Shoulder and Humerus Flashcards
Who do proximal humerus fractures tend to occur in?
What is the mechanism of injury?
Elderly, with osteoporosis
FOOSH or fall directly onto the shoulder
What is the most common type of proximal humerus fracture?
Fracture of the surgical neck with medial displacement of the humeral shaft due to the pull of the pec major
If a fracture of the proximal humerus is comminuted, what are some risks?
AVN of the humeral head and chronic pain
Non-union
When does the position of a displaced proximal humerus fracture resolve?
Once muscle spasm settles
What is the treatment for a proximal humeral fracture in the elderly?
What are the outcomes?
Conservative management (sling and gradual return to mobility)
Poor outcomes but surgery not much better
When should arthroplasty be considered as a treatment for proximal humerus fractures?
If there is head splitting of 3/4 parts of the fracture
If there is a displaced fracture of the proximal humerus in younger patients, what is the treatment?
Internal fixation
What are the two mechanisms of injury for humeral shaft fractures?
Direct trauma (e.g. RTA)
Fall, with or without twisting injury
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?
Transverse or comminuted
Oblique or spiral
What nerve is likely to be injured in a proximal humeral fracture?
Axillary nerve, but any part of the brachial plexus can be affected
What nerve is likely to be injured in a humeral shaft fracture?
How will this present?
Radial nerve
Wrist drop, and loss of sensation in the first dorsal web space
What degree of angulation is accepted in a humeral shaft fracture?
Why is this?
30 degrees
Due to the mobility of the joints above and below
What is the rate of non-union for humeral shaft fractures?
10%, no matter the management
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?
Bracing
IM nail
What type of dislocations can occur during a seizure?
Glenohumeral joint (anterior or posterior)- may be bilateral
Which type of glenohumeral dislocation is most common?
What are the different means by which this can occur?
Anterior
Traumatic (severe external rotation or fall onto back of shoulder)
Atraumatic associated with ligamentous laxity
Clinical signs of a glenohumeral joint dislocation can be subtle- what should you look out for?
Loss of symmetry and contour
Patient supporting their arm
Anterior shoulder dislocation can result in a Bankhart lesion- what is this?
Detachment of the anterior labrum and capsule from the glenoid
What is a Hill-Sachs lesion?
When a shoulder dislocation causes fracture of the posterior humeral head
With anterior shoulder dislocation, there is often an associated tear of what?
How can you assess for this?
Rotator cuff
Ultrasound/MRI
What is the commonest nerve injury in an anterior shoulder dislocation?
What will this result in?
Axillary nerve
Numbness in the badge patch area
Unable to abduct arm beyond 15 degrees
What artery can be damaged in an anterior shoulder dislocation?
How can you test the function of the following nerves:
Median?
Ulnar?
Radial?
Axillary
Patient can make okay sign
Patient can abduct fingers
Patient can flex wrist
Why is it bad if deltoid function does not recover following a shoulder dislocation?
Nothing can be done about it surgically
What investigation is used for shoulder dislocations?
X-ray
How do you manage a shoulder dislocation?
Closed reduction under sedation or anaesthetic with vascular assessment before and after
If the position of the greater tuberosity does not fix when reducing the shoulder dislocation, what needs to be done?
ORIF
When may open reduction of a shoulder dislocation be required?
If they present late i.e. alcoholics
What is the chance of redislocation of the shoulder in an individual < 20?
What management may be offered?
80%
Surgical stabilisation
What is the chance of redislocation of the shoulder in a patient > 30?
What management is offered?
20%
Physio
Once a shoulder dislocation has been reduced, what is the management?
Sling for 3 weeks and physio
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?
Strengthen the rotator cuff
Tightening of the capsule
What is the mechanism of injury for a posterior shoulder dislocation?
A posterior force on an adducted and internally rotated shoulder
What sign will be seen on x-ray of a posterior shoulder dislocation?
Lightbulb sign- seen on AP view
How do you treat a posterior shoulder dislocation?
Closed reduction, sling, physio
What usually causes an acromioclavicular joint injury?
A fall onto the shoulder which is usually sports related
How do you treat mild acromioclavicular joint displacement?
Conservative management- sling for a few weeks and then physiotherapy
If an acromioclavicular joint injury is not settling, or there is more than 100% displacement, how is this treated?
Cpracocavicular ligament reconstruction
Which ligaments are ruptured in acromioclavicular joint subluxation?
Which ligaments are ruptured in acromioclavicular joint dislocation?
Acromioclavicular
Acromioclavivular and coracoclavicular
Which sternocalvicular joint dislocations must be reduced?
Why?
How are these diagnosed?
Posterior
Can compress important structures e.g. trachea, oesophagus
CT
