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MSK- Surgery and Trauma (CORTEXT 5 and 6) > Shoulder and Humerus > Flashcards

Shoulder and Humerus Flashcards

1
Q

Who do proximal humerus fractures tend to occur in?

What is the mechanism of injury?

A

Elderly, with osteoporosis

FOOSH or fall directly onto the shoulder

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2
Q

What is the most common type of proximal humerus fracture?

A

Fracture of the surgical neck with medial displacement of the humeral shaft due to the pull of the pec major

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3
Q

If a fracture of the proximal humerus is comminuted, what are some risks?

A

AVN of the humeral head and chronic pain

Non-union

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4
Q

When does the position of a displaced proximal humerus fracture resolve?

A

Once muscle spasm settles

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5
Q

What is the treatment for a proximal humeral fracture in the elderly?

What are the outcomes?

A

Conservative management (sling and gradual return to mobility)

Poor outcomes but surgery not much better

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6
Q

When should arthroplasty be considered as a treatment for proximal humerus fractures?

A

If there is head splitting of 3/4 parts of the fracture

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7
Q

If there is a displaced fracture of the proximal humerus in younger patients, what is the treatment?

A

Internal fixation

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8
Q

What are the two mechanisms of injury for humeral shaft fractures?

A

Direct trauma (e.g. RTA)

Fall, with or without twisting injury

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9
Q

What type of humeral shaft fracture is direct trauma most likely to cause?

What type of humeral shaft fracture is a fall most likely to cause?

A

Transverse or comminuted

Oblique or spiral

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10
Q

What nerve is likely to be injured in a proximal humeral fracture?

A

Axillary nerve, but any part of the brachial plexus can be affected

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11
Q

What nerve is likely to be injured in a humeral shaft fracture?

How will this present?

A

Radial nerve

Wrist drop, and loss of sensation in the first dorsal web space

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12
Q

What degree of angulation is accepted in a humeral shaft fracture?

Why is this?

A

30 degrees

Due to the mobility of the joints above and below

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13
Q

What is the rate of non-union for humeral shaft fractures?

A

10%, no matter the management

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14
Q

What is the treatment for humeral shaft fractures without any complications?

What is the treatment for a humeral shaft fracture with complications or a particularly high energy injury?

A

Bracing

IM nail

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15
Q

What type of dislocations can occur during a seizure?

A

Glenohumeral joint (anterior or posterior)- may be bilateral

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16
Q

Which type of glenohumeral dislocation is most common?

What are the different means by which this can occur?

A

Anterior

Traumatic (severe external rotation or fall onto back of shoulder)

Atraumatic associated with ligamentous laxity

17
Q

Clinical signs of a glenohumeral joint dislocation can be subtle- what should you look out for?

A

Loss of symmetry and contour

Patient supporting their arm

18
Q

Anterior shoulder dislocation can result in a Bankhart lesion- what is this?

A

Detachment of the anterior labrum and capsule from the glenoid

19
Q

What is a Hill-Sachs lesion?

A

When a shoulder dislocation causes fracture of the posterior humeral head

20
Q

With anterior shoulder dislocation, there is often an associated tear of what?

How can you assess for this?

A

Rotator cuff

Ultrasound/MRI

21
Q

What is the commonest nerve injury in an anterior shoulder dislocation?

What will this result in?

A

Axillary nerve

Numbness in the badge patch area

Unable to abduct arm beyond 15 degrees

22
Q

What artery can be damaged in an anterior shoulder dislocation?

How can you test the function of the following nerves:

Median?

Ulnar?

Radial?

A

Axillary

Patient can make okay sign

Patient can abduct fingers

Patient can flex wrist

23
Q

Why is it bad if deltoid function does not recover following a shoulder dislocation?

A

Nothing can be done about it surgically

24
Q

What investigation is used for shoulder dislocations?

A

X-ray

25
Q

How do you manage a shoulder dislocation?

A

Closed reduction under sedation or anaesthetic with vascular assessment before and after

26
Q

If the position of the greater tuberosity does not fix when reducing the shoulder dislocation, what needs to be done?

A

ORIF

27
Q

When may open reduction of a shoulder dislocation be required?

A

If they present late i.e. alcoholics

28
Q

What is the chance of redislocation of the shoulder in an individual < 20?

What management may be offered?

A

80%

Surgical stabilisation

29
Q

What is the chance of redislocation of the shoulder in a patient > 30?

What management is offered?

A

20%

Physio

30
Q

Once a shoulder dislocation has been reduced, what is the management?

A

Sling for 3 weeks and physio

31
Q

What physiotherapy plan is used in those with recurrent dislocations associated with ligamentous laxity?

If surgical treatment is really needed in these individuals, what is done?

A

Strengthen the rotator cuff

Tightening of the capsule

32
Q

What is the mechanism of injury for a posterior shoulder dislocation?

A

A posterior force on an adducted and internally rotated shoulder

33
Q

What sign will be seen on x-ray of a posterior shoulder dislocation?

A

Lightbulb sign- seen on AP view

34
Q

How do you treat a posterior shoulder dislocation?

A

Closed reduction, sling, physio

35
Q

What usually causes an acromioclavicular joint injury?

A

A fall onto the shoulder which is usually sports related

36
Q

How do you treat mild acromioclavicular joint displacement?

A

Conservative management- sling for a few weeks and then physiotherapy

37
Q

If an acromioclavicular joint injury is not settling, or there is more than 100% displacement, how is this treated?

A

Cpracocavicular ligament reconstruction

38
Q

Which ligaments are ruptured in acromioclavicular joint subluxation?

Which ligaments are ruptured in acromioclavicular joint dislocation?

A

Acromioclavicular

Acromioclavivular and coracoclavicular

39
Q

Which sternocalvicular joint dislocations must be reduced?

Why?

How are these diagnosed?

A

Posterior

Can compress important structures e.g. trachea, oesophagus

CT

MSK- Surgery and Trauma (CORTEXT 5 and 6) (13 decks)

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