Thorax/Abdomen

Question 1

for a sternal fracture with possible intrathoracic trauma, what are the first two steps in workup/eval?

Answer 1

CXR and EKG

Question 2

why should displaced sternal fractures be relocated in the hospital?

Answer 2

due to possible associated intrathoracic trauma - reduction should be done during cardiac monitoring

Question 3

directionally, what is the most common type of SC joint dislocation?

Answer 3

anterior

Question 4

what type of chest dislocation causes 25-30% risk of injury to vital structures traversing the thoracic outlet and has 12.5% mortality rate?

Answer 4

posterior SC joint dislocation

Question 5

which xray view should be obtained to evaluate for SC joint dislocation?

Answer 5

Serendipity view

Question 6

how is a typical Grade I/II SC joint injury treated?

Answer 6

sling as needed for pain, avoiding stress on joint for 2-4 weeks, followed by early functional therapy

Question 7

what injection therapies can be offered for patients with chronic SCJ dislocation?

Answer 7

corticosteroid / prolotherapy

Question 8

a violent muscle contraction of the abdomen can cause what type of rib fracture? why?

Answer 8

avulsion fracture of attachments of the external obliques to the lower three ribs / floating ribs

Question 9

what is the term given to fracture of at least 3 consecutive ribs, each in two locations, causing free floating segment of chest wall?

Answer 9

flail chest

Question 10

what modality is more sensitive than conventional radiography in the initial eval of suspected rib fracture?

Answer 10

ultrasound

Question 11

what modality is approved for treatment of a rib stress fracture if after 3 months from diagnosis the fracture line has not healed after non surgical management?

Answer 11

bone stimulator

Question 12

what injection type can be used for acute treatment of pain due to rib fracture?

Answer 12

intercostal nerve block - injecting lidocaine or bupivacaine just below lower border of the fractured rib

Question 13

s/p first rib fracture, if excessive callus forms, what are two possible complications?

Answer 13

TOS / Horner’s syndrome

Question 14

t/f for rib fracture RTP is guided by no pain with palpation, no use of analgesics, full ROM thoracic cage, and ability to sprint/twist without significant discomort

Answer 14

true

Question 15

what is the typical return to play time after uncomplicated rib fracture?

Answer 15

3-8 weeks

Question 16

what is the name of the ligament that attaches rib to sternum and rib, respectively?

Answer 16

sternocostal ligament / costochondral ligament

Question 17

what chest condition is characterized by reproducible pain / clicking when curling fingers under costochondral junction in question and lifting the region superiorly and anteriorly to palpate subluxation?

Answer 17

slipping tib / costochondral separation

Question 18

what is the normal return to play time for a slipping rib / costochondral sprain or separation?

Answer 18

9-12 weeks (slow healing)