Orthopedics 02

Front 1

Muscle attachments of supraspinatus

Back 1

Scapula --> greater tuberosity of humerus

Front 2

Muscle attachments of infraspinatus

Back 2

Scapula --> greater tuberosity of humerus

Front 3

Muscle attachments of teres minor

Back 3

Scapula --> greater tuberosity of humerus

Front 4

Muscle attachments of subscapularis

Back 4

Scapula --> Lesser tuberosity of humerus

Front 5

Nerve supply of supraspinatus

Back 5

Suprascapular nerve

Front 6

Nerve supply of infraspinatus

Back 6

Suprascapular nerve

Front 7

Nerve supply of teres minor

Back 7

Axillary nerve

Front 8

Nerve supply of subscapularis?

Back 8

Subscapular nerve

Front 9

Muscle function of supraspinatus

Back 9

Abduction

Front 10

Muscle function of infraspinatus

Back 10

External rotation

Front 11

Muscle function of teres minor

Back 11

External rotation

Front 12

Muscle function of subscapularis

Back 12

Internal rotation and adduction

Front 13

Clinical features of rotator cuff disease

Back 13

Night pain and difficulty sleeping on affected side, pain worse with active motion, weakness and loss of ROM, especially between 90-130 (e.g., trouble with overhead activities), tenderness to palpation over greater tuberosity

Front 14

Which tests can rule out/differentiate biceps tendinosis from rotator cuff disease?

Back 14

Speed and Yergason's tests; SLAP lesion: O'Brien's test

Front 15

Describe the Jobe's test for supraspinatus tear

Back 15

Place the shoulder in 90 of abduction and 30 of forward flexion and internally rotate the arm so that the thumb is pointing toward the floor; weakness with active resistance suggests a supraspinatus tear

Front 16

Describe the Lift-off test

Back 16

Internally rotate arm so dorsal surface of hands rests on lower back. Patient instructed to actively lift hand away from back against examiner resistance; inability to lift hand away from back suggest a subscapularis tear

Front 17

Describe the posterior-cuff test

Back 17

Arm positioned at patient's side in 90 degrees of flexion. Patient instructed to externally rotate arm against the resistance of the examiner; weakness with active resistance suggests posterior cuff tear (infraspinatus and teres minor)

Front 18

Describe the Neer's test

Back 18

Passive shoulder flexion; pain elicited between 130-170 degrees suggests rotator cuff impingement

Front 19

Describe the Hawkins-Kennedy test

Back 19

Shoulder flexion to 90 degrees and passive internal rotation; pain with internal rotation suggests rotator cuff impingement

Front 20

Describe the painful arc test

Back 20

Patient instructed to actively abduct the shoulder; pain with abduction greater than 90 degrees suggests tendinopathy

Front 21

Investigations for rotator cuff disease

Back 21

X-rays, MRI, and arthrogram (see full thickness tear, difficult to assess partial thickness tear)

Front 22

X-ray findings in rotator cuff disease

Back 22

AP view may show high riding humerus relative to glenoid, evidence of chronic tendonitis

Front 23

MRI findings in rotator cuff tear

Back 23

Coronal/sagittal oblique and axial orientations are useful for assessing full/partial thickness tears and tendinopathy +/- arthrogram: geysir sign (injected dye leaks out of joint through the tear)

Front 24

Treatment of mild rotator cuff disease

Back 24

Non-operative, i.e., physiotherapy and NSAIDs

Front 25

Treatment of moderate ("tear") rotator cuff disease

Back 25

Non-operative treatment +/- steroid injection

Front 26

Treatment of severe ("repair") rotator cuff disease

Back 26

Impingement that is refractory to 2-3 months physio and 1-2 injections: may require arthroscopic or surgical repair, i.e., acromioplasty, rotator cuff repair

Front 27

Ruling out rotator cuff tears

Back 27

98% probability of rotator cuff tear if all 3 of the following are present: supraspinatus weakness, external rotation weakness, and positive impingement signs

Front 28

Which ligaments attach the clavicle to scapula?

Back 28

AC and CC ligaments

Front 29

Mechanism of acromioclavicular joint pathology

Back 29

Fall onto shoulder with adducted arm (fall onto tip of shoulder)

Front 30

Clinical features of AC joint pathology

Back 30

Pain with adduction of shoulder and/or palpation over AC joint; palpate step deformity between distal clavicle and acromion (with dislocation); limited ROM

Front 31

Investigations for AC joint pathology

Back 31

X-rays: AP, Zanca view (10-15 degree cephalic tilt), axillary +/- stress views (10lb weight in patient's hand)

Front 32

Non-operative treatment of AC joint pathology

Back 32

Non-operative (most common): sling for 1-3 weeks, ice, and analgesia

Front 33

Indications for operative treatment of AC joint pathology

Back 33

AC and CC ligaments are both torn and/or clavicle displaced posteriorly

Front 34

Operative treatment procedure of AC joint pathology

Back 34

Excision of lateral clavicle with AC/CC ligament reconstruction

Front 35

Incidence of different types of clavicle fractures

Back 35

Proximal - 5%, middle - 80%, or distal third - 15%

Front 36

In whom are clavicle fractures most common?

Back 36

Children (unites rapidly without complications)

Front 37

Mechanism of clavicle fracture

Back 37

Fall on shoulder (87%), direct trauma (7%), and FOOSH (6%)

Front 38

Potential complications of AC joint dislocation

Back 38

Pneumothorax or pulmonary contusion

Front 39

Clinical features of clavicle fracture

Back 39

Pain and tenting of skin; arm is clasped to chest to splint shoulder and prevent movement

Front 40

First step in management of clavicle fracture

Back 40

Evaluate neurovascular status of entire upper limb

Front 41

Treatment of proximal and middle-third clavicle fractures

Back 41

Figure-of-eight sling for 1-2 weeks, early ROM and strengthening once pain subsides, if ends overlap >2cm, consider open reduction and internal fixation (ORIF)

Front 42

Treatment of distal one-third clavicle fracture

Back 42

Undisplaced (with ligaments intact) - sling for 1-2 weeks, displaced (CC ligament injury) - open reduction and internal fixation (ORIF)

Front 43

Associated injuries with clavicle fractures?

Back 43

Up to 9% of clavicle fractures are associated with other fractures, most commonly rib fractures. Majority of brachial plexus injuries are associated with proximal third fractures

Front 44

Specific complications of clavicle fracture

Back 44

Cosmetic bump usually only complication; shoulder stiffness, and weakness with repetitive activity; pneumothorax, brachial plexus injuries and subclavian vessel (all very rare)

Front 45

What is frozen shoulder (adhesive capsulitis)?

Back 45

Disorder characterized by progressive pain and stiffness of the shoulder usually resolving spontaneously after 18 months

Front 46

Characteristics of primary adhesive capsulitis?

Back 46

Idiopathic, usually associated with diabetes melitus; may resolve spontaneously in 9-18 months

Front 47

Causes of secondary adhesive capsulitis

Back 47

Prolonged immobilization, shoulder-hand syndrome, following MIs, stroke, shoulder trauma; poorer outcome

Front 48

Clinical features of adhesive capsulitis

Back 48

Gradual onset (weeks to months) of diffuse shoulder pain with: 1) decreased active and passive ROM, 2) pain worse at night and often prevents sleeping on affected side, and 3) increased stiffness as pain subsides: continues for 6-12 months after pain has disappeared

Front 49

Investigations for frozen shoulder (adhesive capsulitis)

Back 49

X-rays may be normal, or may show demineralization from disease

Front 50

Treatment of frozen shoulder (adhesive capsulitis) (4)

Back 50

Active and passive ROM (physiotherapy), NSAIDs and steroid injections if limited by pain, manipulation under anesthesia and early physiotherapy; arthroscopy for debridement/decompression

Front 51

Ten conditions associated with an increased incidence of frozen shoulder

Back 51

Prolonged immobilization (most significant), female, age >49, diabetes melitus (5x), cervical disk disease, hyperthyroidism, stroke, MIs, trauma and surgery

Front 52

When is there a danger of AVN with humerus fractures?

Back 52

Anatomic neck fractures; disrupt blood supply to the humeral head and AVN may ensue

Front 53

Mechanism of proximal humeral fracture

Back 53

Young: high energy trauma (MVC); elderly: FOOSH from standing height in osteoporotic individuals

Front 54

Clinical features of proximal humeral fracture

Back 54

Proximal humeral tenderness,

Front 55

Specific complications of proximal humeral fracture

Back 55

AVN, axillary nerve palsy, malunion, and post-traumatic arthritis