Auer Ch 96 Shoulder

Front 1

Radiographic projections of the shoulder:

Back 1

mediolateral, cranioproximal to craniodistal oblique

Front 2

What improves radiographic diagnosis of shoulder injury?

Back 2

double contrast > positive contrast

Front 3

Approach to SH joint anesthesia:

Back 3

18 g, 8.9 cm spinal needle in notch between cranial and caudal prominences of the greater tubercule of the humerus directed toward opposite elbow parallel to ground

Front 4

Disadvantage of SH anesthesia:

Back 4

extrasynovial anesthetic agent can block suprascapular nerve and cause lateral subluxation of SH joint

Front 5

Approach of bicipital bursa anesthesia:

Back 5

18 gauge 8.9 cm spinal needle 4 cm proximal to distal aspect of deltoid tuberosity directed proximomedial between biceps brachii and humerus to depth of 4 cm

Front 6

Locations of OCD in SH joint:

Back 6

humeral head, glenoid cavity

Front 7

What cases are candidates for cartilage repair with PDS pins?

Back 7

Smooth, partially attached, unmineralized cartilage flaps

Front 8

Approaches to shoulder arthroscopy:

Back 8

lateral, craniolateral

Front 9

Lateral approach to shoulder arthroscopy:

Back 9

1-2 cm caudal to infraspinatus tendon, cranial to teres minor muscle, instrument portals in notch between cranial and caudal prominences of greater tubercle of humerus and 2-4 cm caudal to arthroscopic portal

Front 10

Benefits of lateral approach to shoulder arthroscopy:

Back 10

better visualization of medial aspect of humeral head, uses cranial portal available for fluid egress

Front 11

Craniolateral approach to shoulder arthroscopy:

Back 11

notch between cranial and caudal prominences of greater tubercle of humerus

Front 12

Most common fracture of scapula:

Back 12

supraglenoid tubercle

Front 13

Description of supraglenoid tubercle fracture:

Back 13

simple, intra-articular epiphyseal fracture

Front 14

Cause of supraglenoid tubercle fracture:

Back 14

direct trauma or avulsion caused by tension from the biceps tendon

Front 15

Displacement of supraglenoid tubercle fracture:

Back 15

cranioventral because of tension from biceps and coracobrachialis

Front 16

Treatment options for supraglenoid tubercle fracture:

Back 16

conservative therapy, internal fixation or fragment removal

Front 17

Goal of surgical intervention of supraglenoid tubercle fracture:

Back 17

restore articular congruity of glenoid cavity

Front 18

Indications for supraglenoid tubercle fracture removal:

Back 18

chronic fractures older than 1 week, smaller fractures that affect a small portion of the glenoid cavity

Front 19

Indications for internal fixation of supraglenoid tubercle fracture:

Back 19

involve greater than 1/3 of the glenoid cavity

Front 20

Approach to supraglenoid fragment removal:

Back 20

20 cm incision made from distal scapular spine to deltoid tuberosity, brachiocephalicus and supraspinatus separated, brachiocephalicus retracted, supraspinatus separated in direction of fibers over tubercle, fragment dissected free of soft tissue attachments, closure in many layers to reduce dead space +/- drain placement

Front 21

Post-op care for supraglenoid fragment removal:

Back 21

stall rest for 60 days, physical therapy, no paddock exercise or training for at least 6-12 months

Front 22

Approach to internal fixation of supraglenoid tubercle fracture:

Back 22

incision from distal scapular spine to deltoid tuberosity, partial or full transection of biceps tendon, reduction of fracture with bone reduction forceps, 2-3 5.5 cortex screws in lag placed in divergent direction, figure 8 tension band between supraglenoid tubercle and cranial edge of scapula with 1.5mm wire or 1mm cable

Front 23

Post-op care for internal fixation of supraglenoid tubercle fracture:

Back 23

stall rest 8 weeks, PT

Front 24

What can occur with transverse fracture of the greater tubercle of the humerus?

Back 24

SH luxation

Front 25

What scapular fractures are associated with non-weight bearing lameness?

Back 25

Complete fractures of the body or neck of the scapula

Front 26

Complication of scapular neck fractures:

Back 26

suprascapular nerve injury resulting in lateral luxation of SH joint (sweeny)

Front 27

Palpable abnormality associated with SH luxation:

Back 27

humeral head is lateral or cranial to scapula

Front 28

Treatment of SH luxation:

Back 28

closed reduction, open reduction + internal fixation (SH tension wires), arthrodesis in mini or small (<250 kg)

Front 29

Indications for closed SH reduction:

Back 29

within 24 hours of injury, before open reduction tried

Front 30

Origin of biceps brachii muscle:

Back 30

supraglenoid tubercle

Front 31

Insertion of biceps brachii muscle:

Back 31

medial radial tuberosity

Front 32

Relations of biceps brachii muscle/ tendon:

Back 32

bound to intertubercular groove by tendinous portion of superficial pectoral muscle

Front 33

Function of biceps brachii muscle:

Back 33

flex elbow, provide stability to SH joint

Front 34

Location of biceps brachii bursa:

Back 34

between proximal biceps and humerus

Front 35

Location infraspinatus tendon:

Back 35

extends from infraspinatus muscle over lateral SH joint and caudal eminence of greater tubercle of humerus to insert on dorsolateral humerus

Front 36

Location of infraspinatus bursa:

Back 36

between infraspinatus tendon and caudal eminence of greater tubercle of humerus

Front 37

Approach to bicep arthroscopy:

Back 37

2-3 cm proximal to deltoid tuberosity on dorsolateral aspect of humerus directed proximomedially through brachiocephalicus, beneath biceps muscle along cranial surface of humerus

Front 38

Approach to bicep brachii tendon transection:

Back 38

incision from distal scapular spine to deltoid tuberosity

Front 39

When is EMG used to diagnose sweeny?

Back 39

7 days after initial injury

Front 40

Non-surgical management of Sweeney?

Back 40

Stall rest

Front 41

How long does shoulder stability take to recover after suprascapular nerve injury?

Back 41

average of 7 months

Front 42

Surgical management of Sweeney:

Back 42

decompression of suprascapular nerve

Front 43

Indication for decompression of suprascaular nerve:

Back 43

if no improvement after 3 months of non-surgical management

Front 44

Complications of decompression of suprascapular nerve:

Back 44

glenoid tubercle or scapular neck fractures

Front 45

Describe decompression of suprascapular nerve:

Back 45

25 cm incision over spine of scapula, elevation of brachiocephalicus, elevation of suprascapular nerve from scapula, bone rasped from cranial margin of scapula, tendinous band limiting movement of suprascapluar nerve on medial aspect of scapula is transected

Front 46

How long does risk of post-op fracture exist after decompression of suprascapular nerve?

Back 46

6 weeks

Front 47

Post-op care for decompression of suprascapular nerve:

Back 47

stall rest 2-3 months, PT

Front 48

Approaches to humeral fracture repair:

Back 48

lateral, craniolateral

Front 49

Internal fixation methods for ruminant humeral fractures:

Back 49

IM pins +/- cerclage wire & interlocking nails for diaphyseal fractures, interlocking nails for distal fractures, single cranial plate for young calves, >200 kg requires plate on cranial and lateral aspect

Front 50

Closed reduction of SH luxation in ruminants:

Back 50

traction applied caudally with manual pressure on humeral head or traction applied distally & slightly cranial with firm pressure applied caudally during slow release of traction

Front 51

Types of humeral fractures:

Back 51

proximal humeral head (epiphyseal and metaphyseal in foals), greater tubercle, mid-diaphysis, distal metaphysis, distal condyle and epicondyle