Shoulder fractures

Question 1

what is the most common direction for the shoulder to dislocate?

Answer 1

anterior

Question 2

what is a bankart lesion?

Answer 2

damage to anteroinferior glenoid labrum

Question 3

what is a hill sachs lesion?

Answer 3

cortical depression in the postolateral part of the humeral head following importation against the glenoid rim during anterior dislocation

Question 4

what are the two methods of reduction under anaesthetic for shoulder dislocations ?

Answer 4

Hippocratic: Longitudinal traction ̄c arm in 30O abduction and counter traction @ the axilla

 Kocher’s: external rotation of adducted arm, anterior movement, internal rotation

Question 5

how long does a shoulder dislocation have to be in a sling for?

Answer 5

3-4weeks

Question 6

what are two complications of shoulder dislocations?

Answer 6

further dislocations

axillary nerve damage

Question 7

what causes impingement syndrome at the shoulder?

Answer 7

Entrapment of supraspinatus tendon and subacromial bursa between acromion and grater tuberosity of humerus.

Question 8

what is the presentation of impingement syndrome ?

Answer 8

painful arc 60-120 degrees
weakness and decreased ROM
positive hawkins test

Question 9

what is hawkins test ?

Answer 9

shoulder flexed 90 degrees and elbow flexed at 90 degrees then internally rotate

Question 10

what is the treatment for impingement syndrome ?

Answer 10

Conservative
 Rest
 Physiotherapy

 Medical
 NSAIDs
 Subacromial bursa steroid ± LA injection

 Surgical
 Arthroscopic acromioplasty

Question 11

what is a DD for impingement syndrome ?

Answer 11

Supraspinatous tear or partial tear

 AC joint OA

Question 12

what is the presentation of frozen shoulder ?

Answer 12

Progressive ↓ active and passive ROM  ↓ ext. rotation <30O
 ↓ abduction <90O
 Shoulder pain, esp. @ night

Question 13

what is the cause of frozen shoulder ?

Answer 13

unknown

Question 14

what is the Tx for frozen shoulder ?

Answer 14

Conservative
 Rest
 Physiotherapy

 Medical
 NSAIDs
 Subacromial bursa steroid ± LA injection

Question 15

what are the signs of a complete tear of rotator cuff tear?

Answer 15

Shoulder tip pain
 Full range of passive movement
 Inability to abduct the arm
 Active abduction possible following passive
abduction to 90O

Question 16

what type of fall could cause supracondylar fractures ?

Answer 16

common in children after FOOSH

fallen on outstretched hand

Question 17

what are the two classifications of supracondylar fractures ?

Answer 17

extension and flexion

Question 18

what structure could be damaged during a supracondylar fracture?

Answer 18

brachial artery

Question 19

what is the commonest type of supracondylar fractures ?

Answer 19

extension

Question 20

what is the further class-action of extension supracondylar fractures ?

Answer 20

gartland
Type 1: non-displaced
Type 2: angulated ̄c intact posterior cortex 
Type 3: displaced ̄c no cortical contact

Question 21

during an extension supracondylar fracture which way does the distal fragment displace ?

Answer 21

displaces posteriorly

Question 22

during an flexion supracondylar fracture which way does the distal fragment displace ?

Answer 22

displaces anteriorly

Question 23

what structures can be damaged with a supracondylar fracture ?

Answer 23

brachial artery

radial and median nerve

Question 24

what is a complication of supracondylar fractures ?

Answer 24

compartment syndrome 
- pain on passive extension 
Volkmanns ischaemic contracture 
- claw hand 
gunstock deformity 
- cubitus varus

Question 25

what is the management of supracondylar fractures with and without displacement ?

Answer 25

 No displacement → flex the arm as fully as
possible and apply a collar and cuff for 3wks –
triceps acts as sling to stabilise fragments.

 Displacement → MUA + fixation with K-wires +
collar and cuff with arm flexed for 3wks.