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Orthopaedics ST3 > Upper Limb > Flashcards

Upper Limb Flashcards

1
Q

Which view other than AP, is required for shoulder dislocation?

A

Axillary view

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2
Q

which nerve is most commonly affected in shoulder dislocations?

A

axillary nerve

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3
Q

what does the axillary nerve supply? (motor)

A

Deltoid, teres minor

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4
Q

what does the axillary nerve supply? (sensory)

A

regimental badge area

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5
Q

from what cord of the brachial plexus does the axillary nerve arise?

A

Posterior cord

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6
Q

through which space does the axillary nerve pass?

A

quadrangular space

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7
Q

what forms the superior border of the quadrangular space?

A

Teres minor

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8
Q

what forms the inferior border of the quadrangular space?

A

Teres major

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9
Q

what forms the medial border of the quadrangular space?

A

long head of triceps

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10
Q

what forms the lateral border of the quadrangular space?

A

humeral shaft

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11
Q

what structures pass through the quadrangular space?

A

Axillary nerve, posterior circumflex humeral artery

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12
Q

what classification system is used for supracondylar fractures?

A

Gartland

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13
Q

which neurological injury is most common in displaced supracondylar fractures?

A

Neuropraxia of anterior interosseous nerve (close to fracture site with soft tissue tethering)

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14
Q

which muscles are supplied by the anterior interosseous nerve?

A

Flexor pollicis longus
Flexor digitorum profundus (radial 1/2)

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15
Q

in the boast guidelines is absence of a radial pulse an indication for urgent surgery in supracondylar fractures?

A

Yes

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16
Q

what size K wire should be used for supracondylar fracture fixation ?

A

2mm

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17
Q

what are kanavels cardinal signs for flexor sheath infection?

A
  • Fusiform swelling of digit
  • Finger held in flexion
  • pain on passive extension
  • tenderness along flexor sheath
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18
Q

which organisms commonly cause flexor sheath infections?

A

Staph aureus
Staph epidermidis (skin flora)
MRSA

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19
Q

what is the origin of the FDS muscle?

A

Common flexor origin, adjacent part of the ulnar with a second part originating from the radius.

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20
Q

where does FDS insert?

A

Middle phalanges

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21
Q

where does FDP originate?

A

Interroseous membrane and part of the ulna

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22
Q

where are the incisions made for a flexor sheath washout?

A

2 x transverse incisions over A1 & A5 pulley

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23
Q

which two ligaments make up the coracoclavicular ligament?

A

Conoid ligament
Trapzeoid ligament

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24
Q

which of the conoid or trapezoid ligament is most medial?

A

Conoid ligament

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25
Q

which 3 ligaments are at the medial end of the clavicle?

A

Interclavicular ligament
Costoclavicular ligament
sternoclavicular ligament

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26
Q

what are the muscular attachments of the clavicle?

A

Deltoid
Pec major
Trapezius
Subclavius
Sternocleidomastoid
Sternohyoid

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27
Q

which end of the clavicle is concave?

A

Acromial end

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28
Q

which end of the clavicle is convex?

A

Sternal end

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29
Q

what structures pass through the 2 heads of FDS in the forearm?

A

Median nerve
Ulnar artery

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30
Q

what nerve innervates FDP?

A

Anterior interosseous nerve (radial half)
Ulnar nerve (ulnar half)

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31
Q

in which compartment is FDS in the forearm?

A

intermediate

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32
Q

what are the 4 cardinal/Kanavels signs of flexor sheath infection?

A

Fusiform swelling
Held in flexion
pain on passive extension
tenderness along flexor sheath

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33
Q

where do you make the incisions for a flexor sheath washout?

A

Over A1 and A5 pulley

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34
Q

What radiographic sign is seen in posterior shoulder dislocation?

A

lightbulb sign

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35
Q

which structures are at risk in the FCR approach to the wrist?

A

Median nerve
Radial artery

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36
Q

which muscle lies underneath the FCR tendon?

A

FPL

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37
Q

which muscle must be lifted of the distal radius in FCR approach?

A

Pronator quadratus

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38
Q

which direction is the FCR commonly retracted?

A

Ulnarly (protect median nerve)

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39
Q

what position should a patient be placed for the deltopectoral approach to the shoulder?

A

Beachchair

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40
Q

what is the inter nervous plane for the deltopectoral approach to the shoulder?

A

Deltoid (axillary nerve)
Pec major (medial + lateral pectoral nerves)

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41
Q

which structures are at risk in the deltopectoral approach to the shoulder?

A

Musculocutaneous nerve
Axillary nerve
Cephalic vein
Anterior circumflex humeral artery

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42
Q

what steps are involved in superficial dissection of the deltopectoral approach?

A

Skin, fat, deltopectoral fascia, cephalic vein mobilised

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43
Q

what steps are involved in deep dissection of the deltopectoral approach?

A

Short head of biceps + coracobrachialis (conjoint tendon) retracted medially
Subscapularis partially cut
Capsule incision

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44
Q

where does the musculocutaneous nerve enter the biceps muscle?

A

5-8cm distal to the coracoid process

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45
Q

what is the superior border of the triangular interval?

A

teres major

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46
Q

what is the medial border of the triangular interval?

A

long head of triceps

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47
Q

what is the lateral border of the triangular interval?

A

humerus

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48
Q

what are the contents of the triangular interva?

A

radial nerve, profunda brachii artery

49
Q

what is the superior border of the triangular space?

A

teres minor

50
Q

what is the inferior border of the triangular space?

A

teres major

51
Q

what is the lateral border of the triangular space?

A

long head of triceps

52
Q

what are the contents of the triangular space?

A

circumflex scapular artery

53
Q

what are the contents of the antecubital fossa?

A

Tendon of biceps
Brachial artery
Median Nerve

54
Q

which structure is most medial in the antecubital fossa?

A

Median nerve

55
Q

which structure if the most lateral in the antecubital fossa?

A

Tendon of biceps

56
Q

which muscles make up the floor of the antecubital fossa?

A

Brachialis + Supinator

57
Q

what is the lateral border of the antecubital fossa?

A

Medial border of brachioradialis

58
Q

what is the medial border of the antecubital fossa?

A

Lateral border of pronator teres

59
Q

what makes up the roof of the antecubital fossa?

A

Fascia and skin

60
Q

which muscles originate from the medial epicondyle of the humerus?

A

Superficial Flexors
(Pronator teres, FCR, PL, FCU)

61
Q

which muscle is considered to be in the intermediate compartment of the anterior forearm?

A

FDS

62
Q

what muscles does the median nerve supply in the hand?

A

LOAF muscles:
- 1st + 2nd lumbricals
- Opponens pollicis
- Abductor pollicis brevis
- Flexor pollicis brevis

63
Q

how do you test the function of Abductor pollicis brevis?

A

Place hand facing up on table, ask pt to point thumb to ceiling

64
Q

what movements test all nerves in the hand?

A
  • OK sign
  • Cross 2 fingers
  • Thumbs up
65
Q

what areas does the median nerve supply sensation in the hand?

A

Skin of palm
Nail beds of radial 3.5 digits

66
Q

what are the borders of the carpal tunnel?

A

roof - flexor retinaculum
floor - carpal bones
ulnar - pisiform + hook of hamate
radial - scaphoid tubercle + trapezium

67
Q

what are the contents of the carpal tunnel?

A

median nerve
FPL
4 x FDS
4 x FDP

68
Q

where is the palmar cutaneous branch of the median nerve given off?

A

5cm proximal to wrist
travels superficial to carpal tunnel

69
Q

this definition describes what:
angle formed by a line drawn perpendicular to the axis of the radial shaft and a line that crosses along the radial intraarticular surface

A

volar tilt

70
Q

what is a normal volar tilt?

A

11 degrees

71
Q

what is a normal radial height?

A

11 degrees

72
Q

the below describes what:
between 2 perpendicular lines - one at the level of the ulnar border of the radius and one at the level of the radial styloid

A

Radial height

73
Q

the below describes what:
angle between a line drawn between the radial styloid and ulnar border of radius and a line drawn perpendicular to shaft/long axis of radius

A

radial inclination

74
Q

what is a normal radial incliniation?

A

21 degrees

75
Q

what alignment is considered acceptable in a distal radius fracture?

A

<3mm loss in radial height
<10 degree loss in volar tilt
<5 degree change in radial inclination

76
Q

what is the internervous plane used in the FCR approach to the distal radius?

A

FCR - median nerve
FPL - AIN

77
Q

what is the radial border of the anatomical snuffbox?

A

EPB + APL

78
Q

What is the ulnar border of the anatomical snuffbox?

A

EPL

79
Q

what forms the floor of the anatomical snuffbox?

A

Radial styloid, scaphoid, trapezium, base of metacarpal

80
Q

what forms the roof of the anatomical snuffbox?

A

Deep fascia

81
Q

what is the blood supply to the scaphoid?

A

Dorsal carpal branch of radial artery

82
Q

what does the mnemonic CRITOL stand for with regards to ossification at the elbow?

A

C - capitellum 2y
R - radial head 4y
I - internal epicondyle 6y
T - trcohlea 8y
O - olecranon 10y
L - lateral epicondyle 12y

83
Q

what does the mnemonic CRITOL stand for with regards to ossification at the elbow?

A

C - capitellum 2y
R - radial head 4y
I - internal epicondyle 6y
T - trcohlea 8y
O - olecranon 10y
L - lateral epicondyle 12y

84
Q

what characteristics will a gartland I supracondylar fracture have?

A

Displacement <2mm
intact humeral line

85
Q

what characteristics will a gartland II supracondylar fracture have?

A

Displacement >2mm
anterior humeral line disrupted
posterior cortex intact

86
Q

what characteristics will a gartland III supracondylar fracture have?

A

displaced with periosteum torn and no cortical contact

87
Q

what characteristics will a gartland VI supracondylar fracture have?

A

as with III but unstable in flexion and extension

88
Q

what are flexor tendon sheaths?

A

Synovial sheaths surrounded by a fibrous later

89
Q

what are the function of flexor tendon sheaths?

A

Synovial fluid provides nutrition and lubrication to tendons
Fibrous layer prevents bow stringing of tendons

90
Q

what are the displacing forces in a clavicle fracture?

A

Medial - sternoclediomastoid
Lateral infero - pec major
Lateral - weight of arm

91
Q

what is the allmann classification of clavicle fractures?

A

Grade I - middle 1/3
Grade II - Lateral 1/3
Grade III - Medial 1/3

92
Q

what are the absolute indications for fixation in clavicle fractures?

A

Open Fracture
Subclavian artery/vein injury
displaced fracture with skin tenting
floating shoulder
symptomatic non union

93
Q

what is a ‘floating shoulder’?

A

ipsilateral clavicle and scapula neck fractures

94
Q

what are the relative indications for fixation in clavicle fractures?

A

Brachial plexus injury
polytrauma
seizure disorder
closed head injury
unstable fracture pattern (neer IIA/IIB/V)
displaced >2cm shortening

95
Q

how do you manage a clavicular non union?

A

asymptomatic - nothing
symptomatic - ORIF + bone graft

96
Q

which muscles attach onto the olecranon?

A

Triceps - posterior aspect
Anconeus - Lateral aspect

97
Q

what are the clinical features of a displaced olecranon fracture?

A

Bruising
Swelling
Palpable gap
inability to extend elbow

98
Q

what is the usual mechanism for dislocating the elbow joint?

A

Hyperextension (axial load)
ie. fall on outstretched hand
rotational/valgus force in posterolateral direction

99
Q

in what direction does the elbow usually dislocate?

A

Posterior
(posterolateral)

100
Q

what steps take place to reduce a posteriorly dislocated elbow?

A

Traction
Supination
Flexion
Posterior pressure on olecranon

101
Q

what is the post reduction management of a stable elbow dislocation?

A

Above elbow backslab - immobilise for 7-10 days
Early ROM

102
Q

which soft tissue structures may need repair after a posteriorly dislocated elbow ?

A

LCL or MCL

103
Q

which ligament is the first to go in a posteriorly dislocated elbow?

A

LCL

(MCL is last)

104
Q

what is the terrible triad associated with elbow injurues?

A

Elbow dislocation (posterolateral)
Radial head fracture
Coronoid fracture

105
Q

what are the static stabilizers of the elbow joint?

A

Ulnohumeral joint
Radiocapitellar joint
MCL
LCL
capsule
Flexor + extensor origins

106
Q

what are the dynamic stabilizers of the elbow joint?

A

Triceps
Brachialis
Anconeus

107
Q

what should be done prior to immobilisation after reduction of elbow dislocation?

A

elbow should be taken through ROM in flexion - extension plane to assess the stable range

108
Q

what are gilulas carpal arcs?

A

used in assessment of normal alignment of carpys on PA wrist radiographs

109
Q

what may disruption of gilulas arcs indicate?

A

Ligamentous injury or fracture at side of the broken arc

110
Q

what neurovascular injury are patients with perilunate dislocations susceptible to?

A

Acute carpal tunnel syndrome

111
Q

what do the boast guidelines state re dislocations with neurological symptoms?

A

need urgent relocation

112
Q

what must you do after every reduction?

A
  • repeat radiographs
  • examine neurovascular status
  • document findings
113
Q

what is a bankart lesion?

A

Avulsion of anterior labrum

114
Q

what is a bony bankart lesion?

A

fracture of anterior inferior glenoid

115
Q

what is a hill sachs defect?

A

chondral impaction injury in the posteroseuprior humeral head secondary to contact with the glenoid rim

116
Q

greater tuberosity fractures are associated with what type of shoulder dislocation?

A

anterior - >50y

117
Q

lesser tuberosity fractures are associated with what type of shoulder dislocation?

A

posterior

118
Q

a reverse hill sachs defect is what?

A

chondral impactio injury to anterior humeral head in posterior shoulder dislocations

Orthopaedics ST3 (7 decks)

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