Upper Limb conditions

Question 1

Dislocated shoudler

Answer 1

• visibling might see bruising /swelling - movement is restricted
• 90-95% are anterior (humerus sits in glenoid cavity wc is shallow, and is well supported superior, anterior and posteriorly but weak inferiorly therefore head of humerus dislocates anteroinferioly
• 60% d to subcoracoid location d pull pf muscles disturbs the anterior capsule ad ligament
• 30% subglenoid - frist episode of dislocation when person as hadn’t behind head then pushed arm a little more posterity sodislates anterior
• inferiorly - another way to dilate is blow from posterior

Question 2

Labral tear aka? and whats is it

Answer 2

• Bankart lesion
• look at the labrum inferioraspect on x rays
• force of the humerus coming out the labrum c glenoid labrum to be torn off, and sometimes a small piece of bone can leave too

Question 3

what happens also in terms of muscles involved in anterior disolcation

Answer 3

the tone of infraspinaus and teres minor muscle c posterior aspect of humeral head to become jammed against the anterior lip of glenoid fossa c dent known as the ‘indentation fraction’ in postolateral humerus head known as Hill-Sachs Lesion

-50% of those under 40 get anterior shoulder dislocation , 80% with recurrent shoulder dislocations get Hill-Sachs lesion, wc increases risk of secondary osteoarthritis in shoulder joint

Question 4

posterior dislocations

Answer 4

• less common only (2-4% fo cases)
• occurs with violent muscle contractions d epileptic seizures , electrocution or lightening or when blow to anterior shoulder or flexed across the body elbow and fall/ rotator cuff tears
• p presents with internally rotated arm and adducted,
• on x ray can be missed as it looks likes normal, but the projection of humeral head is a more bulb shape more runded

Question 5

what bone help s detect shoulder dislocation and what test?

Answer 5

• scapular as you’re supoosed to see a Y view were birufication where glenoid fossa and humerus are in line, you take x ray from end on lateral view ‘scapular y view’

Question 6

inferior dislocatiosn

Answer 6

• rare (0.5%)
• head humerus inferior to the glenoid , patient presents with forced hand extended over head can’t get hand down
• c due to hyperadbuction
• associated with damages to nerves(60%), rotator cuff tears(80%) and injury to b vessels (3%)

Question 7

whats the most issue common shoulder dislocation complication

Answer 7

recurrent dislocation wc c damage to stabilising tissues

Question 8

chances of dislocation and age?

Answer 8

increases60% dependent on age and activity level

Question 9

how often does damage to axillary nerve occur and artry

Answer 9

artery = 1-2%

n = 10-40% (most recover when shoulder put back into place) less commonly this can also c damage to the cords of brachial plexus

Question 10

how often do fractures occur in shoulder dislocations

Answer 10

• depends on traumatic mechanism that c the dislocationadn in first time dislocation or nor to if person over 40, if fractured occurs mostly to humerus, (head and greater tubercule) ,clavicle and acromion

Question 11

rotator cuff muscle tears

Answer 11

• can be associated with shoulder dislocation and is most commonly in older people (80% have them both together)
• tendon tears are common
• supraspinatus tendon one mostly affected where it tears at place of insertion
• c are shoulder displation or age
• related degradation or degenerative
• microtrauma model where d age micro minor injury will c it to tear d v supply and toe d age..then inflammatory cells come to site and oxidative stress leads to tenocyte apoptosis (tendon cell) leading to further degeneration creaticycle known as ‘vicious cycle’ -most are asymotic but experience pain when lean on their elbow and push downwards or when reaching forward

Question 12

clavicular fractures

Answer 12

• mostly kids and young adult
• 3-5% of all fractures
• 80% are middle of clavicle
• c by fall into affected shoulder or onto outstretched hand
• most treated w/o surgery
• free moving arm
• complete or incomplete displacement

Question 13

what will happen if …..

Answer 13

-

Question 14

complications of fracture healing genrally

Answer 14

union =failure to unite

malunion = uniting in suboptimalposition

Question 15

what are some complications for clavicular fraction

Answer 15

• fracture healing issues
• penumothroaz image to surrounding neuromuscular structures like the suprascpaular nerve

Question 16

impingement syndrome and whats a special type?

Answer 16

• soft tissue irritation the subacromail space
• supraspinatus tendon impinges creating painful arc between 60-120 degree abduction
• it is with rotator cuff damage or not?
• usually middle age
• MID PAINFUL ARC?cant do work at 90 angle because the tendons are being squashed
• sometimes d bone in the area

Question 17

calcified Supraspinatus tendiopathy

Answer 17

present of hydroxapaptite in the tendon of supraspinatus (can occur in any rotator cuff muscle tendon but commonly spinatus)

• throes is tenches damaed transform into chondrocytes and lay down cartilafe
• treatment is rest and analgesia and sometimes surgery

Question 18

adhesive capsulitis (frozen schouder)

Answer 18

• inflamed gelohuemrual joint c it to become stiff exacerbated in cold and at night many risk factors eg.femal, thyroid disease,trauma, daibee -patients complain fo sleep deprivation -treamnt s physio alagesia and anitinlamtomnu 90% of patients regain shoulder function

Question 19

osteoathetis

Answer 19

people over 50 treatment IsNSAIDSm osteoid injections and sometimes viscosupllentationinjection of hyulanoic acid to increase lubricatiom but can do arthroscopy surgery (key hoe)

Question 20

less than 35 conditons

Answer 20

• instability so dislocations d trauma and clavicular fractures

Question 21

over 35

Answer 21

-degenrative and impingement, -tendiopathy -proximal humeral fractures -osteoarthritis -surgical humeral neck - adhesive capsulitis (50s-60s) -acromioclavicular

Question 22

shoulder joint compec

Answer 22

-gh -sternoc -ac -scapiulothoracic articulations -thoracic spine

Question 23

why isn’t scapulothroacic articulations a real joint

Answer 23

doesnt contain bursae

Question 24

1;2 movement and 2:1

Answer 24

-ratio of glenohumeral to scapulothoracic movement during elevation

Question 25

Elhers danklos syndrome

Answer 25

-

Question 26

shoulder isntability more common in? and what about kids?

Answer 26

- younger -male ^ than women -children uncommon, usually break clavicle , or wrist etc they usually break bones instead of the ligament, so since their bones are weaker they get more boney injuries than ligament

Question 27

why is it bad to dislocate your shoudler

Answer 27

do it once more often to get recurrent episodes -recurrent subluxation (partial dislocation)

Question 28

classification of shoulder dislocations

Answer 28

-direction uni / multi -timing acute /recurrent -mechanism traumatic/atraumatic/habitual/voluntary - fracture present?

Question 29

why doesnt it dislocate superiorly

Answer 29

acromion in the way

Question 30

most common

Answer 30

acute, unidirectional anterior/antrioinferior d trauma

Question 31

patho-anatomy of traumatic anterior dislocation

Answer 31

- tear of gelnoid labrum and stretch of gh ligament (BANKART LESION) - bony bankart (w bone) -hill-sachs lesion (+/-) posterior humeral head impactions fracture LOOK AT THE POSTERIORLATERALaspect on the x-ray everything moves more medially

Question 32

why recurrent dislocations?

Answer 32

-labrum is poor to recover

Question 33

treatment of traumatic anterior dislocation

Answer 33

- analgesia put in place -or surgery to reduce the pathos-anatomy to prevent shoulder dislocation again

Question 34

to tell the difference between posterior / anterior

Answer 34

- contrasting view at axillary view but you don't do that or Y scapula

Question 35

treatment for posterior dislocation

Answer 35

-MUA -suregery to adress bony defects

Question 36

why bulb on x ray with posterior ?

Answer 36

locked into media rotation here the bulb but if you internally rate your arm you can see bulb on x ray

Question 37

pathos-anatomy of posterior

Answer 37

- hill-sacks inverted ?

Question 38

posterior y scapular view image

Answer 38

image

Question 39

why inferior danergous

Answer 39

neurovascualr damage

Question 40

reduction techniques

Answer 40

image -reduce pain and stop the spasm -give sedate or analgesia

Question 41

complications of shoulder dislocations

Answer 41

-recurrenc e(more common in younger, uncommon in 40 d reduction of elastic's

Question 42

recurrance rate

Answer 42

100-age

Question 43

multi-directional instability

Answer 43

-atrauamtic -no structural damage -capsular dysfunction and laxity - d to abnormal muscle patterning -treatement is phsysio

Question 44

joint

Answer 44

-acromnioclavicualr -directly fall onto it -treatment is broad arm sling, surgery

Question 45

proximal humeral fracture

Answer 45

-common in elderly -surgical neck = -downward 9sometimes add plaster) to make sure they experience the reduction force