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Clin Med IV Exam 1 > Shoulder and UE Injuries > Flashcards

Shoulder and UE Injuries Flashcards

1
Q

What artery supplies the proximal humerus w/ blood?

A

Axillary Artery

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2
Q

What are the 2 branches of the axillary artery?

A

Ant humeral circumflex artery

Pos humeral circumflex artery

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3
Q

Muscles of the Rotator Cuff

A

Supraspinatus
Infraspinatus
Subscapularis
Teres Minor

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4
Q

Function of supraspinatus

A

Abduction

Superior stabilizer of the shoulder

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5
Q

Function of Infraspinatus

A

External rotation

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6
Q

Function of Teres Minor

A

External rotation in 90deg of abduction

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7
Q

Function of subscapularis

A

Internal rotation

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8
Q

MOI of Clavicle fx

A

Fall w/ arm adducted

Sports injury during football, ice hockey

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9
Q

Clavicle fx presentation

A

Pain w/ active/passive ROM esp abduction/flexion of shoulder

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10
Q

How do you tx clavicle fx?

A
  • SLING
  • Start w/ glenohumeral ROM within 1wk
  • Conservative tx if non or minimally dispalced (sling, ice NSAIDS, analgesics, passive ROM)

-Displaced –> ORIF w/ plate & screws, sling, ROM, analgesics, PT

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11
Q

MOI of AC joint injury?

A
  • Direct force to lateral aspect of shoulder w/ arm ADDUCTED
  • Acromion driven INFERIORLY & MEDIALLY w/ respect to clavicle
  • Common in young athletic ppl (hockey)
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12
Q

During an AC joint injury, in what direction does the acromion move in respect to the clavicle?

A

INFERIORLY & MEDIALLY

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13
Q

AC joint injury presentation

A
  • pain in affected shoulder
  • decrease ROM
  • TTP over AC joint
  • Visible deformity
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14
Q

What test can you do to diagnosis AC joint injury?

A. Empty can test
B. Cross arm test
C. Hawkin Impingement test
D. Phalen test

A

CROSS ARM TEST

-pt elevated affected arm 90deg, then actively adducts it

pos = pain in ac joint

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15
Q

Grade I AC joint injury

A

Sprain on AC ligament

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16
Q

Grade II AC joint injury

A

Tear of AC ligament

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17
Q

Grade III AC joint injury

A

Tear of AC ligament & coracoclavicular ligament

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18
Q

How would you tx a grade I and II AC joint injury?

A

Conseravatively

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19
Q

How would tx a grade III + AC joint injury?

A

Surgery

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20
Q

MOI of AC joint dislocation

A
  • tackled during football

- grade III AC joint injury –> increase CC distance & superior displacement of distal clavicle

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21
Q

Sternoclavicular Joint Dislocation MOI

A

Uncommon

Fall on ABDUCTED and EXTENDED arm
*may not dislocate till days after injury

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22
Q

Would you be more worried with a posterior or anterior dislocation of the sternoclavicular joint? Why?

A

Posterior dislocation; worried about neuro structures

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23
Q

If a pt has a fx in the diaphysis of the humerus, what neurovascular structure are you worried about?

A

Radial Nerve

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24
Q

Proximal humerus fx presentation

A
  • Mod-severe shoulder pain that increase w/ shoulder movement
  • swelling & ecchymosis
  • pt holds ADDUCTED arm against side
  • neurovascular injury more likely to occur in displaced fx or fx-dislocation (involve axillary or suprascapular n)
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25
Q

What kind of pt population is more likely to get a proximal humerus fx? MOI?

A

ELDERLY >60yo

Fall from standing

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26
Q

Tx of proximal humerus fx?

A

Nondisplaced –> Conservatively
(sling, ice, analgesic, sleep semi-recumbant, gentle ROM 2wks later, ROM elbow)

Unstable humerus neck fx –> ORIF

Reverse total shoulder replacement

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27
Q

Shoulder dislocation presentation

A
  • Obvious deformity w/ humeral head dislocated ANTERIORLY
  • affected arm at side of body in EXTERNAL ROTATION
  • shoulder loses roundness & will be fully anteriorly to palpation
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28
Q

Are shoulder dislocations more likely to be anterior or posterior?

A

ANTERIOR (95%)

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29
Q

MOI of shoulder dislocation

A

Posterior –> fall from height, epileptic seizures, or electric shock

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30
Q

What x-ray views do you want for shoulder dislocation/instability?

A

AP
Axillary
Scapular Y

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31
Q

What do you want to do immediately to a dislocated shoulder?

A

REDUCE SHOULDER ASAP
Sling immobilization for 2wks
Early PT

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32
Q

Impingement syndrome presentation

A
  • onset of pain w/ active ROM of shoulder
  • pain w/ overhead activities
  • pain on internal rotation (putting on jacket)
  • tenderness over anterolateral shoulder at greater tuberosity
  • decrease active ROM but have PRESERVED passive ROM
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33
Q

MOI of impingement syndrome

A

Pain from compression of tissues between humeral head & coracoacromial arch

Recent hx of over activity

Pt >40yo

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34
Q

What is the most common cause for impingement syndrome?

A

Partial RC tears

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35
Q

What special test can be used to dx impingement syndrome?

A. Empty can test.
B. Hawkin Impingement test
C. Cross arm test
D. Phalen test

A

HAWKIN IMPINGEMENT TEST

  • eval impingement of RC and subacromial bursa
  • pt seated or standing w/ shoulder forward flexed to 90 deg and elbow flexed to 90deg
  • stabilize top of shoulder while internally rotating arm at forearm
  • Postive = pain in anterior shoulder or reproduction of pt sx w/ test
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36
Q

What x-ray views do you want with impingement syndrome of the shoulder?

A

AP
Lateral
Grashey
Scapular Y

37
Q

Tx for impingement syndrome?

A

Conservative

  • Activity modification
  • PT
  • NSAIDs
  • Corticosteorid injection

Surgical

  • arthroscopic acromioplasty w/ coracoacromial ligament release
  • bursectomy
  • debridement or repair of RC tears
38
Q

Rotator cuff tear presentation

A
  • weakness or pain w/ overhead movement
  • inability to sleep on affected side
  • obvious WEAKNESS noted w/ light resistance testing
  • difficulty lifting arm w/ limited active ROM; passive ROM in tact
39
Q

Which RC muscle is common torn?

A

Supraspinatus

40
Q

MOI of RC tears?

A

Acute

  • fall on oustretched arm
  • pulling on shoulder

Chronic
-repetitive injuries w/ overhead movements & lifting

Pt >40yo

41
Q

What findings may you see on an x-ray for RC tears?

A

High riding humeral head

42
Q

RC tear tx

A

Partial tear –> heal w/ scarring
-tx conservatively w/ PT

Full thickness tear –> do not heal well
-should tx w/ surgery esp if young

43
Q

What is a SLAP lesion? and how does it happen?

A

Injuries of glenoid labrum at point of attachment of long head of biceps

FOOSH
Throwing sports athletes (baseball/softball)

44
Q

What diagnostic imaging would you get if you suspect SLAP lesion?

A

MR arthrogram***

High signal found on T2WI

45
Q

Adhesive Capsulitis presentation

A

Inflammatory phase: pain out of proportion of clinical findings (last 4-6mo)
Freezing phase: shoulder gets progressively stiffer (last 4-6mo)
Thawing phase: resolution; regaining ROM (up to 1yr)

-pain w/ decrease passive & active ROM

46
Q

MOI for Adhesive Capsulitis

A

Thickening of entire joint capsule of shoulder
Triggered by minimal or no trauma
Commonly seen in pt 40-65yo
Women (perimenopausal or w/ DM or thyroid dz)

47
Q

Tx of adhesive capsulitis

A 
NSAIDs
PT
Intra-articular corticosteroid injections
\+/-oral prednisone
Surgical tx
48
Q

Calcific Tendonitis presentation

A
  • very painful shoulder triggered by minimal or no trauma
  • acute onset
  • pt looks in pain and tired
49
Q

MOI of calcific tendonitis

A
  • deposition of calcium hydroxyapatite within substance of tendon
  • most commonly supraspinatus
  • middle age pt 30-60yo
  • Diabetic 2-4x >non-diabetic
50
Q

Tx of Calcific tendonitis

A
  • Analgesic/anti-inflammatory med
  • Subacromial local anesthetic/steroid injection –> immediate relief
  • PT w/ US relief
  • Arthroscopy w/ aspiration of minerialized material
51
Q

What is another name for frozen shoulder?

A

Adhesive Capsulitis

52
Q

What is the bimodal distribution seen in humerus fractures?

A

Male in 3rd decade –> high velocity trauma

Women in 7th decade –> low velocity falls

53
Q

Humerus Fx presentatoin

A
  • severe pain
  • referred pain to shoulder or elbow
  • swelling & ecchymosis
  • significant tenderness to palpation & crepitus
54
Q

MOI of humerus fx

A
  • Trauma; direct blow or bending forward

- Midshaft fx –> strong muscle contraction (high-velocity throwing or arm wrestling)

55
Q

What nerve is commonly injured during a midshaft humerus fx? How can you test motor function? Sensory function?

A

-Radial nerve –> results in weakness of wrist, finger &
thumb extension & some weakness of elbow supination

  • Test motor function by giving “thumbs up” sign & test resisted extension of thumb
  • Test sensory function at dorsal web space between thumb & index finger
56
Q

How should you tx a non-displaced midshaft humerus fx?

A

put them in a functional brace; apply it 1-2wks after injury, allowing swelling to go down

57
Q

What is a diagnostic sign on x-ray for elbow fracture?

A

Posterior fat pad sign or “sail sign”

58
Q

MOI elbow fracture?

A

FOOSH

  • radial head fx
  • supracondylar humerus fx
  • olecranon fx
59
Q

Radial head fx MOI

A

FOOSH w/ abducted arm & minimal or mod flexion of elbow joint (0-80 deg)

60
Q

What views on x-ray do you want to for the elbow?

A

AP
External Oblique
Lateral

61
Q

Radial arm fx tx

A 
Long arm posterior splint for 3-4days
Sling for 1-2wks
Analgesics
Gentle ROM
Serial radiographs (2wks)
PT
62
Q

MOI of supracondylar elbow fx

A
  • extra-articular fx of distal humerus at elbow
  • almost always d/t ACCIDENTAL TRAUMA
  • FOOSH from mod height (monkey bars)
  • Hyper-extended elbow
63
Q

What pt population does a supracondular elbow fx commonly occur in?

A

PEDIATRIC PTS

age 5-9

64
Q

Olecranon fx presentation

A
  • pain localized to POSTERIOR elbow
  • palpable defect
  • inability to extend elbow
  • effusion around elbow
65
Q

MOI of olecranon fx

A

Direct blow –> usu results in comminuted fx

Indirect blow –> fall onto outstretched UE; usu transverse or oblique fx

66
Q

Can you tx olecranon fx conservatively?

A

NO

Need ORIF w/ tension band or ORIF w/ plate & screw

67
Q

Are elbow dislocations most commonly anterior or posterior?

A

Posterior

68
Q

MOI of elbow dislocations

A
  • fall onto an extended arm
  • hyperextension
  • posterolateral rotatory mechanism
69
Q

Epicondylitis presentation

A
  • Pain over medial or lateral epicondyle

- Pain ranges from minimal and annoying to debilitating severely affecting activity of daily living

70
Q

What is Tennis Elbow?

A
  • pain over lateral epicondyle

- affects extensor tendons of forearm particularly extensor carpi radialis

71
Q

What is Golfer’s Elbow?

A
  • pain over medial epicondyle

- affects flexor tendons of forearm, particuarly pronator teres & flexor carpal radialis muscle

72
Q

Tx for tennis/golfer elbow?

A 
Rest
Ice cube amssage
Brace
NSAIDs
PT
Cortisone
73
Q

MOI Both bone forearm fx

A

Direct trauma –> protecting one’s head

Indirect trauma –> MVA, fall from height, athletic competition

74
Q

Tx of both bone forearm fx

A

Sugar tong splint

Nondispalced –> cast
Displaced –> ORIF

75
Q

Greenstick fx MOI

A
  • incomplete fx of long bone
  • forearm of child
  • result from force applied perpendicualr to shaft
76
Q

In a greenstick fx, is the fx produced on the concave or convex cortex?

A

Convex

77
Q

Greenstick fx tx

A
  • SUGAR TONG SPLINT
  • analgesics
  • casting x3-4wks
  • splinting if pt and family reliable and fx stable
78
Q

What is a buckle fracture?

A
  • incomplete fx
  • occurs at metaphyseal diaphyseal junction after a FOOSH
  • stable fx
  • heals quicker than greenstick fx
79
Q

Tx of buckle fx?

A
  • VOLAR SPLINT
  • analgesics
  • casting 3-4wks
  • splinting if pt & family reliable & fx stable
80
Q

What is a Colles Fx?

A
  • Fx of distal radial metaphyseal region w/ DORSAL ANGULATION & impaction
  • common fx of distal radius
  • result of FOOSH
  • extra-articular
81
Q

Tx Colles Fx?

A

Conservative

  • closed reduction
  • sugar tong splint followed by long/short arm cast 4-6wks

Surgical
-ORIF followed by cast/splint immobilization for 4-6wks

82
Q

What fractures would you do a sugar tong splint?

A

Both bone forearm fracture
Greenstick Fx
Colles Fx

83
Q

What is a Smith Fracture?

A
  • distal radius w/ assoc VOLAR ANGULATION of distal fx fragment
  • extra-articular transverse fx
  • aka reverse colles fx
84
Q

MOI Smith Fx?

A
  • Fall onto flexed wrist

- Direct blow to back of wrist

85
Q

What kind of splint would you use for a Smith Fx?

A

Volar (cock-up) forearm splint

  • applied midpalmar crease almost to elbow ventrally
  • Position: neutral forearm (thumb up), wrist at 20deg extension
86
Q

Which is worse, Colles or Smith fx?

A

Smith Fx bc of flexion

87
Q

65yo women presents with a stiff right shoulder that was previously very painful 4mo ago. No history of any fractures or injury to the right shoulder. Decrease active and passive ROM. What injury may this be?

A. SLAP lesion
B. Adhesive Capsulitis
C. Calcific Tendonitis
D. Clavicle Fracture

A

Adhesive Capsulitis (frozen shoulder)

Key words: previously very painful shoulder (inflammatory phase), stiff shoulder (freezing phase); 65yo (perimenopausal women); no trauma

88
Q

What kind of injury is most likely the result of falling off the monkey bars in a 6yo child?

A. Radial head fx
B. Olecranon fx
C. Supracondylar elbow fx
D. Elbow dislocation

A

Supracondylar elbow fx

  • common pedi elbow fx
  • 90% d/t hyper-extended elbow

Clin Med IV Exam 1 (9 decks)

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