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Netter's Orthopaedics > Shoulder/Arm > Flashcards

Shoulder/Arm Flashcards

1
Q

Lateral vs medial winging?

A

Trapezius - lateral winging (spinal accessory n)

Serratus anterior - medial winging (long thoracic n)

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2
Q

Clavicle fracture groups?

A

Group 1 - Middle 1/3 (most common, 80%)
Group 2 - Distal 1/3
Type 1 - lateral to CC ligaments
Type 2a - medial to CC ligaments
Type 2b - between CC ligaments (conoid torn, trapezoid intact)
Type 3 - fracture into into AC joint
Group 3 - Proximal 1/3

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3
Q

Associated injury with scapula fracture?

A

(85% have associated injuries) - Rib fx #1, pulmonary contusion, pneumothorax, brachial plexus injury

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4
Q

Ideberg classification

A

Glenoid fracture:
Type I: anterior avulsion fracture
Type II: transverse/oblique fx through glenoid, exit inferiorly
Type III: oblique fracture through glenoid, exits superiorly
Type IV: transverse f exits through scapular body
Type V: type II + type IV

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5
Q

Rockwood classification

A

AC separation
I: Sprain
II: AC tear, CC intact
III: AC+CC tears

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6
Q

Hill-Sachs lesion

A

Posterolateral humeral head compression fracture often secondary to multiple anterior shoulder dislocations

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7
Q

Glenohumeral dislocation, most common and associations?

A

Anterior more common (>90%) >90% recurrence if

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8
Q

Neer classifications

A

Proximal humerus fracture

Based on number of free fragments (head, greater/lesser tuberosity, shaft), must be >1cm displaced

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9
Q

Buford complex?

A

Thickened MGHL and absent anterior/superior labrum

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10
Q

Significance of SGHL?

A

resists inferior translation and ER in shoulder abduction

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11
Q

Significance of MGHL?

A

resists AP translation in 45° of abduction

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12
Q

Significance of IGHL (and components)

A

MOST IMPORTANT LIGAMENT
Anterior band of IGHL - resists anterior and infection translation in abduction and ER
Posterior band of IGHL - resists posterior translation in IR and 90o flexion

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13
Q

Superior transverse scapular related nerve/artery?

A

Suprascapular nerve travels UNDER it, suprascapular artery travels OVER it

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14
Q

Impingement sign test

A

Impingement: forward flexion more than 90°, pain=positive

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15
Q

O’brien’s (active compression)

A

O’Brien’s: FF 90°, adduct 10°, resist FF in pronation then supination. More pain with pronation = SLAP tear (or AC)

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16
Q

Apprehension test (shoulder)

A

Apprehension: pain or apprehension on abduction and ER = anterior instability

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17
Q

Cross body adduction

A

Cross body adduction: adduct arm across body. Pain at AC joint = AC joint path

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18
Q

Proximal humerus insertions

A

PLT medial to lateral

Pec major, lat dorsi, teres major

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19
Q

Quadrangular space, triangular space, triangular interval. Borders and contents

A

Quadrangular space: Humerus, teres major, teres minor, long head of triceps. Transmits Posterior circumflex humeral artery and axillary nerve
Triangular space: Teres major and minor, long head of triceps. Transmits circumflex scapular artery
Triangular interval: long and lateral heads, teres major. Transmits radial nerve and profunda brachii (deep artery of arm)

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20
Q

Muscle at risk from anterior approach to shoulder?

A

Subscapularis

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21
Q

Which muscle protects what nerve in posterior approach to shoulder?

A

Teres major protects radial nerve

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22
Q

Draw the brachial plexus

A

do it

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23
Q

Dorsal scapular nerve runs through which muscle

A

middle scalene

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24
Q

Long thoracic nerve travels on which muscle

A

serratus anterior

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25
Q

Which muscles does brachial plexus travel between

A

between anterior and middle scalene

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26
Q

What nerve is at risk in lateral shoulder approach

A

Axillary nerve

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27
Q

What runs in the deltopectoral groove?

A

Cephalic vein

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28
Q

Subdivision of brachial plexus?

A 
Roots
Trunks
Divisions
Cords
Branches
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29
Q

Branches off of subclavian

A 
VITC,D
Part 1) Vertebral a
Internal thoracic a
Thyrocervical a (Inferior thyroid a., transverse cervical a., suprascapular a.)
Part 2) Costocervical a
Dorsal scapular a
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30
Q

When does the subclavian change name

A

After 1st rib, becomes the Axillary artery

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31
Q

Branches of axillary artery

A

Sixties Teens Love Sex And Pot
1) Superior thoracic
2) Thoracoacromial (Cadavers are dead people = clavicular, acromial, deltoid, pectoral)
Lateral thoracic
3) Subscapular - circumflex scapular, thoracodorsal
Anterior circumflex humeral (main supply to humeral head)
posterior circumflex humeral

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32
Q

Artery at risk in subacromial decompression

A

Acromial branch of the thoracoacromial

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33
Q

When does axillary artery name change?

A

Brachial at the lower border of teres major

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34
Q

Defining characteristic of adhesive capsulitis?

A

decreased active AND passive ROM

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35
Q

Bankart lesion?

A

Anterior inferior labral detachment from glenoid

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36
Q

Glenohumeral instability, two types

A

TUBS
trauma, unilateral, Bankart lesion, surgery
AMBRI
atraumatic, multidirectional, bilateral, rehab, inferior capsular shift helpful.

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37
Q

SLAP lesion

A

Superior labrum (biceps anchor) from anterior to posterior

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38
Q

Sprengel’s deformity

A

Small scapula, omovertebral bone connects c-spine to scapula. Associated with Klippel-Feil syndrome, scoliosis, kidney disease

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39
Q 
Anterior (deltopectoral) shoulder approach
internervous planes
dangers
protect nerve with?
Complications
A

IN planes: Deltoid, pectoralis major
dangers: MC nerve, (retraction of conjoined tendon), cephalic vein, axillary nerve
protect axillary nerve with adduction and ER
Subscapularis rupture

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40
Q

6 portals for shoulder arthroscopy + dangers

A 
Posterior - posterior capsule/labrum
Anterior superior - CA ligament/artery
Anterior inferior - MC nerve
Lateral - axillary nerve
Wilmington - safe
Neviaser (supraspinatus) - Rotator cuff
41
Q

Tennis vs golfers elbow

A

Tennis lateral, golf medial epicondyle

42
Q

What runs in spiral groove?

A

Radial n

43
Q

Holstein-Lewis fracture? Nerve entrapped?

A

Distal 1/3 humerus fracture, radial n

44
Q

Supracondylar process ligament entrapping nerve

A

Ligament of Struthers, entrapping Median n

45
Q

Most susceptible part of radial head + why?

A

Anterolateral portion of radial head, less subchondral bone

46
Q

Humerus shaft fracture?

A

Descriptive

47
Q

Distal humerus fracture?

A

Descriptive (uni/bicondylar, T/y/lambda)

48
Q

Gartland classification

A

Extension type supracondylar humerus fracture (Posterior displacement, common in peds)
I: nondispaced
II: partially displaced (post. ctx intact)
III: displaced (no ctx intact)

49
Q

Colton classification

A

Olecranon fracture
I: nondisplaced (2mm) + description (avulsed, transvers/oblique, comminuted, displaced)
II: Displaced: avulsion, transverse/oblique, comminuted, displaced fx-dx

50
Q

Mason classification

A

Radial head fx

I: nondisplaced (

51
Q

Risk with olecranon fracture?

A

ulnar nerve injury

52
Q

Essex-Lopresti fracture?

A

Comminuted radial head with dislocation of distal RU joint, proximal migration of radius, and tear of IO membrane.

53
Q

Terrible triad of elbow

A

Elbow dislocation, radial head fx, coronoid fx

54
Q

Most common elbow dislocation?

A

posterolateral

55
Q

Nursemaid’s elbow

A

Radial head subluxation from annular ligament

56
Q

Bundles of medial ulnar collateral ligament, most important?

A

Anterior (most important against valgus stress)

posterior, transverse

57
Q

What compresses ulnar n in cubital tunnel?

A

Arcuate (Osbourne’s) ligament

58
Q

Sail sign?

A

displaced fat pads seen on XR when fracture causes hematoma

59
Q

Ligament of Struthers can compress

A

Median nerve proximally

60
Q

Arcade of Struthers can comress

A

Ulnar nerve proximal to cubital tunnel

61
Q

Leash of Henry can compress

A

radial n/PIN

62
Q

C5, C6, C7 reflexes?

A

C5 - biceps
C6 - brachioradialis
C7 - triceps

63
Q

Tennis elbow test

A

TET: make fist, pronate, extend wrist and fingers against resistance. pain @ lateral condyle = positive

64
Q

Conjoined tendon components (on coracoid process)

A

Short head biceps, coracobrachialis, pec minor

65
Q

Course of MC nerve in arm

A

Pierces coracobrachialis, then travels between biceps and brachilais muscles.

66
Q

Course of radial n in arm

A

Starts medial, spirals posteriorly, and laterally around the humerus in spiral groove and emerges between brachialis and brachioradialis.

67
Q

Course of ulnar n in arm

A

In medial arm from anterior to posterior compartment across the IM septum into cubital tunnel

68
Q

course of median n in arm

A

In anteromedial arm, lateral to brachial artery but crosses to become medial.

69
Q

Course of brachial artery in arm

A

runs with median nerve, then crosses under it to become more midline in distal arm.

70
Q

Innervation of brachialis

A

Medial is MC nerve, lateral is radial n

71
Q

Where are the 4 places the ulnar nerve can get trapped

A

IM septum
Arcade of Struthers
Cubital tunnel
FCU fascia

72
Q

Osteochondritis dissecans of elbow, XR findings?

A

vascular insufficiency to capitellum. Lucency of capitellum

73
Q

Humerus anterior approach. IN plane, dangers

A

Proximal planes: deltoid, pec major
Distal planes: brachialis (radial n lateral and MC nerve medial)
Dangers: proximal - axillary n, humeral circumflex artery
Distal: radial n, MC n

74
Q

Kocher approach to elbow

A

Lateral
IN planes: anconeus, ECU
Dangers: PIN, radial n
Keep arm pronated

75
Q

Posterior approach to elbow

A

No IN plane, olecranon is osteotomizes.

Dangers ulnar n.

76
Q

Bryan/Morrey approach to elbow

A

Posterior approach. Same as other posterior approach, but leave olecranon, triceps is partially reflected.
Dangers: ulnar n.

77
Q

Elbow arthroscopy portals (5) - dangers

A

Proximal anteromedial - ulnar nerve, MAC
Proximal anterolateral - radial nerve
Posterocentral - safe (thru tendon)
Posterolateral - med and post antebrachial cutaneous n
Direct lateral - posterior antebrachial cutaneous n

78
Q

Hawkins test

A

Hawkins: ff shoulder 90° then IR pain=positive impingement

79
Q

Empty can test

A

Empty can: pronate arm, resist FF weakness/pain=SS tear or RC tear

80
Q

Drop arm test

A

Drop arm: FF shoulder 90o, hold. drop=SS tear

81
Q

ER lag sign

A

ER lag sign: ER shoulder, patient holds. weakness = IS tear

82
Q

Horn blower’s test

A

Horn blower’s: ER shoulder in slight abduction. weakness = IS tear

83
Q

Lift off/lag/belly press:

A

Lift off/lag/belly press: lift hand off back, press on belly. weakness = subscap tear

84
Q

Crank test

A

Crank: abduct, axial load, rotate. pain = SLAP

85
Q

Speed’s test

A

Speed’s: resisted FF of shoulder, pain = biceps lesion

86
Q

Yergason’s test

A

Yergason’s: elbow 90o, resist supination and ER, feel biciptal groove. Pain = biceps tendinits

87
Q

Relocation (shoulder)

A

Relocation: abduct and ER with posterior force to arm. Relief from apprehension = anterior instability

88
Q

Load and shift

A

Load and shift: axial load with AP translation. increased translation = anterior or posterior instability

89
Q

Jerk test

A

Jerk: supine, adduct, FF90o, push posterior. pain/apprehension/translation = posterior instability

90
Q

Sulcus test

A

Sulcus: pull down on adducted arm. Sulcus under lateral acromion = inferior instability

91
Q

Scapular winging

A

Scapular winging: Push against wall, winging = LTN/serratus anterior weakness, or trap for lateral winging

92
Q

Adson’s test

A

Adson’s: Palpate pulse, rotate neck. Numbness/tingling suggests thoracic outlet syndrome (TOS)

93
Q

Wright’s test

A

Wright’s: Extend arm, rotate neck away, Numbness/tingling suggests thoracic outlet syndrome (TOS)

94
Q

Spurling’s test

A

Spurling’s: lateral flex/axillary compress neck. symptoms = cervical neck pathology

95
Q

Golfer’s elbow test

A

GET: supinate arm, extend wrist and elbow. pain @ medial epicondyle = positive

96
Q

Ligament instability

A

Ligament instability: 25° flexion, apply varus/valgus stress. Pain or laxity = positive

97
Q

Pivot shift shoulder

A

Pivot shift: supine, extend elbow, flex shoulder above head, supinate, axial load, valgus and flex elbow. Apprehension, palpable subluxation of the radial head or skin dimpling = positive.

98
Q

Tinel’s arm

A

Tinel’s: tap in ulnar groove. Numbness/tingling=positive

Elbow flexion: maximal elbow flexion for 3 mins. Tingling = positive

99
Q

Pinch grip

A

Pinch grip: pinch thumb and index. Pinching pads = AIN pathology.

Netter's Orthopaedics (7 decks)

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