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14. Year 2: Musculoskeletal > Upper Limb Injuries > Flashcards

Upper Limb Injuries Flashcards

1
Q

What are some examples of upper limb injuries?

A
  • Clavicular fracture
  • Acromioclavicular injury
  • Shoulder dislocation
  • Proximal humeral fracture
  • Distal radial fracture
  • Scaphoid fracture
  • Bennet’s fracture
  • Ulnar collateral ligament of thumb
  • Boxers injury
  • Flexor tendon injury
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2
Q

Describe the aetiology of clavicular fracture?

A
  • Fall onto shoulder/outstretched hand
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3
Q

Where is the most common location of clavicular fracture?

A
  • Middle 1/3 80%
  • Lateral 1/3 15%
  • Medial 1/3 5%
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4
Q

Describe the management of clavicular fracture?

A
  • Vast majority unite
  • Analgesia
  • Sling
    • 3-4 weeks
    • Progressive mobilisation from 2 weeks
  • Surgery
    • Indications
      • Some displaced
      • Open fractures
      • Threatening to skin
      • Neurovascular complications
      • Polytruma
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5
Q

What are indications for surgery for clavicular fracture?

A
  • Some displaced
  • Open fractures
  • Threatening to skin
  • Neurovascular complications
  • Polytruma
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6
Q

Describe the aetiology of dislocation of AC joint?

A
  • Fall onto the point of shoulder
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7
Q

How is dislocatino of AC joint graded?

A
  • Graded from sprain to complete dislocation
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8
Q

Describe the treatment for dislocation of AC joint?

A
  • Sprains
    • Treated in sling 3-4 weeks
  • Displaced AC joint displocation
    • Early fixation
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9
Q

What does AC joint stand for?

A

Acromioclavicular joint

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10
Q

Describe the aetiology of proximal humerus fracture?

A
  • Young
    • High energy injuries
  • Elderly
    • Osteoporotic injuries
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11
Q

Describe the management of proximal humerus fracture?

A
  • Depends on fracture configuration and patient biology
  • Conservative
    • Sling, mobilise from 6 weeks
  • Operative management
    • Fixation with plate
    • Joint replacement
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12
Q

What is the most commonly dislocated joint?

A
  • Shoudler
    • Shoulder most mobile joint in body, at cost of stability
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13
Q

In what direction is a shoulder dislocation most common?

A
  • Anterior 80-85%
  • Posterior 10%
  • Inferior <5%
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14
Q

What investigations are done for shoulder dislocation?

A
  • Test axillary nerve
    • Regimental badge
  • X-ray
    • 2 views as posterior dislocation can be missed on 1 view
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15
Q

Describe the management of shoulder dislocation?

A
  • Acute reduction under sedation/anaesthetic
    • Method – Hippocratic, Kocher’s
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16
Q

Describe possible complications of shoudler dislocation?

A
  • Recurrence
    • Increases with younger age, male, participation in contact sport
    • 90% recurrence rate for this
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17
Q

Describe the aetiology of posterior shoulder dislocation?

A
  • Seizure
  • Electrocution
  • Direct blow to front of shoulder (boxing)
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18
Q

How is posterior shoulder dislocation diagnosed?

A
  • Check passive external rotation (unilateral loss)
  • X-ray
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19
Q

Describe aetiology of distal radial fracture?

A
  • Young patients
    • High velocity injury
  • Older
    • Low velocity injury
    • Colles fracture
    • Osteoporotic
    • Fall outstretched hand
20
Q

Describe presentation of distal radial fracture?

A
  • Examination
    • Dinner fork deformity
    • Radial shortening
    • Radial deviation
    • Dorsal angulation
21
Q

Describe management of distal radial fracture?

A
  • Conservative
    • Undisplaced
      • Splint/cats
    • Displaced
      • Cast
      • Cast with/without wires
  • Surgical
    • Plate
    • External fixator
22
Q

What is Colles fracture?

A

Type of fracture of distal radius

23
Q

Describe complications of Colles fracture?

A
  • Malunion
  • DRUJ pain
  • EPL rupture
  • Carpal tunnel syndrome
  • CRPS
24
Q

Describe the aetiology of scaphoid fracture?

A
  • Fall onto outstretched hand
25
Q

What is the most commonly fractured bone in the carpus?

A
  • Most common fracture boned in carpus
26
Q

What investigations are done for scaphoid fracture?

A
  • X-ray
    • Often difficult to see
  • Repeat x-ray at 2 weeks or MRI
27
Q

Describe the presentation for scaphoid fracture?

A
  • Pain base of thumb
  • Tenderness anatomical snuff box
  • Pain telescoping thumb
28
Q

Describe the management of scaphoid fracture?

A
  • Cast 6 weeks
  • Surgery
    • Indications – displaced, non-union
29
Q

What are possible complications of scaphoid fracture?

A
  • Risk of non-union or avascular necrosis if fracture in proximal third
  • Retrograde blood supply to distal pole
30
Q

What is the anatomical snuff box bordered by:

  • anteriorly
  • posteriorly
  • proximally
A
  • Anteriorly
    • Abductor pollicis longus and extensor pollicis brevis longus
  • Posteriorly
    • Extensor pollicis longus
  • Proximally
    • Radial styloid/radius
31
Q

Describe the aetiology of ulnar collateral ligament injury of thumb MCPJ?

A
  • Radial force
  • Gamekeepers thumb
  • Skiers thumb
32
Q

What are the different types of ulnar collateral ligament injury of thumb MCPJ?

A
  • Ligament only
  • Avulsion fracture
33
Q

Descibe the presentation of ulnar collateral ligament injury of thumb MCPJ?

A
  • Injury
  • Weak pinch grip
  • Examination
    • Tender ulnar side joint
    • Joint opens on radial stress
34
Q

Describe the management of ulnar collateral ligament injury of thumb MCPJ?

A
  • Conservative
    • Splint/cast
  • Operative
    • Repair ligament
    • Fix avulsion fragment
35
Q

What is Bennett’s fracture?

A

Intra-articular fracture at base of 1st metacarpal

36
Q

Describe the aetiology of Bennett’s fracture?

A
  • Axial compression of slightly flexed CMC joint
    • Falling on outstretched hand
    • Boxing
  • Displaced due to proximal pull from abductor pollicis longus
37
Q

Describe the management of Bennett’s fracture?

A
  • Reduction
  • Maintenance reduction
    • Plaster cast
    • With or without wire
    • Screw fixation
38
Q

What are some signs of fight injuries?

A
39
Q

What is a boxer’s fracture?

A

Fracture of little finger metacarpul neck:

  • May also be ring finger
40
Q

Describe the deformity of boxer’s fracture?

A
  • Volar angulated
41
Q

Describe the management of boxer’s fracture?

A
  • Usually conservative
  • Reduce if significant angulation (prominent in palm)
42
Q

Describe the aetiology of flexor tendon injuries of fingers?

A
  • Usually knife laceration
43
Q

Describe the epidemiology of flexor tendon injuries of fingers?

(incidence rising or decreasing, sex, age)

A
44
Q

Describe the zones of the hand to describe flexor injuries?

A
45
Q

Describe the management of flexor of the hand injuries?

A
  • Surgically and early
    • Beware old injuries
  • Partial tears (<60%) do not require repair
  • Rehabilitation
    • Early movement (stress) increases healing and strength
46
Q

Which zone of the hand has the worst prognosis for flexor injuries?

A
  • Zone 2 worst
    • Usually both FDS and FDP tendons involved

14. Year 2: Musculoskeletal (40 decks)

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