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Locomotor system > Upper limb surgical repair > Flashcards

Upper limb surgical repair Flashcards

1
Q

Bone on bone contact in the shoulder can lead to (2)

A

osteophytes and osteoarthritis

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2
Q

Muscle released in shoulder replacement (tendon)

A

subscapularis

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3
Q

muscle released in reverse shoulder replacement

A

deltoid

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4
Q

Plane between deltoid and pectoralis major

A

anterior inter nervous plane

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5
Q

Deltoid nervous supply

A

axillary nerve

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6
Q

Pectoralis major nervous supply (2)

A

medial and lateral pectoral nerves

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7
Q

vein in deltopectoral groove

A

cephalic vein

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8
Q

groove between deltoid and pectoralis major

A

deltopectoral groove

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9
Q

proximal end of deltopectoral groove

A

coracoid process

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10
Q

deltopectoral groove is infero lateral to what

A

clavicle

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11
Q

what is between cephalic vein, deltoid and pectoralis major (2)

A

fascia over deltoid and pectoralis major

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12
Q

once deltopectoral groove is incised what is retracted

A

deltoid

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13
Q

once deltoid is retrancted what is incised

A

subscapularis tendon

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14
Q

what is inferior to subscapularis tendon

A

vessels

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15
Q

where is a drill hole placed when subscapularis is released

A

coracoid process

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16
Q

conjoint tendon (2)

A

short head of biceps brachii and coracobrachialis

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17
Q

what happens to conjoint tendon

A

released with tip of coracoid process

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18
Q

what is between the subscapularis and teres major

A

vessels

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19
Q

what happens to vessels inferior to subscapularis

A

clamped

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20
Q

once subscapularis is incised what happens to it (2)

A

reflected and sutures put in place

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21
Q

once subscapularis is reflected what is incised

A

joint capsule

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22
Q

joint capsule is incised to reveal (3)

A

head of humerus, glenoid fossa, posterior glenoid labrum

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23
Q

what runs medial to coracoid process

A

axillary sheath

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24
Q

what is in the axillary sheath (2)

A

axillary vessels and brachial plexus

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25
Q

when is axillary sheath pulled closer to coracoid process

A

abducted shoulder

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26
Q

nerve closest to area of shoulder replacement

A

musculocutaneous nerve

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27
Q

what nerve lies inferior to subscapularis

A

axillary nerve

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28
Q

muscles inferior to axillary nerve (superficial to deep 2)

A

latissimus dorsi and teres major

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29
Q

what moves the area of work away from axillary nerve

A

shoulder external rotation

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30
Q

rotator cuff tears which muscle contracts strongly to attempt abduction

A

deltoid

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31
Q

deltoid contraction but rotator cuff tear what happens (3)

A

humerus pulled superiorly towards acromion, scapula externally rotated, clavicle elevated

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32
Q

what angle allowed in abduction with rotator cuff tear

A

45 degrees

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33
Q

what happens to abduction at 90 degrees with partial rotator cuff tear

A

unable to hold resistance

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34
Q

what can communicate in rotator cuff tear

A

shoulder joint and subdeltoid bursa

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35
Q

what can occur in rotator cuff tear (3)

A

thickened edematous biceps brachii tendon, retracted tendon, needs to be repaired with surgery

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36
Q

bicep brachii tendon repair if edges fresh (3)

A

notch made in humerus, attach with drill holes, strong sutures

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37
Q

Open acromioplasty removes (2)

A

tip of acromion and most of coracoacromial ligament

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38
Q

where is incision made to inspect rotator cuff for tears in acromioplasty

A

T incision in deltoid

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39
Q

what portion of acromion removed in acromioplasty

A

anterolateral inferior

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40
Q

what tool used in acromioplasty

A

osteotome

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41
Q

deltoid reattachment acromioplasty suture origin

A

acromioclavicular joint capsule

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42
Q

deltoid reattachment acromioplasty suture insertion (2)

A

fibrous stump of coracoacromial ligament or wires and small drill holes in acromion

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43
Q

Arthroscopic acromioplasty setup (6)

A

lateral decubitus position, hips stabilised, padding between knees and ankles, arm extended and abducted, skin traction, screen visualisation

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44
Q

what is inserted from arthroscopic acromioplasty (3)

A

arthroscope, cannula, suction drain

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45
Q

where is burr placed

A

with cannula

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46
Q

where is arthroscope placed

A

below posterior angle of acromion

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47
Q

where is the burr and suction drain placed

A

through cannulas in anterior incision

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48
Q

tool used in arthroscopic acromioplasty

A

power burr

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49
Q

how is acromion portion removed arthroscopically

A

cannula, releasing coracoacromial ligament

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50
Q

What is done to observe bursa

A

burscopy

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51
Q

what can burscopy reveal

A

bursitis

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52
Q

inflamed bursa

A

bursitis

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53
Q

subacromial impingement diagnostic features (5)

A

pain at night, pain with activity, MRI, positive impingement test, weakness

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54
Q

no subacromial impingement arthroscopic view (medial to lateral 3)

A

rotator cuff, biceps tendon, top of humerus

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55
Q

what can bone spurs cause (3)

A

bursitis, tendonitis, rotator cuff tears

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56
Q

what happens when bone spur is removed

A

pressure on rotator cuff released

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57
Q

how is rotator cuff attached in arthroscopic rotator cuff repair

A

sutures and anchors to humerus

58
Q

normal gleno humeral arthroscopic view

A

biceps tendon

59
Q

abnormal gleno humeral arthroscopic view

A

torn biceps tendon

60
Q

how are loose bodies from torn biceps tendon removed

A

grabber

61
Q

average width of sternal end of clavicle

A

22.6 mm

62
Q

average width of acromioclavicular end of clavicle

A

21.1 mm

63
Q

at risk average width of clavicle

A

12.0 mm

64
Q

average at risk length of clavicle

A

138.4 mm

65
Q

subclavian artery average width

A

0.42 mm

66
Q

subclavian vein average width

A

0.33 mm

67
Q

safe trajectory through clavicle

A

superiorly

68
Q

dangerous trajectory through clavicle

A

anteriorly

69
Q

dangerous clavicular trajectory at risk elements (superficial to deep)

A

subclavian vein, scalenus anterior, subclavian artery, brachial plexus

70
Q

what could lead to a proximal humeral fracture

A

fall

71
Q

what is one way of fixing proximal humeral fracture

A

plate and screws

72
Q

which nerve runs around the humerus

A

axillary nerve

73
Q

what is important to do before proximal humeral fracture surgery (2)

A

measuring and marking nerve

74
Q

At what angle is the nerve felt deep to deltoid, run along the bone

A

Cobb

75
Q

What is one way to visualise the axillary nerve

A

arthroscope

76
Q

for proximal humeral fracture repair where is the plate slipped

A

deep to deltoid

77
Q

where are K wires positioned for proximal humeral fracture repair (2)

A

top and bottom

78
Q

what is used to reduce shaft to plate in proximal humeral fracture repair

A

screws

79
Q

Once screws are in place for proximal humeral fracture repair what is done

A

screws are locked

80
Q

How many screws at top and bottom of plate in proximal humeral fracture repair

A

4 each

81
Q

In proximal humeral fracture repair what arteries need to be avoided (3)

A

posterior and anterior humeral circumflex. arcuate

82
Q

Which artery runs in the intertubecular groove of the humerus

A

anterolateral branch of anterior humeral circumflex

83
Q

what is between the greater and lesser tubercles of the humerus

A

intertubecular groove

84
Q

which is bigger anterior or posterior humeral circumflex arteries

A

posterior

85
Q

which artery does the anterior and posterior humeral circumflex arteries branch from

A

axillary

86
Q

types of proximal humeral fracture repair (3)

A

3 part, 4 part, valgus 4 part

87
Q

chance of 3 part proximal humeral fracture repair

A

12-25%

88
Q

chance of 4 part proximal humeral fracture repair

A

21-75%

89
Q

chance of valgus 4 part proximal humeral fracture repair

A

8-26%

90
Q

Predictors of humeral head ischaemia (3)

A

metaphyseal head extension calcar less than 8 mm (97% PPV), loss of integrity of medial hinge, fracture pattern (anatomic neck)

91
Q

When is the humeral head likely not viable for proximal humeral fracture repair

A

lateral head displacement

92
Q

When will a longer plate be required

A

proximal and shaft fracture

93
Q

what is a SLAP lesion

A

superior labral anterior posterior

94
Q

grades of SLAP lesion

A

I-IV

95
Q

How can SLAP be diagnosed

A

MRI

96
Q

Paralabral cysts (4)

A

superior, posterior, inferior, anterior

97
Q

what can be involved with paralabral cysts (2)

A

suprascapular notch extension, spinoglenoid notch involvement

98
Q

How can paralabral cysts be diagnosed

A

MRI

99
Q

what is released to reveal spinoscapular nerve

A

TSL

100
Q

types of clavicular dislocation

A

I-VI

101
Q

type I clavicular dislocation

A

acromion inferior

102
Q

type II clavicular dislocation

A

acromioclavicular ligament torn

103
Q

type III clavicular dislocation

A

acromioclavicular and coracoclavicular ligaments torn

104
Q

type IV clavicular dislocation

A

coracoclavicular ligament torn

105
Q

type V clavicular dislocation

A

acromioclavicular and coracoclavicular ligaments torn, clavicle shifted superiorly

106
Q

type VI acromioclavicular and coracoclavicular ligaments torn

A

acromioclavicular and coracoclavicular ligaments torn, clavicle shifted inferiorly, distal clavicle behind tendons of biceps brachii and coracobrachialis

107
Q

fixing clavicular dislocation (2)

A

screw through clavicle and coracoid process

108
Q

Where does the clavicle normally fracture

A

lateral 1/3

109
Q

What produces a popeye arm

A

proximal long head of biceps tendon tear

110
Q

What indicates proximal long head of biceps tendon tear

A

active flexion of elbow

111
Q

what is another name for a torn tendon

A

avulsed

112
Q

what needs to be reflected for proximal long head of biceps tendon tear repair (2)

A

deltoid and pectoralis major

113
Q

where are stitches placed for proximal long head of biceps tendon tear repair

A

biceps tendon and acromion

114
Q

what technique is used for bicep brachii insertion tear repair

A

pullout wire trapdoor technique

115
Q

where is a trapdoor placed for insertion of biceps tendon repair

A

radius

116
Q

who came up with pullout wire trapdoor technique

A

Bunnell, Bovd, Anderson

117
Q

what sutures are used for bicep brachii belly tear

A

mattress sutures

118
Q

what is a distal humeral fracture called

A

Holstein Lewis humeral fracture

119
Q

What is at risk with a Holstein Lewis humeral fracture (2)

A

lateral intermuscular septum and radial nerve

120
Q

Which shoulder dislocation occurs 30% of the time

A

anterior inferior

121
Q

dislocated shoulder can result in

A

proximal humeral fracture

122
Q

what happens secondary to axillary nerve injury

A

deltoid wasting and weakness

123
Q

Hilton’s law (3)

A

nerves supply a muscle moving a joint, nerves supply articular branches to joint, nerves supply skin overlying muscle insertion

124
Q

Axillary nerve roots

A

C5-C6

125
Q

dorsal scapular nerve roots

A

C5

126
Q

Subclavius nerve roots

A

C5-C6

127
Q

Suprascapular nerve roots

A

C5-C6

128
Q

Lateral pectoral nerve roots

A

C5-C7

129
Q

Musculocutaneous nerve roots

A

C5-C7

130
Q

Radial nerve roots

A

C5-T1

131
Q

Median nerve roots

A

C5-T1

132
Q

Ulnar nerve roots

A

C7-T1

133
Q

Upper subscapular branch nerve roots

A

C5-C6

134
Q

medial antebrachial cutaneous nerve roots

A

C8-T1

135
Q

lower subscapular nerve roots

A

C5-C6

136
Q

thoracodorsal nerve roots

A

C6-C8

137
Q

medial brachial cutaneous nerve roots

A

T1

138
Q

medial pectoral nerve roots

A

C8-T1

139
Q

long thoracic nerve roots

A

C5-C7

140
Q

to longius colli and scalene nerve roots

A

C5-C8

Locomotor system (13 decks)

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