Trauma and Orthopedic Surgery: PART IV

Question 1

What is this describing:
Arm typically held in abduction and slight external rotation (limited adduction)
Humeral head palpable below the coracoid process
Loss of shoulder contour: prominent acromion and flattening of the deltoid muscle

Answer 1

Anterior shoulder dislocation

Question 2

What is this describing?
Arm held in fixed abduction at ∼ 125° (limited adduction)
Humeral head may be palpable in axilla
Elbow typically held in flexion with a pronated forearm
Axillary nerve injury may be present.

Answer 2

Inferior shoulder dislocation

Question 2

What is this describing?
Arm held in adduction and internal rotation (limited external rotation)
Prominent coracoid process with anterior soft tissue flattening
Humeral head not palpable [6]

Answer 2

Posterior shoulder dislocation

Question 3

caused by inflammation of subacromial structures (e.g., rotator cuff tendons, subacromial bursa, and long head of the biceps) and subsequent narrowing of the subacromial space.

Answer 3

subacromial impingement syndrome

Question 4

Most common rotator cuff tear

Answer 4

supraspinatus

Question 5

A syndrome of pain during shoulder abduction, forward flexion, and/or extreme adduction associated with narrowing of the subacromial space

Answer 5

Subacromial impingement syndrome

Question 6

Pain and restriction of active movement between 60 and 120° is characteristic of what shoulder impingement?

Answer 6

Subacromial impingement

Question 7

These may be positive in this impingement syndrome: Positive provocative clinical examination
Neer test
Hawkins test
Painful arc test

Answer 7

Subacromial impingement

Question 8

What muscles make up the rotator cuff?

Answer 8

Includes the supraspinatus, infraspinatus, teres minor, and subscapularis muscles and their associated tendons.

Question 9

A physical examination maneuver used to assess the supraspinatus.

Answer 9

Jobe/empty can test

A physical examination maneuver used to assess the supraspinatus. The patient outstretches and internally rotates their arm so that the thumb faces downward, which minimizes the effect of the deltoid muscle on abduction. Considered positive if the patient cannot maintain their arm abducted against resistance or if it is painful to do so, which suggests injury to the supraspinatus tendon or muscle or injury to the suprascapular nerve.

Question 10

lift off test

Answer 10

A physical examination maneuver used to assess the subscapularis muscle. The patient places her or his hand on the lower back with the palm facing outwards and lifts the arm posteriorly off the back against resistance. Considered positive if the patient cannot lift the arm posteriorly, which indicates injury to the subscapularis muscle or tendon.

Question 11

what action does subscapularis do?

Answer 11

internal rotation of the arm/shoulder

Question 12

What muscle is he likely testing?

Answer 12

infraspinatous because hes testing external rotation

Question 13

Subacromial impingment syndrome can include what pathologies?

Answer 13

Encompasses a spectrum of pathologies, including rotator cuff disease, subacromial bursitis, and biceps tendinopathy [

Question 14

Referred pain in the deltoid area with overhead activities can be seen in

Answer 14

rotator cuff tendinopathies

Question 15

A condition of inflammation and fibrosis of the joint capsule that leads to contracture of the shoulder joint. Can be idiopathic, a complication of proximal humerus fracture, or a postoperative complication due to immobility. Can be a complication of rotator cuff pathology

Answer 15

frozen shoulder (adhesive capsulitis)

Question 16

What is the allman classification used for?

Answer 16

clavicle fracture

Question 17

Where is the clavicle most likely the break?

Answer 17

Most common site of fracture is the middle third segment of the clavicle because its weakest point is at the junction of the middle and lateral third of the clavicle.

Question 18

Treatment for stable clavicle fracture

Answer 18

simple shoulder sling

Question 19

treament for unstable clavicle tracture

Answer 19

surgical fixation

Question 20

Midshaft fractures of the humerus run the risk of what palsy?

Answer 20

The radial nerve runs through the radial sulcus of the upper arm and is especially at risk in fractures of the middle third (midshaft) of the humerus!

Question 21

In fractures of the humerus, what is more common in adults and what is more common in kids?

Answer 21

Proximal humerus fractures are common in older adults

Supracondylar fracture is most common in kids. (most common elbow fracture)

Question 22

Most common cause of humerus fracture?

Answer 22

Falls with axial loading on an outstretched hand, Typically resulting in proximal humerus fracture in older adults and distal supracondylar fracture in children

Question 23

Major complications of suprachondylar fractures include

Answer 23

Injuries to the median nerve and brachial artery, which both cross the elbow, are common complications of supracondylar fractures.

Question 24

Wrist drop and decreased sensation over dorsal hand is consistent with _______________ nerve palsy likely from a fracture of the ______________ humerus

Answer 24

Wrist drop and decreased sensation over dorsal hand is consistent with radial nerve palsy likely from a fracture of the shaft of the humerus

Question 25

claw hand deformity is most consistent with a ___________________ nerve palsy likely due to fracture of the ________________ humerus

Answer 25

ulnar, distal

Question 26

A continuation of the axillary artery that serves as the main arterial supply for the arm, including the coracobrachialis, biceps, and triceps brachialis muscles. Originates at the inferior border of the teres major, passes from the medial aspect of the humerus to the anterior aspect of the arm, and terminates just below the cubital fossa by bifurcating into the radial and ulnar arteries.

Answer 26

brachial artery

Question 27

Most common mode of injury for an elbow dislocation

Answer 27

A fall on an outstretched hand is the usual mode of injury.

Question 28

sail sign

Answer 28

It indicates the presence of an elbow joint effusion such as in a supracondylar fracture. The anterior fat pad normally gets displaced.

Question 29

Colles Fracture

Answer 29

A distal radius fracture with dorsal displacement of the distal fragment. Classically occurs after a fall on an outstretched hand and is common in patients with osteoporosis.

Question 30

A fracture of the distal radius associated with volar (radial and ventral) angulation of the distal fracture fragment. Typically caused by a fall on a flexed wrist or direct injury to the back of the wrist.

Answer 30

Smith fracture

Question 31

A radial shaft fracture with disruption of the distal radioulnar joint. It is more common in children and is usually caused by a fall on an outstretched arm.

Answer 31

Galeazzi fracture

Question 32

All suspected scaphoid fractures should be immobilized in a ______________ cast.

Answer 32

thumb spica

Question 33

Tear of the ulnar collateral ligament (UCL)

Answer 33

Gamekeeper’s thumb (Skier’s thumb)

Question 34

Avulsion injury or rupture of the flexor digitorum profundus tendon from the distal phalanx

Answer 34

jersey finger

Question 35

Slippage or disruption of the central band of the extensor digitorum tendon

Answer 35

Boutonniere deformity

Question 36

Positive eichoff/finkelstein

Answer 36

de quervain tenosynovitis

Question 37

injured playing basketball. Examination shows a right index finger flexed at the distal interphalangeal joint and inability to actively extend the distal phalanx

Answer 37

mallet finger, tx w/stack splint in hyperextension

Question 38

Surgical or conservative managment

Answer 38

surgical

This patient has a completely displaced lateral clavicle fracture on x-ray, likely with a torn conoid ligament. A completely displaced clavicle fracture involves displacement greater than one bone width and requires surgical management.

Question 39

surgical or conservative managment

Answer 39

conservative

Conservative treatment with a simple shoulder sling for 4–6 weeks is the treatment of choice for nondisplaced midshaft fractures of the clavicle because these fractures typically heal very well without significant intervention. After 2–4 weeks, physiotherapy should be initiated. Excessively shortened or displaced fractures require surgery.

Question 40

There is tenderness to palpation in the area between the tendons of the abductor pollicis longus, extensor pollicis brevis, and extensor pollicis longus muscle.

Answer 40

scaphoid fracture, anatomical snuff box tenderness

Question 41

anatomical snuff box

Answer 41

There is tenderness to palpation in the area between the tendons of the abductor pollicis longus, extensor pollicis brevis, and extensor pollicis longus muscle.

Question 42

Why do we get a repeat x ray in 2 weeks for suspected scaphoid fractures?

Answer 42

the fracture may not show on xray initially

Question 43

_____________________is the most common nerve injury in shoulder dislocation because of the close proximity of the axillary nerve to the humeral head.

Answer 43

Axillary nerve injury (ANI) is the most common nerve injury in shoulder dislocation because of the close proximity of the axillary nerve to the humeral head.

Question 44

Answer 44

Circular appearance of the humeral head, or the light bulb sign, is a diagnostic radiographic sign of posterior shoulder

Question 45

An adducted, internally rotated arm and a flattened shoulder with a prominent coracoid process suggest ______________ shoulder dislocation.

Answer 45

An adducted, internally rotated arm and a flattened shoulder with a prominent coracoid process suggest posterior shoulder dislocation.

Question 46

Rupture of the flexor digitorum profundus (FDP) tendon

Answer 46

jersey finger

Question 47

Inflammation of the flexor tendon sheath is a condition known as

Answer 47

trigger finger

Question 48

Slipping or disruption of the central band of the extensor digitorum (ED) tendon is a condition known as

Answer 48

Boutonniere deformity

Question 49

Is this more likely to be an adult or child?

Answer 49

Distal humerus fractures, including supracondylar fractures, are more common in kids

Question 50

What neurovascular compromise must you consider with this?

Answer 50

Distal humerus fractures, including supracondylar fractures, can lead to brachial artery injury either by entrapping or directly injuring the artery.

Question 51

When her right arm is passively abducted in an arc, there is pain between 60 and 120 degrees of abduction. When asked to lower the right arm slowly from 90 degrees of abduction, she is unable to hold her arm up and it drops to her side. What is the most likely insult and why?

Answer 51

it is likely a rotator cuff etiology because of the angle of pain- its consistent with a subacromial impingement. Drop arm test is also suggestive of a tear in the supraspinatus muscle.

This could be a tendinitis/opathy or tear, if it improves with lidocaine injection, then its an itits. If drop arm is still present, its likely a tear.

Question 52

it is attributed to repetitive activities involving postures that maintain the thumb in extension and abduction. Diagnosis of this tendinopathy is established by the physical exam findings of pain over the radial styloid

Answer 52

de quervain tenosynovitis