Upper Limb Injuries Flashcards
In an acromioclavicular rupture which structures are damaged?
Caracoclavicular ligament
Acromioclavicular ligament
In which demographic are AC joint injuries more common?
Younger people as it is a high energy injury.
What are the different subtypes of AC injury? (6)
Type I: Sprain of AC ligament joint intact
Type II: AC ligament is torn other ligaments intact
(Types I and II are treated non operatively)
Type III: AC and CC ligaments tor joint dislocation
Type IV: As above with posterior displacement
Type V: Gross displacement
Type VI: Inferior displacement
(Types III to VI are treated operatively with a hook plate or synthetic ligament)
What is the mechanism of proximal humeral #?
Fragility fracture caused by a FOOSH mechanism
Common accounts for 5% of all #
How are proximal humeral # classified?
Describe the same as a long bone fracture.
Classified by number of pieces 2/3/4
What is a major complication of proximal humeral fractures?
Avascular necrosis as blood supply to the head is carried in a singular distal branch. (risk if fracture is in anatomical neck)
Other complications are the standard:
- Bleeding
- Infection
- Non-union
- Rotator cuff damage (likely to be worn anyway as this injury is more common in elderly)
- Radial nn damage (if mid shaft)
How are proximal humeral fractures usually managed?
Conservative management is most common with a collar and cuff.
If surgical a hemiarthoplasty may be done to avoid AVN.
Note: Arthroplasty of shoulder is not very successful in terms of function.
What is the most common site of fracture in the elbow?
What X ray changes are a sign of this fracture
Radial head.
Difficult to see on X-ray often look for fat pad sign. Posterior fat pad is always abnormal. Anterior may be raised.
What is the common mechanism of action in radial head fractures?
FOOSH
How are radial head fractures classified?
Mason Classification:
I: Undisplaced
II: Minimally displaced
III: Comminuted and displaced
How do you manage radial head fractures?
I: Undisplaced
II: Minimally displaced
III: Comminuted and displaced
I and II treat conservatively
III: Surgical management, attempt to reconstruct radial head if not possible can be excised providing medial ligament is intact.
What is the terrible triad of the elbow?
Dislocation
Radial Head #
Coronoid Process #
Known as the terrible triad as it is very difficult to treat as all of the supporting structures of the capsule of the elbow are damaged. This can make treatment very difficult particularly if the radial head cannot be reconstructed.
Note: dislocation can also be caused by FOOSH and often accompanies medial collateral ligament damage
What is the eponymous name given for a radial head dislocation + ulnar fracture?
Monteggia’s
Mon-teg-ee-a
What is the eponymous name given for an ulnar head dislocation + radial fracture?
Galeazzi’s
Gal-ee-at-zees
In which demographic is supracondylar fractures seen?
Paediatric fracture
How are fractures of the supracondylar humerus classified?
Gartland classification:
I: no displacement
II: posterior cortex intact therefore periosteum is intact posteriorly
III: complete displacement
Note: In children the periosteum is very thick as it provides all the blood supply for growth therefore if to is intact provides a degree of stability
What is the most common wrist fracture?
Colle’s (radial fracture) caused by a FOOSH on an outstretched wrist
What are the main points regarding a colle’s fracture?
Extrarticular
Dorsally angulated
Radial shortening due to impaction
What is a smith’s fracture?
Same as Colle’s except it is volarly angulated.
What is a Barton’s fracture?
It is an intrarticular radial fracture which can have dorsal or volar angulation
How are wrist fracture’s treated?
Dependent on stability.
Reduction and fixation with plastering. Repete X rays 1 / 2 weeks
OR
Open reduction and internal fixation with plates and screws.
In order of stability:
Colle’s
Smith’s
Barton’s (almost always need ORIF)
What is tennis elbow?
Lateral epicondylitis.
Pain is over the lateral epicondyle and is increased by active or resisted extension of the wrist.
What is golfers elbow?
Medial epicondylitis.
Pain over the medial epicondyle.
Worsened by grasping items and opening jars. Resisted flexion of the wrist.
- What is the mechanism of a schaphoid fracture?
- What are the key examination findings of a schaphoid fracture?
- Why are 4 X ray views of a potential schaphoid fracture done?
- Describe the management of a schaphoid fracture
- What are the risks associated with a schaphoid fracture?
- FOOSH.
- Pain maximal at anatomical snuff box, weak pinch grip
- Notoriously hard to see on Xray
- Immobilisation of thumb for 2 months.
- 10% risk of non-union. Avascular necrosis common here
Which nerves are at risk of damage in the following fractures:
- Colle’s
- Elbow and forearm (radius)
- Humeral shaft
- Shoulder dislocation/ head of humerus fracture
- Median nerve damage
- Anterior interosseus (branch of median nerve) OR posterior interosseus (branch of radial nerve) both purely motor
- Radial nerve
- Axillary nerve
Describe the mechanism of action AND X-ray findings of:
- Anterior shoulder dislocation
- Posterior shoulder dislocation
90% anterior dislocations
- add+ext rotation, FOOSH. Humeral head in inferior and medial
- trauma to front of shoulder, electrocution.
Humerus head looks like a light bulb as rotated inwards. Trough line
What signs are associated with a poor prognosis of an anterior shoulder dislocation?
Bankart lesion = Part of the glomeral joint gets damaged during dislocation, gets broken off
Hill-sachs lesion = Posterolateral humeral head compression fracture, typically secondary to recurrent anterior shoulder dislocations- Chunk out of humeral head.
What are the signs and symptoms of carpel tunnel syndrome?
- Numbness and tingling down the median nerve distribution
- Worse in the morning and may wake from sleep
- Thenar wasting
- Reduced abduction and opposition of thumb
Tinels and Phalens positive
Name syndromes associated with Carpel tunnel
DM, RA, Hypothyroid, Acromegaly, Prgenancy, renal disease, menopause
What is De Quesvains tenosynovitis
What symptoms does it cause
Inflammation of the sheath covering the abductor pollivis longus and the extensor pollicis brevis
Pain around anatomical snuffbox and radial styloid - especially when using thumb
tenderness over radial boarder
Finkelstein positive
Describe the treatment of:
- Dupuytrens contracture
- Trigger finger
- Fasciotomy
2. Conservative, tenosynovectomy
