T&O (Upper) Flashcards
Describe the pathophysiology of a Clavicle Fracture
Normally caused by a FOOSH
Medial segment displaced superiorly, inferior segment dislaced inferiorly
Describe the Allman classification of Clavicle Fractures
I - Fractured middle 1/3
II - Lateral 1/3
III - Medial 1/3 (associated with polytrauma, pneumothorax/haemothorax)
How do clavicular fractures present?
Sudden onset localised severe pain (worsened by movement)
How are claviular fractures managed?
- Conservatively as too superficial for metal work
- Sling until patient regains movement of shoulder (try to
early to avoid frozen shoulder - Generally heals in 4 to 6 weeks
Surgery indicated if not healed, comminuted or open
Name the four Rotator Cuff muscles and their innervation
Supraspinatus (Suprascapular Nerve)
Infraspinatus (Suprascapular Nerve)
Teres Minor (Axillary Nerve)
Subscapularis (Subscapular Nerve)
Describe the movements of the Rotator Cuff muscles
Supraspinatus - Abduction
Infraspinatus and Teres Minor - Lateral Rotation
Subscapularis - Medial Rotation
Name two ways Rotator Cuff Tears can be classified
- Acute or Chronic (>3 months)
- Can be full or partial thickness
Describe three features of a Rotator Cuff Tear
- Pain over lateral aspect of shoulder
- Inability to abduct arm over 90 degrees
- Tenderness over Greater Tuberosity
How can you test the integrity of each Rotator Cuff Muscle?
Supraspinatus - Empty Can Test
Subscapularis - Gerber’s Lift Off (dorsum on back and pushing against resistance)
Infraspinatus and Teres Minor - Posterior Cuff (abducting fists against resistance)
How do you manage Rotator Cuff Tears?
Conservative - Analgesia, Physiotherapy, Corticosteroid Injections
Surgery - If conservative has failed or if presenting after 2 weeks (can be done arthroscopically or open)
What is the main complication of Rotator Cuff Tears?
Adhesive Capsulitis
Describe the cause of an Anteroinferior and Posterior Shoulder Dislocation respectively
Anteroinferior - Force applied to extended/abducted/externally rotated arm
Posterior - Seizures/Electrocution
Describe three clinical features of Shoulder Dislocation
Pain and Reduced Mobility
Instability
Asymmetry/Flattened Deltoid
Give 3 associated injuries of Shoulder Dislocations
Bankart - Fracture of anteroinferior Glenoid
Hill Sachs - Impaction fracture to Humeral Head
Rotator Cuff Tears
Name the three XRay views used in a Shoulder Dislocation
AP
Axial
Y Scapular (useful for differeniating between anterior and posterior)
How would an Anterior and Posterior Dislocation present on an Xray?
Anterior - Humeral head is out of glenoid fossa
Posterior - Lighbulb sign
How would you manage a Shoulder Dislocation?
A to E
Analgesia
Reduction/Immobilisation (broad arm sling for two weeks)/Rehabilitation
How would a Humeral Shaft Fracture present?
Pain and Deformity (commonly after a FOOSH)
Radial Nerve Involvement (Reduced sensation in dorsal web space, weakness in wrist extension
What is a Holstein Lewis Fracture?
Fracture of distal 1/3 of Humerus
How are Humeral Shaft Fractures investigated?
AP and Lateral X-Ray films
Describe the conservative and surgical management of Humeral Shaft fractures
Conservative - Realignment and Humeral/Over elbow cast
Surgical - ORIF Plating, IM Nails
What is Biceps Tendinopathy?
Encompasses a variety of pathological changes resulting in a weaker tendon and greater risk of rupture
Presenting with pain/associated stiffness/weakness
Describe the two tests for Biceps Tendinopathy?
Speed Test - Proximal Biceps Tendon
Yergason’s Test - Distal Biceps Tendon (Queens Wave against resistance)
Describe the conservative and surgical management of Biceps Tendinopathy
Conservative - Analgesia/Ice/Physio
Surgical - Arthroscopic Tenodesis (cut and reattached) and Tenotomy (Division of Tendon)