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NMSK 2 - upper limb > shoulder girdle fractures > Flashcards

shoulder girdle fractures Flashcards

1
Q

where is the most likely location of a clavicle fracture & why?

A

the middle 1/3 as it is the thinnest

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2
Q

what joint injuries can a clavicle fracture be associated with?

A

-AC joint injury
-SC joint injury

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3
Q

what are the 3 main MOI’s of a clavicle fracture?

A

-fall with arm out, onto hand
-fall onto shoulder
-direct blow to shoulder

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4
Q

what are the complications of a clavicle fracture?

A

-malunion or deformity
-damage to blood vessels
-non union
-if fractured in a downward direction, it could damage a lung

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5
Q

how is an undisplaced clavicle fracture treated?

A

-broad arm sling for 2-3 weeks MAX (as we don’t want shoulder joint to get stiff)
-must provide support for the weight of the arm
-sling needed for comfort only
-try to get shoulder moving ASAP

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6
Q

how is an displaced clavicle fracture treated?

A

-ORIF & sling
-longer period of immobilisation which is guided by orthodox doctor

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7
Q

what are the causes of an AC joint injury?

A

blow to the shoulder in a downward force eg rugby or hockey

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8
Q

how many grades of an ACJ injury are there?

A

1-6

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9
Q

upon examination, what might you notice with an ACJ injury?

A

-tenderness
-palpable step (deformity)
-arm may look longer
-AP x ray

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10
Q

what are the 2 main MOI’s of an ACJ injury?

A

-fall onto the point of the shoulder
-fall onto outstretched hand with the humerus in an adducted position

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11
Q

what is the classification of an AC joint injury called?

A

Rockwood classification

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12
Q

Describe a grade 1 ACJ injury

A
  • sprain of the capsule
    -localised tenderness and pain on horizontal flexion (flexion across body)
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13
Q

Describe a grade II ACJ injury

A

-complete tear of the AC ligaments with sprain of the coracoclavicular ligaments (conoid & trapezoid)
-localised tenderness, pain on mat and palpable step deformity (but might not see it)

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14
Q

Describe a grade III ACJ injury

A
  • complete tears of the AC ligaments and CC ligaments
    -marked step deformity and pain on mat
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15
Q

describe a grade IV-VI ACJ injury

A

-complete rupture of all ligament complexes and dislocation of the joint
-pain, loss of mvt & function

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16
Q

what is a very specific special test for AC joint injury?

A

the scarf test

17
Q

is there a loss of ROM seen with ACJ injuries?

A

yes

18
Q

how are ACJ injuries managed (GRADE1-6)

A
  • grade I & II are treated conservatively
    -grade III - surgical vs conservative - there is an ongoing debate about this
    -grade IV, V 7 VI are treated surgically
19
Q

what does conservative management of grade I & II ACJ injuries involve?

A

-advice 7 education
-reduce pain - ice, period of immobilisation in sling ( 2-3 days in grade 1 & up to 6 weeks with grade II)
-joint and ST manual therapy
-isometric exercises may commence as pain permits
-muscle strength, endurance and proprioception
-avoid horizontal pressing motions - will irritate the joint

20
Q

how long are you in a sling for with a stable vs unstable ACJ injury for?

A
  • stable - sling 4-6 weeks, commence ROM after this
    -unstable- ORIF, sling and body bandage 4-6 weeks
21
Q

describe an anterior SC joint dislocation- is it common?, MOI, treatment

A

-uncommon
-fall on hand
-high energy force
-treatment includes reduction, sling for 2-3 weeks and may need ORIF and brace for 4-5 weeks

22
Q

describe a posterior dislocation of SC joint

A

rare but more serious
treatment includes ORIF

23
Q

What is the cause of a fractured scapula?

A

usually direct violence

24
Q

what does the treatment of a fractured scapula involve?

A

-broad arm sling of 2-4 weeks
-followed by ROM and physio

25
Q

where can fractures in the proximal humerus occur?

A

-neck of humerus - surgical neck
-greater tuberosity - avulsion

26
Q

what are the causes of an avulsion of greater tuberosity of humerus?

A

-forceful avulsion of supraspinatus tendon
-fall on shoulder in older patients

27
Q

what is the treatment for undisplayed vs displaced avulsion of GT of humerus?

A
  1. undisplayed- support - collar and cuff for 2-3 weeks and early mobilisation
  2. displaced - ORIF, collar and cuff needed for support 4-6 weeks
28
Q

what can cause a fracture of the surgical neck of the humerus?

A

fall on outstretched hand

29
Q

what are the complications to a fracture of surgical neck of humerus?

A

-non union
-damage to axillary nerve
-damage to radial nerve
-avascular necrosis

30
Q

how are stable surgical neck fractures managed ?

A
  • can be impacted or non impacted
    -non impacted - collar and cuff for 4-6 weeks and mob after this
    -impacted - collar and cuff for 2 weeks , mob after 2 weeks
31
Q

how are unstable surgical neck fractures managed?

A

-ORIF
-collar and cuff for 4-6 weeks
mob after this

32
Q

what are the causes of fracture of shaft of humerus?

A

-direct violence
-indirect violence eg fall

33
Q

what are the different types of humerus shaft fractures?

A

-spiral
-transverse
-pathological

34
Q

what are the complications of a fracture of the shaft of humerus?

A

-radial nerve palsy
-mal union
-non union

35
Q

what symptom is seen with radial nerve palsy?

A

wrist drop - due to weak or absent wrist and finger extension

36
Q

how is radial nerve palsy managed?

A

-may take number of weeks or months to recover
-maintain passive ROM
-aerobic exercise is good for nerves eg swim, run, bike
-strengthening once recovery is occurring

37
Q

compare the conservative vs surgical treatment of fracture to shaft of humerus

A
  1. conservative
    -surrounding musculature / stabilise the weight of arm
    -U slab/hanging cast
    -collar and cuff
  2. surgical
    - plate and screw
    -intramedullary nailing

NMSK 2 - upper limb (16 decks)

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