Shoulder/Arm Flashcards by Tyler Paras

Lateral vs medial winging?

Trapezius - lateral winging (spinal accessory n) Serratus anterior - medial winging (long thoracic n)

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Clavicle fracture groups?

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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Associated injury with scapula fracture?

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

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Ideberg classification

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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Rockwood classification

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

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Hill-Sachs lesion

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

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Glenohumeral dislocation, most common and associations?

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

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Neer classifications

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

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Buford complex?

Thickened MGHL and absent anterior/superior labrum

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Significance of SGHL? (Superior GlenoHumeral Ligament)

resists inferior translation and ER in shoulder abduction

Identifying ligaments…

https://radedasia.com/gleno-humeral-ligaments-mri-anatomy-superior-gleno-humeral-ligament-coraco-humeral-ligament-radiology-education-asia/

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Significance of MGHL?

resists AP translation in 45° of abduction

https://radedasia.com/gleno-humeral-ligaments-mri-anatomy-superior-gleno-humeral-ligament-coraco-humeral-ligament-radiology-education-asia/

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Significance of IGHL (and components)

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

https://radedasia.com/gleno-humeral-ligaments-mri-anatomy-superior-gleno-humeral-ligament-coraco-humeral-ligament-radiology-education-asia/

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Superior transverse scapular related nerve/artery?

Suprascapular nerve travels UNDER it, suprascapular artery travels OVER it

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Impingement sign test

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

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O’brien’s (active compression)

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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Apprehension test (shoulder)

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

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Cross body adduction

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

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Proximal humerus insertions

PLT medial to lateral Pec major, lat dorsi, teres major

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

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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Muscle at risk from anterior approach to shoulder?

Subscapularis

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Which muscle protects what nerve in posterior approach to shoulder?

Teres major protects radial nerve

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Draw the brachial plexus

do it

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Dorsal scapular nerve runs through which muscle

middle scalene

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Long thoracic nerve travels on which muscle

serratus anterior

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Which muscles does brachial plexus travel between

between anterior and middle scalene

What nerve is at risk in lateral shoulder approach

Axillary nerve

What runs in the deltopectoral groove?

Cephalic vein

Subdivision of brachial plexus?

Roots Trunks Divisions Cords Branches

Branches off of subclavian artery

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

When does the subclavian change name

After 1st rib, becomes the Axillary artery

Branches of axillary artery

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

Artery at risk in subacromial decompression

Acromial branch of the thoracoacromial

When does axillary artery name change?

Brachial at the lower border of teres major

Defining characteristic of adhesive capsulitis?

decreased active AND passive ROM

Bankart lesion?

Anterior inferior labral detachment from glenoid

Glenohumeral instability, two types

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

SLAP lesion

Superior labrum (biceps anchor) from anterior to posterior

Sprengel's deformity

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

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

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

6 portals for shoulder arthroscopy + dangers

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

Tennis vs golfers elbow

Tennis lateral, golf medial epicondyle

What runs in spiral groove?

Radial n

Holstein-Lewis fracture? Nerve entrapped?

Distal 1/3 humerus fracture, radial n

Supracondylar process ligament entrapping nerve

Ligament of Struthers, entrapping Median n

Most susceptible part of radial head + why?

Anterolateral portion of radial head, less subchondral bone

Humerus shaft fracture?

Descriptive

Distal humerus fracture?

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

Gartland classification

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

Colton classification

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

Mason classification

Radial head fx I: nondisplaced (

Risk with olecranon fracture?

ulnar nerve injury

Essex-Lopresti fracture?

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

Terrible triad of elbow

Elbow dislocation, radial head fx, coronoid fx

Most common elbow dislocation?

posterolateral

Nursemaid's elbow

Radial head subluxation from annular ligament

Bundles of medial ulnar collateral ligament, most important?

Anterior (most important against valgus stress) posterior, transverse

What compresses ulnar n in cubital tunnel?

Arcuate (Osbourne's) ligament

Sail sign?

displaced fat pads seen on XR when fracture causes hematoma

Ligament of Struthers can compress

Median nerve proximally

Arcade of Struthers can comress

Ulnar nerve proximal to cubital tunnel

Leash of Henry (radial recurrent artery) can compress

radial n/PIN

C5, C6, C7 reflexes?

C5 - biceps C6 - brachioradialis C7 - triceps

Tennis elbow test

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

Conjoined tendon components (on coracoid process)

Short head biceps, coracobrachialis, pec minor

Course of MC nerve in arm

Pierces coracobrachialis, then travels between biceps and brachilais muscles.

Course of radial n in arm

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

Course of ulnar n in arm

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

course of median n in arm

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

Course of brachial artery in arm

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

Innervation of brachialis

Medial is MC nerve, lateral is radial n

Where are the 4 places the ulnar nerve can get trapped

IM septum Arcade of Struthers Cubital tunnel FCU fascia

Osteochondritis dissecans of elbow, XR findings?

vascular insufficiency to capitellum. Lucency of capitellum

Humerus anterior approach. IN plane, dangers

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

Kocher approach to elbow

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

Posterior approach to elbow

No IN plane, olecranon is osteotomizes. Dangers ulnar n.

Bryan/Morrey approach to elbow

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

Elbow arthroscopy portals (5) - dangers

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

Hawkins test

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

Empty can test

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

Drop arm test

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

ER lag sign

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

Horn blower's test

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

Lift off/lag/belly press:

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

Crank test

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

Speed's test

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

Yergason's test

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

Relocation (shoulder)

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

Load and shift

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

Jerk test

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

Sulcus test

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

Scapular winging

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

Adson's test

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

Wright's test

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

Spurling's test

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

Golfer's elbow test

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

Ligament instability

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

Pivot shift shoulder

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.

Tinel's arm

Tinel's: tap in ulnar groove. Numbness/tingling=positive Elbow flexion: maximal elbow flexion for 3 mins. Tingling = positive

Pinch grip

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