Shoulder - Ortho

Front 1

Dermatomal examination of brachial plexus

Back 1

C2-C4: Trapeizus muscle
C5: Deltoid, lateral arm sensation
C6: Biceps, lateral forearm/thumb sensation
C7: Thumb extensors, tip of long finger
C8: FInger flexors: tip of litter finger/medial forearm
T1: Hand interossei medial arm

Front 2

Standard trauma views of shoulder

Back 2

(1) Modified AP
(2) Axillary view (gold tee view)
(3) Transscapular (Y View)

Front 3

Classification/mechanisms of clavicular fractures

Back 3

Medial third - blow to anterior chest
Middle third - Force to lateral aspect of shoulder
Lateral third - Direct blow to top of shoulder

Front 4

Subtypes of lateral 1/3 claviuclar fractures

Back 4

- Type I: stable/minimal displacement as coracoclavicular ligaments are intact
- Type II: Displaced as ligament torn
- Type III: Intra-articular

Front 5

Indications for:

ED consulation with clavicular fractures
Urgent ortho consulation:

Back 5

ED consultation
Open
Significant skin tenting
Associated neurovascular injuries
Interposition of soft tissue

Urgent consultation
Type II/III Lateral fractures
Severely comminuted/displaced middle third fractures

Front 6

Scapular fracture Types:

Back 6

Glenoid fossa
Neck
Spine
Body
Acromion
Coracoid process

Front 7

Scapular fracture management

Back 7

Most are managed conservatively
Exceptions:
Displaced acromion/coracoid fractures
Displaced glenoid and neck fractures

Key management step is to be aware of high energy mechanism and screen for associated nerve, artery, and thoracic trauma injuries

Front 8

Fracture segments in proximal humerus fractures

Back 8

(1) Articular surface (anatomic neck)
(2) Greater tuberosity
(3) Lesser Tuberosity
(4) Humeral shaft (surgical neck)

Front 9

Neer's classifcation system for displaced proximal humerus fractures

Back 9

Displaced if angled greater than 45 degrees of displaced at least 10mm from neighboring segment

# pieces displaced
dislocations

Front 10

Management of proximal humerus fractures

Back 10

Minimally displaced: Sling immbolization, early ROM, ortho F/U

Displaced: Orthopedic referral for possible OR

Fracture-dislocation: Typically reduction in consultation with ortho unless neurovascular compromise

Front 11

Fractures of humeral epiphysis

Back 11

Salter Harris I: Sling
Slater Harris II: Reduction if angulated greater than 20 degrees and immbolization

Front 12

Mechanism of Anterior Sternoclavicular joint dislocaton

Back 12

Anterolateral force to shoulder

Front 13

Mechanism of Posterior Sternoclavicular Joint dislocation

Back 13

Posterolateral force to shoulder or Direct blow to medial clavicle

Front 14

Complications of posterior Sternoclavicular joint dislocation

Back 14

Intrathoracic and superior mediastinal structures
- Great vessel injury
- Tracheoesopheal fistula
- Tracheal injury/compression
- Pneumothorax
- Thoracic outlet syndrome
- Brachial plexus injury

Front 15

Types of Sternoclacivular Joint Injuries

Back 15

Type I: Sprain secondary to stretching of the sternoclavicular and costoclavicular ligaments

Type II: Subluxation secondary to torn sternoclaviulcar ligament and stretched costoclaviular ligament

Type III: Dislocation with tearing of ligaments

Front 16

Management of Sternoclavicular joint dislocations

Back 16

Type I: Immoblize in sling
Type II: Immoblize in sling or figure of 8/clavicle sling
Type III: Reduction with ortho consultation

Front 17

Reduction method for Sternoclavicular joint dislocation

Back 17

Position patient with rolled sheet between shoulder blades to raise 5cm above table

Apply traction with arm in extended and abducted position

Assistant to apply pressure/direction of median end of clavicle as required

Front 18

Rockwood classifcation of AC Joint Injuries

Back 18

I: Sprain of AC ligament with no separation of acromion and clavicle

II: Subluxation/elevation of clavicle but not above superior margin of acromion and joint space widened
AC ligament is torn and tearing of muscular attachments but coracoclavicular ligament is intact

III-VI: complete dislocation with tearing of CC ligament

III: Superior displacement
IV: Posterior displacement
V: Exaggerated superior displacement (> 2X normal)
VI: Inferior Displacement

Front 19

Management of AC Joint Injuries

Back 19

Type I & II: Sling immoblization with PCP F/U
Type III: Sling with ortho F/U
IV - V: Orthopedics referral

Front 20

Bankart lesion

Back 20

Fracture/damage to anterior/inferior glenoid associated with anterior shoulder dislocations

Front 21

Hill-Sachs deformity

Back 21

Fracture to posterior/lateral humeral head associated with anterior shoulder dislocations

Front 22

Types of anterior dislocations of shoulder

Back 22

Subcoracoid
Subglenoid
Subclavicular
Intrathoracic

Front 23

Methods for anterior shoulder dislocation reduction

Back 23

Stimson (hanging weight)
Traction/countertraction
External rotation
Milch technique (external rotation/abduction)
FARES (FAst/REliable/Safe)
Scapular manipulation
Cunningham technique

Front 24

Types of posterior shoulder dislocations

Back 24

Subacromial
Subglenoid
Subspinous

Front 25

AP findings of posterior shoulder dislocation

Back 25

- Lack of overlap of humeral head and glenoid fossa
- Rim sign (increased distance between anterior glenoid rim and humeral head)
- Reverse hill sachs (anteromedial compression fracture of humeral head)
- Posterior glenoid fracture
- Humeral head in internal rotation (lightbulb sign)

Front 26

Reduction of posterior shoulder dislocations

Back 26

(1) Adduction and internal rotation with simultaneous lateral traction on arm to disimpact humeral head

(2) External rotation and pressure on humeral head to bring anterior

Front 27

Inferior shoulder dislocations (Luxatio erecta)

Back 27

Superior aspect of humeral head below the glenoid
Arm is held overhead in 110-160 degrees of abduction

Differentiated from subglenoid anterior dislocations as humeral shaft is parallel to spine of scapula

Complications include brachial plexus injuries and axillary artery thrombosis

Front 28

Reduction of luxatio erect

Back 28

(1) Traction countertraction
(2) Two step: Convert to anterior and then reduce

Front 29

Rotator cuff muscles and function

Back 29

Supraspinatus - Abduction
Infraspinatus - External rotation
Teres minor - External rotation
Subscapularis - Internal rotation

Front 30

Subacrominal painful arc

Back 30

60 - 120 degrees of abduction

Front 31

Acromoclavicular painful arc

Back 31

120 - 180 degrees of abduction

Front 32

Content of subacrominal spcae

Back 32

Rotator cuff
Subacromial bursa
Long head of bicep

Front 33

Neer Stages of Impingement syndrome

Back 33

I: Edema and hemorrhage -> characterized by pain with activity
II: Tendinitis and fibrosis -> Greater impairment and night pain
III: Bone spurs and tendon rupture -> Weakness

Stage 1: Conservative therapy
Stage 2: Conservative +/- surgical referral
Stage 3: Surgical referral

Front 34

Xray findings suggesting complete rotator cuff tear

Back 34

Reduced space between superior aspect of humeral head and acromion