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Artritis > Shoulder Trauma > Flashcards

Shoulder Trauma Flashcards

1
Q

common U/E fractures, particularly in patients older

than 65 years

A

Proximal humeral fractures

most are isolated and stable

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2
Q

70% of proximal humeral fractures occur in

A

women due to osteoporosis

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3
Q

If displaced fracture is present, it increases chances of

A

AVN of the Humeral Head

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4
Q

used for radiologic-clinical correlation and the severity of

the proximal humeral fractures

A

Neer classification

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5
Q

physeal lines that divide proximal humerus

into four parts:

A

1) the head
2) the greater tuberosity
3) the lesser tuberosity
4) surgical neck and/or the proximal shaft

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6
Q

As defined by Neer in 1970, fragments are considered displaced if there is

A

> 1 cm of separation and/or >45-degrees of angulation of a fragment

(Most fractures are minimally or un-displaced (80% to 85%)

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7
Q

80 % of proximal humeral fractures are

A

minimally displaced

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8
Q

One-part Neer fracture

A

No fragments displaced (80%)

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9
Q

Two-part Neer fracture:

A

One fragment displaced >1cm or 45-degrees (13%)

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10
Q

Three-part Neer fracture:

A

Displacement of the surgical neck and either the greater

or lesser tuberosity (3%)

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11
Q

Four-part Neer fracture:

A 
Typically displaced fractures of both tuberosities and
surgical neck (4%)
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12
Q

Un-displaced fractures (Neer one-part) should be treated

A

conservatively (e.g. sling)

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13
Q

lucent line and cortical breach with variable degrees of

cortical off-set, angulation, impaction and displacement

A

Proximal humeral fractures

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14
Q

most common Neer two-part fracture

A

Surgical neck fracture

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15
Q

may occur from

Pectoral pull during surgical neck or proximal metaphysis fractures

A

medial

displacement of proximal fragment

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16
Q

Some sources may refer to greater tuberosity Fx as

A

“Flap

Fracture”

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17
Q

Shoulder dislocations

A

1) Anterior GH dislocation (most common)
2) posterior GH dislocation
3) inferior GH dislocation (Luxatio Erecta)

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18
Q

most common shoulder dislocation

A

subcoracoid Anterior GH

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19
Q

Anterior shoulder dislocation usually results from

A

forced abduction, external rotation and extension

protective falls

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20
Q

inferior GH dislocation, also known as?

A

Luxatio Erecta

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21
Q

anterior shoulder dislocation mostly occur to

A

young men with high-energy injuries

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22
Q

types of Anterior dislocations

A

subcoracoid: most common
subglenoid
subclavicular
intrathoracic: very rare

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23
Q

anterior dislocations of the humeral head comes to lie

A

anterior, medial and

somewhat inferior to its normal location and glenoid fossa

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24
Q

complications of anterior shoulder dislocations?

A

Hill-Sachs deformity/impaction Fx and Bankart lesion

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25
Q

Kocher’s manoeuvre can be

performed by

A

traction and external rotation and then adduction and

internal rotation.

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26
Q

dislocation treatment for patient under 40

A

3-weeks of collar and a cuff shoulder

immobilization

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27
Q

dislocation treatment for older patient

A

collar and a cuff are applied for 48-hours followed by

some attempts to mobilize the shoulder.

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28
Q

Posterolateral humeral head impaction fracture as the humeral head pressed against the antero-inferior part of the glenoid

A

Hill-Sachs lesion

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29
Q

Hill-Sachs lesion is often associated with a

A

Bankart lesion of the glenoid

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30
Q

When a Hill-Sachs lesion is identified careful assessment of the anterior glenoid rim should be performed to search for potential

A

Bankart lesion

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31
Q

Hill-Sachs impaction is best appreciated following relocation
of the joint especially on what view?

A

internal rotation view

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32
Q

sclerotic vertical line extending from the top of the humeral
head towards the shaft

A

Hill-Sachs lesion (wedge defect may be noted)

33
Q

the wedge defect sometimes found with Hill-Sachs lesions is also called a?

A

“hatchet deformity”

34
Q

common complication of anterior shoulder dislocation and

is frequently seen with Hill-Sachs impaction deformity

A

Bankart lesion (may heal spontaneously)

35
Q

Bankart lesion associated with detachment of the

A

anterior inferior labrum

from the underlying glenoid

36
Q

bankart lesion, labral only

A

“cartilagenous Bankart”

37
Q

bony bankart with…

A

detached fragment of inferior glenoid rim

38
Q

less common than anterior and sometimes hard to identify if only AP projections are obtained

A

Posterior shoulder dislocation (PSD)

39
Q

Posterior shoulder dislocation (PSD) accounts for what % of all shoulder dislocations?

A

2-4%

40
Q

mechanism of Posterior shoulder dislocation (PSD)

A

Humeral head is forced posteriorly in internal rotation whilst the arm is being
abducted

41
Q

most common cause of Posterior shoulder dislocation (PSD)

A

Convulsive disorder (epilepsy)

42
Q

known classic but rare cause of posterior shoulder dislocation

A

Electrocution

43
Q

the preferred view for diagnosis of posterior shoulder dislocation

A

axillary view

44
Q

absence of what on radiographs is a major clue to posterior shoulder dislocation?

A

Absence of external rotation of the humeral head on images in a standard shoulder series

45
Q

internally rotated humeral head takes on a rounded appearance

A

Light bulb sign

46
Q

vertical dense line in medial humeral head indicating impaction by the posterior glenoid

A

Trough sign

47
Q

with trough sign there will be Loss of normal

A

semilunar overlap sign on frontal views

48
Q

widened glenohumeral joint > 6 m (important)

A

RIM SIGN

49
Q

inferior shoulder dislocation is also known as ________ ,

A

luxatio erecta

50
Q

inferior shoulder dislocation is also known as luxatio erecta because the arm appears to be

A

permanently held in fixed in an abducted position

51
Q

inferior shoulder dislocation is caused by a

A

hyperabduction/inferior push of the arm

52
Q

inferior shoulder dislocation is caused by a

A

hyperabduction/inferior push of the arm

53
Q

in inferior shoulder dislocation the humeral head is displaced directly below, and a little _____ to the glenoid

A

medial

54
Q

Inferior dislocations have a high or low complication rate

A

high

55
Q

ACJ injuries usually occur from a _______ or following a fall onto the shoulder with an _______ arm.

A

direct blow, adducted

56
Q

ACJ injuries are uncommon.

True or false?

A

false

57
Q

AP and cephalad angled (10-15 degree) view with and w/o weights (10lb)
are obtained for?

A

ACJ injury

58
Q

Surgical intervention on a grade __ ACJ injury should be considered

A

lll

59
Q

Features of ACJ injury include:

A
  • soft tissue swelling
  • widening of the AC joint
  • increased coracoclavicular (CC) distance
  • superior displacement of the distal clavicle
60
Q

may be the only finding in grade I ACJ injuries

A

soft tissue swelling

61
Q

normal ACJ space is?

A

5-8 mm (narrower in the elderly)

62
Q

normal coracoclavicular (CC) distance is?

A

10-13 mm

63
Q

Normally the undersurface of the acromion should be leveled with the
undersurface of the

A

clavicle

64
Q

Classification commonly used for the radiographic-clinical grading of ACJ
injury?

A

Rockwood

65
Q

Type I Rockwood ACJ injury

A

AC ligament is sprained

everything else is normal

66
Q

Type II Rockwood ACJ injury

A
  • AC ligament is RUPTURED
  • CC ligament: sprain
  • joint capsule: ruptured
  • deltoid muscle: minimally detached
  • trapezius muscle: minimally detached
  • clavicle elevated but not above the superior border of the acromion
67
Q

Type IIl Rockwood ACJ injury

A

A- C & CC ligaments are RUPTURED

  • joint capsule: ruptured
  • deltoid muscle: detached
  • trapezius muscle: detached
  • clavicle elevated above the superior border of the acromion
68
Q

Which types of Rockwood ACJ injuries can be treated conservatively?

A

1 and 2

69
Q

Humeral shaft fractures account for ____ % of all fractures

A

3-5

70
Q

2-age groups for humeral shaft fracture?

A

males in their 30’s and patients over 65

71
Q

Direct blow to the upper arm usually causes a?

A

transverse fractures

72
Q

The most common associated injury during Humeral shaft fractures is damage to the

A

radial nerve in the spiral groove

73
Q

In some cases of a spiral fracture of the humeral shaft its distal fragment may be
displaced in such way that its proximal end will be displaced in what direction?

A

radially (i.e.

laterally)

74
Q

when spiral fracture of humeral shaft causes radial displacement of proximal end, this is called a?

A

Holstein-Lewis Fx

75
Q

Holstein-Lewis Fx may lead to damage to the

A

Radial nerve as it passes in the intermuscular

septum

76
Q

location of 30% of Humeral Shaft Fractures

A

proximal third

77
Q

60% of Humeral Shaft Fractures occur where?

A

middle third

78
Q

10% of Humeral Shaft Fractures occur where?

A

distal third

79
Q

most common humeral shaft fractures occur where?

A

middle third

Artritis (7 decks)

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