likely to be injured if the humerus fractures at the top vs the middl?

A

axillary nerve

radial nerve

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23
Q

when does radial nerve palsy occur, its symptoms and recovery time?

A

8-15% closed fractures, increased incidence distal 1/3 fractures
wrist drop
spontaneous recovery avg 7 weeks, full recpvery 6 months

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24
Q

what are the epicondyles for on the distal humerus and which is bigger and why?

A

large surface area for muscle attachments

medial as has flexor origins and flexors are stronger than extensors

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25
Q

what is a complication of distal humerus fracture?

A

bones come forward and injure median nerve and brachial artery
check for radial pulse, colour of arm

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26
Q

what is the common MOI for fracture of radial head and how is it mx?

A

cyclists falling on outstretched hand

no splinting or cast, move

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27
Q

what causes golfers elbow, its sx and imaging?

A

over use of flexors
pain in medial epicondyle
MRI: oedema and degerneration

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28
Q

what causes tennis elbow, its sx and imaging?

A

overuse of extensors, extensor carpi radialis brevis
pain in lateral epicondyle
MRI: oedema and degeneration

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29
Q

how is the anterior interosseus nerve tested?

A

make OK sign-uses muscles it supplies (flexor digitorum profundus and flexor policis longus)

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30
Q

how is the brachial artery protected in the cubital fossa?

A

bicipital aponeuorsis

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31
Q

where does the median nerve lie relative to the tendon of the biceps in the cubital fossa?

A

medial

32
Q

when is the tendon of the biceps most palpable?

A

flexion and supination

33
Q

which nerve in the arm is least likely to be damaged by frature of humerus?

A

musculocutaneous

34
Q

where are the volar and dorsal surfaces of the hand?

A

anterior

posterior

35
Q

what should you look for in the normal anatomy of the distal radius?

A

find thumb to know which side is anterior.
radial inclination line
radial shortening: styloidshould be highest
volar tilt: fossa facing towards thumb

36
Q

which fractures of the distal radius are extra articular and intra articular?

A

extra: angulation-dorsal=colles, volar=smiths
intra: volar bartons, dorsal bartons, lunate fossa die-punch

37
Q

what arethe features of a dorsal angulation fracture?

A 
colles fracture
fall on outstretched hand
normall stable
few require surgery
may be radial shortening
38
Q

what are the features of volar angulation fracture?

A 
smiths
fall on flxed wrist
loss of radial inclination and some shortening
unstable, usually requires surgery
less common than colles
39
Q

what are the features of dorsal bartons fracture?

A

wrist slides posterior, unstable surgery

40
Q

what are the features of volar bartons fracture?

A

slides anteriorly

41
Q

what imaging is used for fractures of distal radius?

A

XR, CT for detail

42
Q

what are the features of a lunate fossa die-punch fracture?

A

motor sports, hands on bars and deceleration, lunate pushed on to radius and crushed distal part
XR@ piece of bone pushed down and out by lunate

43
Q

when is the scaphoid often fractured?

A

falling on to outstretched hand

44
Q

where do the extrinisc ligament sof the carpal bones run?

A

from the radius and ulnar to the carpal bones

45
Q

where are the intrinsic carpal ligaments?

A

between carpal bones

46
Q

which intrinsic carpal ligament is most commonly injured?

A

scapholunate

47
Q

how is the scapholunate ligament injured and what imaging is used?

A

high forced
XR: 2 bones separated, clench fist view on XR also shows separation. lateral view=dorsal intercalated segment instability (lose normal alignment-lunate points to dorsal surface)

48
Q

what is seen on XR for lunate-triquetral ligament disruption/

A

volar intercalated segment instability (lunate points to volar surface)

49
Q

what is the blood supply of the scaphoid?

A

retrograde

50
Q

which pole of the scaphoid is at risk of avascular necrosis after fracture?

A

proximal pole, will start to crumble away

51
Q

how are scaphoid feactures diagnosed and treated?

A

often 18-25 years falling from a height. palpate anatomical snuffbox and scaphoid tubercle for pain
XR and delayed XR (10-14d), CT, MRI (look for oedema)
tx: immobilisation forearm in neutral position for 6-8 weeks

52
Q

what is the MOI and diagnosis perilunate dislocation?

A

varies, cycling, snatch and grab in weight lifting
capitate falls off lunate
XR: AP=jumble, lateral=lunate fossa not articualting with capitate

53
Q

what is kienbocks disease and its cause?

A

avascular necrosis of lunate, most common men aged 20-40 years
ulnar shorter than radius, increased pressure on lunate
not caused by sport byt often injury unmasks condition

54
Q

what imaging and tx is used for kienbocks disease?

A

XR: advanced disease, lunate collapsed
MRI: oedema on lunate, can see ulnar shorter than radius
hard to treat

55
Q

what passes through carpal tunnel

A

median nerve, flexor digitorum tendons x4, flexor digitorum superficialis tendon x4

56
Q

which arteries form the palmar arches?

A

superficial mainly ulnar

deep mainly radial

57
Q

how many compartments are the extensors divided into>

A

6

58
Q

what goes through compartment 1 extensor retinaculum?

A

1st: extensor pollicis brevis, abductor pollicis longus

forms snuffbox

59
Q

what goes through 2nd extensor compartment?

A

extensor carpi radialis brevis

extensor carpi radialis longus

60
Q

what goes through 3rd extensor compartment?

A

extensor pollicis longus

commonly has problems due to angle change-arounf listers tubercle to thumb

61
Q

what goes through 4th extensor compartment?

A

extensor digitorum and extensor indices

62
Q

what is in 5th extensor compartment?

A

extensor digit minimi

63
Q

what is in 6th extensor compartment?

A

extensor carpi ulnaris

64
Q

what is de quervains tendosynovitis?

A

1st extensor compartment effected, inflammation and swelling

finkelsteins test: tuck thumb into palm and push wrist to ulnar side, pain in compartment

65
Q

what is intersection syndrome?

A

1st and 2nd compartments cross in writs, friction causes pain

66
Q

what causes extensor pollicis longus rupture and presentation?

A

common after distal radius fracture, rubs on rough surface=post fracture attrition rupture
cant lift up thumb#US

67
Q

what are the exclusive sensory areas for the nerves in the hand?

A

ulnar=little finger
median=tip index or middle
radial=anatomical snuffbox

68
Q

how does carpal tunnel syndrome present?

A

median nerve area
power: LOAF (muscles supplied by median nerve): 1st 2 lumbricals, opponens pollicic, abductor pollicis brevis, flexor pollicus brevis

69
Q

which muscles in the hand does the ulnar nerve supply?

A

hypothenar, adductor pollicis, interossei, 3rd and 4th lumbricals

70
Q

what are the actions of the interossei?

A

PAD: palmar cause adduction
DAB: dorsal cause abduction

71
Q

how does injury to ulnar collateral ligament to thumb present and tx?

A

skiing, bent in abnormal direction

surgery

72
Q

where is bennets fracture?

A

base of thumb

73
Q

how can the flexor tendons be examined?

A

profundus: flex distal IP
superficialis: flex proximal IP while holdin other fingers down
US or MRI

74
Q

what causes rugger jersey finger, presentation and imaging?

A

digitorum profundus tendon pull cuases bone avulsion
cant flex finger
XR: fracture of insertion of flexor digitorum profundus tendon

75
Q

what is mallet finger?

A

damage to extensor tendons
soft tissue if nothing on XR, tendon pulled off bone, often in older people
bone: fracture, in younger people and psort

76
Q

whenis MRI imaging is used for the hand and wrist?

A

ligament injuries, occult fractures, avascular necrosis

Sports injury anatomy (8 decks)

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