Unit 5 - Upper Limb Joint Replacement

Question 1

Typically, patients undergoing upper limb joint replacement will have been diagnosed with which condition?

Answer 1

Rheumatoid arthritis
Osteoarthritis
Osteonecrosis
Post-traumatic arthritis
Fractures

Question 2

Why are problems with the spine or lower limb normally given priority over the upper limb?

Answer 2

1. RA of the cervical spine may cause instability and can be associated with significant or progressive neurological symptoms
2. Successful hip/knee replacements will reduce the need for the upper body to support body weight during walking

Question 3

In the upper limb why are distal joints normally given priority?

Answer 3

1. To allow restoration of hand function
2. Problems in distal joints may compromise physiotherapy post-surgery in more proximal joints
3. More functional improvement is gained the more distal the joint

Question 4

Why do some surgeons prefer to replace the shoulder joint before any other upper limb joint?

Answer 4

1. Shoulder pain is more troublesome at night
2. An immobile shoulder will cause abnormal loadings at the elbow
3. Rehabilitation of other upper limb joints can be simplified with a pain-free shoulder

Question 5

What range of shoulder abduction is generally achieved from unconstrained designs?

Answer 5

90 to 135 degrees

Question 6

What 3 synovial joints make up the shoulder?

Answer 6

Glenohumeral
Acromioclavicular
Sternoclavicular

Question 7

What bone-on-muscle-on-bone joint is important to the mobility of the shoulder?

Answer 7

Scapulothoracic

Question 8

What 4 muscles make up the rotator cuff?

Answer 8

Supraspinatus
Infraspinatus
Subscapularis
Teres minor

Question 9

How could an unconstrained shoulder design be converted to a semi-constrained design?

Answer 9

By fitting a hooded glenoid

Question 10

What are the disadvantages of a semi constrained shoulder design compared to an unconstrained design?

Answer 10

1. Restricted range of motion

2. More frequent glenoid component loosening

Question 11

What material is used to construct. the glenoid component of a Neer type shoulder prosthesis?

Answer 11

Polyethylene

Question 12

What type of designs are most constrained shoulder replacements?

Answer 12

Ball-in-socket

Question 13

What 3 articulations does the elbow consist of?

Answer 13

1. Humeroulnar
2. Humeroradial
3. Proximal radioulnar

Question 14

How much movement does a normal elbow joint allow?

Answer 14

140 degrees flexion
70 degrees pronation
80 degrees supination

Question 15

In flexion which ligament provides over 50% of the elbow’s stability?

Answer 15

Medial collateral ligament

Question 16

What are the main problems of uniaxial hinged elbow prostheses?

Answer 16

Loosening

Loss of bone stock

Question 17

Name the 3 cobalt chromes parts present in Dee’s design?

Answer 17

Humeral component
Ulnar component
Axis pin

Question 18

What is the possible range of flexion in Dee’s design?

Answer 18

0-150 degrees of flexion

Question 19

What are the 2 types of wrist joint prostheses?

Answer 19

1. Flexible hinge

2. Total wrist

Question 20

How much movement does a normal wrist allow?

Answer 20

80-90 degrees flexion
70-80 degrees extension
35 degrees adduction
15-20 degrees abduction

Question 21

For most daily activities how much flexion and extension of the wrist is required as a minimum?

Answer 21

10 degrees flexion

35 degrees extension

Question 22

What is a flexible hinge wrist prosthesis constructed from?

Answer 22

Silicone elastomer (rubber)

Question 23

What percentage of flexible wrist prostheses have been found to tear on the sharp bony edges of the medullary canal?

Answer 23

20%

Question 24

What are the two main problems associated with total wrist prostheses?

Answer 24

1. Loosening

2. Stress-shielding of the distal radius

Question 25

Which joint does the Voltz prosthesis resemble?

Answer 25

Radiocarpal

Question 26

What are the 2 types of MCP joint prostheses?

Answer 26

1. Flexible hinge

2. Total metacarpophalangeal

Question 27

What 3 problems are associated with total MCP replacement?

Answer 27

1. Implant fracture
2. Implant migration
3. Implant loosening

Question 28

What is the range of flexion for the PIP and DIP joint?

Answer 28

0-110 degrees for PIP

0-90 degrees for DIP