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Orthopedic Surgery Ultimate > Shoulder/Arm Approaches > Flashcards

Shoulder/Arm Approaches Flashcards

1
Q

position for anterior approach to the clavicle

A

supine

elevate head

sandbag between scapula and spine

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2
Q

incision for anterior approach to the clavicle

A

start medial after palpating subcutaneous border of clavicle

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3
Q

internervous plane for anterior approach to the clavicle

A

none

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4
Q

superficial dissection for anterior approach to the clavicle

A

through platysma

diathermy vessels

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5
Q

deep dissection for anterior approach to the clavicle

A

strip soft tissue off clavicle in epiperiosteal plane

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6
Q

danger for anterior approach to the clavicle

A

1) brachial plexus
2) subacromial artery and vein immediately inferior to clavicle - avoid inferior dissection

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7
Q

position for anterior approach to shoulder joint

A

supine

sandbag between scapula and spine

elevate table 30°

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8
Q

incision for anterior approach to shoulder joint

A

10-15 cm along deltopectoral groove starting at corocoid

alternatively, you can use the axillary incision, which is vertical in the axilla starting at the anterior crease

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9
Q

internervous plane for anterior approach to shoulder joint

A

between deltoid and pecs

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10
Q

superficial dissection for anterior approach to shoulder joint

A

retract pec medial and delt lateral

take the cephalic vein in the convenient direction

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11
Q

deep dissection for anterior approach to shoulder joint

A

displace the short head of biceps and coracobrachialis medially

osteotomize the corocoid if necessary with the arm adducted (takes brachial plexus and artery away from field)

retract corocoid medially

externally rotate to ID subscap

divide subscap 1 cm from insertion and use stay sutures to anchor it (or take some bone with it)

incise joint capsule where appropriate

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12
Q

danger for anterior approach to shoulder joint

A

1) MSK nerve as it enters the coracobrachialis 5-8 cm distal to corocoid
2) cephalic vein

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13
Q

position for anterolateral approach to the AC joint and subacromial space

A

supine

sandbag between scapula and spine

elevate head 45°

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14
Q

incision for anterolateral approach to the AC joint and subacromial space

A

transvers incision beginning at the anterolateral corner of the acromion ending just lateral ato the coracoid

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15
Q

internervous plane for anterolateral approach to the AC joint and subacromial space

A

none - delt is detached

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16
Q

superficial dissection for anterolateral approach to the AC joint and subacromial space

A

fascia

palpate AC joint

ligate the coracoacromial artery

spare as much deltoid as possible

split delt 5 cm down if approaching for rotator cuff repair

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17
Q

deep dissection for anterolateral approach to the AC joint and subacromial space

A

detach coracoacromial ligament from acromion and coracoid - remove for decompression of teh subacromial space

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18
Q

danger for anterolateral approach to the AC joint and subacromial space

A

1) axillary nerve runs deep to delt 7 cm below the acromion
2) acromial branch of the coracoacromial artery must be ligated just under the delt as you approach

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19
Q

position for lateral approach to proximal humerus

A

supine with arm at edge of table

elevate head of table

sandbag for shoulder

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20
Q

incision for lateral approach to proximal humerus

A

5 cm longitudinal from tip of acromion down lateral arm

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21
Q

internervous plane for lateral approach to proximal humerus

A

none - split delt

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22
Q

superficial dissection for lateral approach to proximal humerus

A

split delt in line with fibres from acromion down

insert stay suture at inferior margin

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23
Q

deep dissection for lateral approach to proximal humerus

A

incise subacromial bursa

expose humerus and rotator cuff

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24
Q

danger for lateral approach to proximal humerus

A

1) axillary nerve 7 cm below acromion travelling transversely under delt

*note that the minimally invasive lateral approach is also available with 2 incisions, but the key is ID the axillary nerve and go deep to it*

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25
Q

position for posterior approach to the shoulder joint

A

lateral

stand behind

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26
Q

incision for posterior approach to the shoulder joint

A

linear along scapular spine extending to posterior corner of acromion

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27
Q

internervous plane for posterior approach to the shoulder joint

A

between teres minor and infraspinatus

28
Q

superficial dissection for posterior approach to the shoulder joint

A

detach delt from scapular spine

develop plane between infraspinatus and delt

29
Q

deep dissection for posterior approach to the shoulder joint

A

ID plane between infraspinatus and teres minor and develop

retract superior and inferior respectively

expose joint and incise

30
Q

danger for posterior approach to the shoulder joint

A

1) axillary nerve as it runs through quadrangular space beneath teres minor
2) suprascapular nerve passes around the base of the spine of scapula
3) posterior circumflex humeral artery runs with axillary nerve

31
Q

position for anterior approach to the humeral shaft

A

supine

arm board

tilt patient away

NO tourniquet

32
Q

incision for anterior approach to the humeral shaft

A

longitudinal from tip of coracoid run distal and lateral along delto-pectoral groove then following the lateral border of biceps as far as necessary

33
Q

internervous plane for anterior approach to the humeral shaft

A

proximally between pec and delt

distally between medial and lateral fibres of brachialis

34
Q

superficial dissection for anterior approach to the humeral shaft

A

ID deltopectoral groove using cephalic vein as a guide

fascia

interval betwen biceps and brachialis

retract biceps medially

35
Q

deep dissection for anterior approach to the humeral shaft

A

incise periosteum lateral to pec insertion

ligate anterior humeral circumflex artery

may need to detach pec major and move medially

split fibres of brachialis to expose distal shaft

36
Q

danger for anterior approach to the humeral shaft

A

1) radial nerve - vulnerable at 2 spots - spiral groove and anterior compartment of distal third of arm between brachialis and brachioradialis
2) axillary nerve running under deltoid 7 cm distal to acromion
3) anterior humeral circumflex artery
4) lateral ante-brachial cutaneous nerve medial to brachialis

*note that this can also be done via two small minimally invasive incisions

37
Q

position anterolateral approach to the distal humerus

A

supine

arm board

tourniquet

38
Q

incision anterolateral approach to the distal humerus

A

curved over lateral aspect of biceps starting 10 cm proximal to flexor crease

39
Q

internervous plane anterolateral approach to the distal humerus

40
Q

superficial dissection anterolateral approach to the distal humerus

A

incise deep fascia

ID lateral biceps and retract medially

ID interval between brachialis and brachioradialis develop plane

find radial nerve

41
Q

deep dissection for anterolateral approach to the distal humerus

A

incise lateral border of the brachialis muscle down to bone and retract medially

42
Q

danger for anterolateral approach to the distal humerus

A

1) ID the radial nerve and protect it

43
Q

position for posterior approach to the distal humerus

A

either lateral or prone with arm abducted with sandbag under shoulder

44
Q

incision for posterior approach to the distal humerus

A

longitudinal in posterior midline from 8 cm below acromion to olecranon fossa

45
Q

internervous plane for posterior approach to the distal humerus

A

none - separate heads of triceps

46
Q

superficial dissection for posterior approach to the distal humerus

A

fascia

ID 3 parts of triceps - the radial nerve will be between the lateral and medial heads

47
Q
A

lateral head of triceps

48
Q
A

profunda brachii artery and radial nerve

49
Q
A

hiatus in lateral intermuscular septum

50
Q
A

medial head of triceps

51
Q
A

long head of triceps

52
Q

deep dissection for posterior approach to distal humerus

A

incise medial head of triceps midline down to bone

53
Q

danger for posterior approach to the distal humerus

A

1) radial nerve between medial and lateral head of triceps
2) ulnar nerve as in passes posteromedially
3) profunda brachii artery with radial nerve

54
Q

position for lateral approach to distal humerus

A

supine

arm across chest

tourniquet

55
Q

incision for lateral approach to distal humerus

A

4-6 cm straight incision lateral aspect of elbow over lateral supracondylar ridge

56
Q

internervous plane for lateral approach to distal humerus

A

none - between triceps and brachioradialis

57
Q

superficial dissection for lateral approach to distal humerus

A

fascia

find plane between brachioradialis and triceps and cut down to bone

retract triceps posteriorly and brachioradialis anteriorly

58
Q

deep dissection for lateral approach to distal humerus

A

ID common extensor origin and release if needed

59
Q

dangers for lateral approach to distal humerus

A

1) radial nerve pierces lateral intermuscular septum in distal third of arm

60
Q

position for minimal access approach for humeral nailing

A

supine

elevate table 45°

shoulder over edge of table

61
Q

incision for minimal access approach for humeral nailing

A

2 cm from acromion vertically down arm

62
Q

internervous plane for minimal access approach for humeral nailing

A

none - split deltoid

63
Q

superficial dissection for minimal access approach for humeral nailing

A

insert wire under fluoro as guide

remove and make small incision

put wire back and use awl

insert nail

64
Q

danger for minimal access approach for humeral nailing

A

1) axillary nerve 7 cm below the acromion under deltoid
2) brachial artery medial to proximal humerus
3) median nerve with brachial artery
4) supraspinatus tendon is partially incised - take care when drilling not to cause more damage

Orthopedic Surgery Ultimate (88 decks)

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