Shoulder Flashcards

You may prefer our related Brainscape-certified flashcards:
1
Q

Adult >40 with shoulder dislocation has high rate of:

A

rotator cuff tear

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2
Q

Which phase of throwing has highest tensile strain on the cuff?

A

deceleration phase

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3
Q

Size of supraspinatus footprint

A

12.7mm on anterosuperior greater tuberostiy. Thus a 50% tear is 6mm long.

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4
Q

Most rotator cuffs occur on this side of the cuff:

A

articular side. Because articular side is 50% tensile strength of the bursal side.

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5
Q

Which cuff side is most vascular?

A

Bursal side, therefore more likely to heal

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6
Q

Contents of the rotator interval

A

SGHL, CHL, capsule

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7
Q

The Rotator Cable

A

fibers from the CHL, perpendicular to the Supraspinatus,

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8
Q

see a subscap tear and think…

A

subcoracoid impingement

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9
Q

Massive rotator cuff tear definition

A

> 5cm, t ypically involving more than 1 tendon

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10
Q

Ellman Classification of Partial Cuff Tears

A

1: <3mm/<25%
2: 3-6mm/25-50%
3. >6mm/>50%
subclassified as A (articular) B (bursal) or I (intradentinous)

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11
Q

Goutallier Classification

A

Cuff Atrophy

  1. Normal tissue
  2. some fatty streaks
  3. more muscle than fat
  4. more fat than muscle
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12
Q

Night pain in a rotator cuff tear suggests:

A

worse non-operative otucomes

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13
Q

Medial biceps tendon subluxation suggest:

A

Subscapularis tear

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14
Q

Tangent sign:

A

supraspinatus atrophy. Does not cross a line between the scapular spine and the coracoid on the sagittal MRI

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15
Q

What %age of asymptomatic patients >60 have a RCT?

A

55%

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16
Q

What size bursal sided cuff tear needs repair?

A

> 25%

msut be treated more aggressively than articular sided tears

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17
Q

What size aritcular sided cuff tear needs repair?

A

> 50% (PASTA lesion)

if less than this and failing PT, can do a selective subacromial decompression and debridement. Has a 5% failure rate

18
Q

Best treatment for irreparable posterosuperior tears with intact subscap?

A

latissimus dorsi transfer

best in a young laborer

19
Q

most common cause of RCR failure is:

A

failure to heal, causing suture pullout from the repaired tissue

20
Q

Does early vs delayed motion affect outcomes of Rotator cuff repair?

A

no difference in clinical outcomes or healing with early vs delayed motion protocols. PT and guided early ROM exercises do not reduce stiffness one-year post-operatively

21
Q

TUBS Means:

A

traumatic unilateral dislocations with a Bankart requiring surgery.

one of the most common shoulder injuries

22
Q

Shoulder instability recurrence rates related to age:

A

90% chance of recurrence in patients <25 years old

23
Q

Avulsion of the anterior labrum and anterior band of the IGHL from the anterior inferior glenoid

A

Bankart lesion

24
Q

HAGL Lesions:

A

occurs in patients slightly older than those with Bankart lesions, but much less common than Bankart

treatment = open repair

25
Q

Anterior labral periosteal sleeve avulsion (ALPSA)

A

issue is the labrum can heal medially along the medial glenoid neck

26
Q

Hill-Sachs defect

A

chondral impaction injury in the posterosuperior humeral head secondary to contact with the glenoid rim

  • seen in 80% of traumatic dislocations and 25% of trumatic subluxations
  • clinically significant if it engages the glenoid
27
Q

% Glenoid bone loss considerations for surgical management of instability:

A

<20% glenoid bone loss can be managed with arthroscopic Bankart repair
>20% bone loss requires glenoid augmentation such as open coracoid transfer

28
Q

Failure risks for arthroscopic bankart repair:

A
  • inverted pear shape glenoid
  • engaging Hill-Sachs lesion

67% recurrence in all, 89% recurrence in athletes… therefore contact athletes require open surgery and bone-block reconstruction (Burkhart 2000)

29
Q

Open vs Arthroscopic Bankart Repairs?

A

scopes have slightly better post op ROM, slightly higher recurrence rates. Slightly lower return to sport and return to work rates

30
Q

Recurrence rate for bankart repairs that have concomitant glenoid defects?

A

at least 60% with glenoid defects of 20-30%

31
Q

What is Remplissage procedure?

A

advancement of the infraspinatus into the engaging Hill-Sachs defect.
- for >25% humeral head deficiency

32
Q

IF shoulder has crepitus in the 90/90 position, think

A

engaging Hill-Sachs lesion

33
Q

Anatomic structures involved in Bankart tear:

A
  • anteroinferior glenoid labrum
  • MGHL
  • IGHL
34
Q

Anatomic area affected by Hill-Sachs lesion?

A

Posterosuperior humeral head

35
Q

In a HAGL lesion, what is torn?

A

the anterior band of the IGHL

36
Q

Pec transfer for subscap deficiency - results?

A

better for anterior instability than for arthroplasty

37
Q

Best xray for viewing a Hill-Sachs

A

Stryker Notch View

  • arm flexed up, hand resting on head
  • A-P xray with 10 deg cephalad angulation
38
Q

SH-III proximal humerus fractures in the adolescent: known copmlication?

A

AVN
- with observation they tend to revascularize and do well without long-term issues
(JDZ 1997)

39
Q

Anterior Labroligamentous Periosteal Sleeve Avulsion Injuries: Treatment

A

the “ALPSA” lesion

- needs periosteal mobilization and fixation to the anterior glenoid neck in order to obtain glenohumeral stability

40
Q

How do you treat a HAGL lesion?

A

Open capsular repair.

No scope!