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Injuries and medical problems in sport > UL injuries > Flashcards

UL injuries Flashcards

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Sports Trivia flashcards USMLE® Step 1 flashcards
1
Q

AC dislocation classification

A
  • Type 1: CC normal, AC sprain
  • Type 2: CC sprain, AC tear

Rest are CC + AC tear, plus:
- Type 3: 25-100% clavicle elevation

  • Type 4: clavicle dislocated posteriorly
  • Type 5: rupture through deltorapezial fascia
  • Type 6: inferior displacement of distal clavicle under conjoined tendon
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2
Q

What is the rotator cuff?

A

4 muscles that support and rotate the GH joint:

  • Supraspinatus
  • Infraspinatus
  • Teres minor
  • Subscapularis
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3
Q

State the functions of each of the rotator cuff muscles

A

Supraspinatus– abduction
Infraspinatus – external rotation
Teres minor – external rotation
Subscapularis – internal rotation

Act to stabilise the humeral head in the glenoid fossa, playing a key role in maintaining overall shoulder stability.

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4
Q

RF for rotator cuff tear

A
  • age
  • trauma
  • overuse
  • repetitive overhead shoulder motions - tennis, swimming, baseball, volleyball
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5
Q

Clinical features of RC injuries

A
  • pain over the lateral aspect of shoulder
  • inability to abduct the arm above 90 degrees.
  • tenderness over the greater tuberosity
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6
Q

3 Tests for rotator cuff injury + muscles tested

A

1) Empty can (Jobe’s) test = supraspinatous
2) Gerber’s lift-off test = subscapularis
3) Posterior cuff test = infraspinatous + teres minor

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7
Q

Describe Jobe’s / the empty can test

A

SUPRASPINATOUS
1) place the shoulder in 90° abduction and 30° of forward flexion and internally rotate fully (as if ‘emptying a can’).

2) Gently push downwards on the arm.
3) weakness on resistance.

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8
Q

Describe Gerber’s lift-off test

A

SUBSCAPULARIS

1) internally rotate arm so the dorsal surface of hand rests on lower back.
2) ask the patient to lift hand away from back against examiner resistance.
3) a positive test is weakness in actively lifting the hand away from back (compare to the contralateral side).

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9
Q

Describe the posterior cuff test

A

INFRASPINATOUS + TERES MINOR

1) arm positioned at patient’s side with elbow flexed to 90°.
2) patient is instructed to externally rotate their arm against resistance.
3) positive test is present if there is weakness on resistance.

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10
Q

Main ddx for rotator cuff injuries

A
  • fracture
  • persistent glenohumeral subluxation
  • brachial plexus injury
  • radiculopathy
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11
Q

Ix rotator cuff tear

A
  • urgent plain X-ray exclude fracture
  • USS for presence and size of tear
  • MRI for size, characteristics, location
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12
Q

Mx rotator cuff injury

A

dependent on the type of tear and functional status of the patient.

CONSERVATIVE

  • little pain/loss of function
  • small tears
  • analgesia + physio
  • <2wks injury
  • corticosteroid injection in subacromial space

SURGICAL

  • Sx despite conservative
  • > 2wks
  • large tears
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13
Q

Main complication from rotator cuff tears

A

Adhesive capsulitis –> stiffness in GH joint

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14
Q

How can rotator cuff injuries by classified?

A

acute (<3 months) or chronic (>3months)

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15
Q
A
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16
Q

Shoulder dislocation incidence

A

account for over half of major joint dislocations which present to emergency departments

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17
Q

Most common shoulder dislocation

A

anteroinferior (usually just termed ‘anterior’)

= 95%

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18
Q

what forces are applied in anterior shoulder dislocation?

A

humerus is extended, abducted, and externally rotated

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19
Q

Label the shoulder joint

A
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20
Q

Causes of posterior dislocation

A
  • typically caused by seizures or electrocution
  • also trauma (a direct blow to the anterior shoulder or force through a flexed adducted arm)

(commonly missed)

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21
Q

clinical features shoulder dislocations

A
  • pain
  • acutely reduced mobility
  • instability
  • asymmetry + loss of shoulder contour (flattened deltoid)
  • anterior bulge from head of humerus
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22
Q

commonly associated boney injuries for shoulder dislocation

A
  • Bony Bankart lesions - fracture of glenoid due to recurrent dislocations
  • Hill-Sachs- impaction injuries on chondral surface of humeral head (80% dislocations)
  • fractures of greater tuberosity/surgical neck of humerus
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23
Q

commonly associated soft tissue injuries for shoulder dislocation

A
  • (Soft) Bankart lesions- avulsions of the anterior labrum and inferior glenohumeral ligament
  • GH ligament avulsion
  • Rotator cuff injuries (v freq ant)
24
Q

What is a SLAP tear? What tendon is commonly involved?

A

Superior Labrum Anterior and Posterior tear

The superior part is where biceps tendon attaches to the labrum- the tear occurs both ant. and post. to biceps tendon

25
Q

SLAP tear versus soft Bankart lesion

A

Bankart labral tear = commonest in dislocations, occurs inferiorly

SLAP = superior, both infront and behind biceps tendon

26
Q

Ix for shoulder dislocations

A
  • Plain radiographs inc trauma shoulder series (Ap, Y-scap, axial)
  • MRI if labral or rotator cuff injuries are suspected
27
Q

Mx shoulder dislocations

A

A-E trauma assessment + analgesia

REDUCTION, IMMOBILISATION, REHABILITATION:

  • closed reduction (if failed, manipulation under GA)
  • assess neurovascular status
  • Immobilisation with broad arm sling for 2wks
  • physio for ROM, stregnthening musculature
28
Q

complications of shoulder dislocation

A

Short term:

  • labral and cartilaginous injuries
  • rotator cuff injury

Long term:

  • adhesive capsulitis
  • nerve damage
  • chronic pain
  • limited mobility
  • stiffness
  • recurrence
29
Q

Causes of SLAP injuries

A

ACUTE

  • fall onto outstretched arm
  • RTA
  • Forceful pulling eg catching heavy object
  • Shoulder dislocation

REPETITIVE SHOULDER MOTION

  • repetitive overhead sports
  • throwing, weightlifters
  • can be normal ageing process ‘wear and tear’
30
Q

SLAP Sx

A

Like many common shoulder problems:

  • locking, popping, catching, or grinding
  • Pain with lifting objects, especially overhead
  • Decreased strength + ROM
31
Q

SLAP tear classification

A

Type 1: fraying of labrum and biceps tendon at glenoid rim

Type 2: detachment of labrum and biceps tendon at glenoid rim

Type 3: Bucket handle tear of superior labrum

Type 4: bucket handle tear of superior labrum with extension into biceps tendon

32
Q

Mx SLAP tear

A
  • initial conservative- NSAID, physio

- arthroscopy

33
Q

Commonest type of clavicular fractures

A

Type 1 = 75% = middle third is weakest

34
Q

clinical features clavicle fracture

A
  • sudden-onset localised severe pain
  • focal tenderness, with deformity and mobility at fracture site
  • may be open injury as clavicle is superior
35
Q

Mx clavicle fracture

A
  • sling till pain free shoulder mobility
  • open fractures/comminuted = surgical
  • pin fixation
36
Q

Major complications of clavicle fractures

A
  • Non-union- associated with a distal third clavicular fractures
  • Neurovascular injury
  • Puncture injury (haemothorax or pneumothorax).

Healing in 4-6 weeks.

37
Q

What is SAIS?

A
  • Subacromial impingement syndrome (SAIS)
  • inflammation of the rotator cuff tendons as they pass through the subacromial space
  • resulting in pain, weakness, and reduced ROM
  • encompasses a range of pathologies
38
Q

What pathologies does SAIS encompass?

A
  • rotator cuff tendinosis
  • subacromial bursitis
  • calcific tendinitis

All these conditions result in an attrition between the coracoacromial arch and the supraspinatus tendon or subacromial bursa.

39
Q

Most common pathology of the shoulder

A

Subacromial impingement syndrome (SAIS)

40
Q

Which structures run through the subacromial space?

A
  • rotator cuff tendons
  • long head of biceps tendon
  • coraco-acromial ligament

surrounded by subacromial bursa

41
Q

Intrinsic mechanisms for SAIS

A

Involve pathologies of the rotator cuff tendons due to tension (proximal migration of humeral head)

  • Muscular weakness/imbalance in RC
  • overuse of shoulder - soft tissue inflammation of tendons + bursa
  • Degenerative changes of acromion –> tearing rotator cuff
42
Q

extrinsic mechanisms for SAIS

A

Involve pathologies of the rotator cuff tendons due to external compression:

  • anatomical variation in shape/gradient acromion
  • scapular muscular dysfunction
  • glenohumeral instability –> superior subluxation
43
Q

Sx SAIS

A

progressive pain in ant. superior shoulder

exacerbated by abduction in affected shoulder and relieved by rest

weakness and stiffness 2/2 pain

44
Q

2 examination signs for SAiS

A

Neers impingement test:

  • arm placed by patient’s side
  • fully internally rotated and passively flexed –> ant.lat. shoulder pain

Hawkins test:

  • shoulder and elbow are flexed to 90deg
  • pain on passive internal rotation
45
Q

4 ddx SAIS + key Sx for each

A
  • Muscular tear (RC, Biceps LH)- weakness persists with pain relief
  • Neurological pain (brachial plexus, cervical radiculopathy)- parasthesia + weakness
  • Frozen shoulder (adhesive capsulitis)- stiffness persists with pain relief
  • acromioclavicular/glenohumeral arthritis- more generalised, weakness and stiffness
46
Q

Ix for SAIS

A
  • Clinical Dx

- MRI - gold standard

47
Q

What is epichondylitis

A

chronic symptomatic inflammation of the forearm tendons at the elbow.

48
Q

Briefly describe the attachment of the extensors and flexors of the forearm

A

EXTENSOR:

  • lateral epicondyle
  • common extensor tendon

FLEXOR:
- medial epicondyle

49
Q

RF lateral epicondylitis

A

excessive use of extensive forearm muscles

- tennis

50
Q

Sx lat epicondylitis

A

pain in elbow radiates to forearm

  • worsens over weeks- months
  • local tenderness on palpation
51
Q

special tests lat epicondylitis

A

Cozen’s test
- elbow flexed to 90 degrees, - extend their wrist against resistance

Mill’s Test
- lateral epicondyle is palpated by the examiner, whilst also pronating the patient’s forearm, flexing the wrist, and extending the elbow

52
Q

ddx lat epicondylitis

A

Cervical radiculopathy
Elbow osteoarthritis
Radial carpal tunnel syndrome

53
Q

Golfers elbow

A

Medial epicondylitis

54
Q

Most commonly affected tendons in Medial epicondylitis

A

pronator teres

flexor carpi radialis

55
Q

Cubital tunnel syndrome

A

Ulnar nerve compression due to excessive leaning on elbow or flexing at the elbow

56
Q

Types of disc problems

A

Injuries and medical problems in sport (17 decks)

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