Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 Trauma And Orthopaedics > Shoulder > Flashcards

Shoulder Flashcards

1
Q

Winged scapula

A

Damage to long thoracic nerve causing weakness of serratus anterior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Axillary nerve lesion

A

Deltoid wasting
Inability to abduct
Regimental badge paraesthesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Nerve causing elbow fleixion and supination

A

Musculocutaneous nerve which innervates biceps brachii

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which nerve damaged in humeral neck fracture or dislocation

A

Axillary nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which nerve damaged in humeral midshaft fracture

A

Radial nerve causing wrist drop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Erb’s palsy

A

Caused by shoulder dystocia when delivering baby with macrosomia

Damage to C5 - C6 therefore waiter’s tip

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Klumpke’s palsy

A

Caused by sudden upwards jerk of hand e.g. grabbing tree

Damage to C8 - T1
- claw hand as cant flex fingers and abduct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Most common type of shoulder dislocation

A

Anterior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Bankart lesion

A

Tear of anteroinferior glenoid labrum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Hill Sachs lesion

A

• Cortical depression in the posterolateral part of the
humeral head following impaction against the
glenoid rim during anterior dislocation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Presentation of anterior shoulder dislocation

A
  • Shoulder contour lost: appears square
  • Bulge in infraclavicular fossa: humeral head
  • Arm supported
  • Severe pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Mx of shoulder dislocation

A
  • Assess for neurovascular deficit: esp. axillary N.
  • X-ray: AP and lateral (Y) view
  • Reduction under sedation
  • Rest arm in a sling for 3-4wks
  • Physio
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Complications of shoulder dislocation

A
  • Recurrent dislocation

* Axillary N. injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Rotator cuff tear

A

Secondary to degeneration or a sudden jolt or fall

  • Partial tears → painful arc
  • Complete tear - drop arm sign

Rx: open or arthroscopic repair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Sign of complete rotator cuff tear

A

Drop arm sign:
- Shoulder tip pain
- Inability to abduct the arm
- Active abduction possible following passive
abduction to 90 degrees
- Lowering the arm beneath this → sudden drop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Epidemiology of clavicle fractures

A

Adolescents and young adults

60 + yo - associated with osteoporosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Allman classification system

A

Type I – middle third of the clavicle - generally stable but significant deformity is usually present

Type II – lateral third of the clavicle
When displaced - unstable

Type III – medial third of the clavicle

  • commonly associated with multi-system polytrauma
  • can be associated with neurovascular compromise as mediastinum is posterior - can get pneumothorax or haemothorax
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How are clavicle fractures done

A

direct - trauma directly onto the clavicle

indirect - fall onto the shoulder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Displacement of clavicle fractures

A

Medial fragment - displaces superiorly - due to the pull of the sternocleidomastoid muscle

Lateral fragment - displaces inferiorly from the weight of the arm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Clinical features of clavicle fractures

A

Sudden-onset localised severe pain
Worse on active movement of the arm

On examination:

  • focal tenderness
  • deformity and mobility at the fracture site
  • essential that any threatened skin is recognised - implies impending conversion to an open injury
  • Ensure to check the neurovascular status of the upper limb - brachial plexus injuries
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Investigations for clavicle fracture

A

Shoulder examination
Neurovascular examination
Basic obs
Xray - 2 views

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Mx of clavicle fractures

A 
Conservative: 
Sling 
- elbow well supported
- kept on until free movement of shoulder 
Early movement recommended

Surgical (not common)

  • if open fracture
  • very commented or shortened
  • bilateral fractures
  • failed union after 2 - 3 months
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Complications of clavicle fractures

A

Non - union
Haemothorax
Pneumothorax
Brachial plexus injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Healing time for clavicle fractures

A

4-6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Rotator cuff muscles and action

A

Supraspinatus - abduction
Infraspinatus - external rotation
Teres minor - external rotation
Subscapularis - internal rotation

26
Q

Acute vs chronic rotator cuff tear

A

Acute - lasting <3 months

Chronic - lasting > 3 months

27
Q

Pathophysiology of rotator cuff tears

A

Acute tears - within tendons with pre-existing degeneration with minimal force.

Or young individuals - large force - often occur alongside other injuries.

Chronic tears - degenerative microtears to the tendon, most commonly from overuse

28
Q

Risk Factors for rotator cuff tears

A

Age
Trauma
Overuse and repetitive overhead shoulder motions - cricketers

BMI>25
Smoking
Diabetes mellitus

29
Q

Presentation of rotator cuff tears

A

Pain over the lateral aspect of shoulder
Inability to abduct the arm above 90 degrees
Common in the dominant arm.

On examination:

Tenderness over the greater tuberosity and subacromial bursa regions

Massive rotator cuff tears - Supraspinatus and infraspinatus atrophy

30
Q

Specific Tests

A

Empty can test - tests supraspinatus

Gerber’s lift-off test - tests subscapularis
- internally rotate arms so hands on back and push

Posterior cuff test - tests infraspinatus and teres minor
- arm positioned at patient’s side, with the elbow flexed to 90°. Patient externally rotates their arm against resistance

31
Q

Investigations of a rotator cuff tear

A

Urgent Xray - exclude fracture

Ultrasonograhy - presence and size of tear

MRI - detect the size, characteristics and location of any tear

32
Q

When to treat rotator cuff tears with conservative treatment

A

Conservative management - if not limited by pain or loss of function

  • if within 2 weeks since the injury
  • if unsuitable for surgery
33
Q

Conservative management for a rotator cuff tear

A

Analgesia
Physiotherapy with activity modification
Corticosteroid injections into the subacromial space

34
Q

Surgical Management of rotator cuff tears

A

Arthroscopic or open repair

35
Q

Complications of rotator cuff tears

A

Adhesive capsulitis

Enlargement of tear

36
Q

Complications of rotator cuff tears

A

Adhesive capsulitis

Enlargement of tear

37
Q

Mechanism of proximal humeral fracture

A

Low energy injuries in elderly patients -osteoporosis
FOOSH

Less commonly occur in younger patients - high energy traumatic injury, often associated soft tissue or neurovascular injuries.

38
Q

Risk factors for proximal humeral fracture

A

Increased risk of osteoporosis:

  • female
  • early menopause
  • prolonged steroid use
  • recurrent falls, and frailty.
39
Q

Clinical Features of proximal humeral fractures

A

Pain around upper arm and shoulder
Restriction of arm movement and abduction

Significant swelling and bruising of the shoulder - can spread to the chest and down the arm

Axillary nerve damage - loss of sensation in - regimental Badge Area and loss of power of the deltoid muscle

40
Q

Investigations of proximal humeral fracture

A

Bloods - FBC, U+Es, LFTs , coagulation and Group and Save

If pathological - serum Ca and myeloma screen

Xray - 2 views

41
Q

Mx of proximal humeral fracture

A

Conservative:

  • immobilisation - polysling
  • early mobilisation 2 - 4 weeks post injury

Surgical
- If multiple segment injuries

42
Q

Surgical management of proximal humeral fracture

A

Head splitting fracture - ORIF

Surgical neck or combined humeral shaft - intramedullary nailing

Complex injuries - Hemiarthroplasty

Low demand patients, or patients who require revision after a failed previous procedure - Reverse shoulder arthroplasty

43
Q

Complications of proximal humeral fractures

A

Reduced range of movement - extensive physio required for approx 1 year

Avascular necrosis of the humeral head - anterior and posterior circumflex arteries

44
Q

Scapular fracture mechanism of injury

A

Rare

High energy trauma

45
Q

Mx of scapular fracture

A

90% non operative

10% - ORIF if glenohumeral instability, displaced scapular neck, or complex fracture patterns

46
Q

Floating shoulder

A

Scapular neck fracture is associated with a clavicle fracture - requires fixation

47
Q

Biceps tendinopathy pathophysiology and epidemiology

A

Painful, swollen, and structurally weaker tendon that is at risk of rupture

Common in younger individuals who are active e.g. cricket and in older individuals with degenerative tendinopathy

48
Q

Clinical features of biceps tendinopathy

A

Pain worse with stressing the tendon (and alleviated through rest and ice therapy)

Weakness of flexion and supination and stiffness.

On examination: Tenderness over tendon.

Loss of muscle bulk due to disuse atrophy

49
Q

Special tests for biceps tendinopathy

A

Speed test - proximal biceps tendon
– The patient stands with their elbows extended and their forearms supinated. They then forward flex their shoulders against the examiners resistance

Yergason’s test- distal biceps tendon – The patients stands with their elbows flexed to 90 degrees and their forearm pronated. They actively supinate against the examiners resistance

50
Q

Investigations for bicep tendinopathy

A

Clinical
Bloods - FBC + CRP
Xray - to exclude other causes

Rarely used:
USS - thickening of tendons

MRI - thickened tendons and inflammation

51
Q

Mx of biceps tendinopathy

A
  • Rest
  • Ice
  • Physio
  • Analgesia - NSAIDS
  • USS guided steroid injections
52
Q

Surgical mx of biceps tendinopathy

A

Rare:

Arthroscopic tenodesis (tendon is severed and reattached)

Tenotomy (division of the tendon) for decompression

53
Q

Biceps tendon rupture classification

A

Complete - through entire tendon

Partial - remains partly intact

54
Q

Mechanism of biceps tendon rupture

A

Sudden forced extension of a flexed elbow

55
Q

Risk factors for biceps tendon rupture

A 
Previous episodes of biceps 
tendinopathy
Steroid use
Smoking
Chronic kidney disease (CKD)
Fluoroquinolone abx
56
Q

Clinical features of biceps rupture

A

Sudden onset pain and weakness at the affected area.

Feeling of a “pop” during the incident.

Examination:
Marked swelling and bruising in the antecubital fossa.

As the proximal muscle belly retracts (due to loss of counter traction) a bulge may appear - “reverse Popeye sign”

57
Q

Special test for biceps tendon rupture

A

Hook test - for distal rupture

The elbow is actively flexed to 90º and fully supinated, the examiner attempts to ‘hook’ their index finger underneath the lateral edge of the biceps tendon (which cannot be done in a ruptured biceps tendon)

58
Q

Ix of biceps rupture

A

Mostly clinical
USS for diagnosis
MRI if USS inconclusive

59
Q

Mx of biceps rupture

A

If lower demand - conservative approach
- Analgesia and physiotherapy

Surgery:
Anterior single-incision or a dual incision technique performed within few weeks of injury

60
Q

Why can flexion and supination still occur in biceps tendon rupture?

A

Due to brachialis and supinator

Year 3 Trauma And Orthopaedics (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions