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Flashcards in Orthopaedic Upper limb Deck (29)
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1
Q

What are the leading cause of shoulder pain?

A

Rotator cuff disorder

2
Q

Less common shoulder pain

A
Frozen shoulder (adhesive capsulitis)
Osteoarthritis of the shoulder (glenohumeral)
3
Q

4 muscles of the Rotator cuff

A
  • subscapularis (anterior muscle)
  • supraspinatus (posterior muscles)
  • infraspinarus (P)
  • teres minor (P)
4
Q

What’s the function of rotator cuff

A
  • Glenohumeral stabilisers

- Stabilise the arm in mid range (capsuloligamentous tissues stabilise end range)

5
Q

Ant + Mid deltoid EMG peaks between __ - __ degrees abduction in scapular plane

A

60 - 90

6
Q

Post operation shoulder rehabilitation (treatment principles)

A
  • Pain must be respected
  • Thorough evaluation of the px
  • Exercise and techniques are progressively advanced
  • Balanced scapula muscle function is integrated into all dynamic exercisses
  • Programme is individualised (tissue, personality, surgical concerns)
7
Q

Post operation shoulder rehabilitation (goals)

A
  • Patient education (pathology)
  • Anti-inglammation and pain reduction
  • Facilitate collagen healing (gentle stress promotes improved collaged alignment and strength)
  • Improve ROM
  • Strengthen muscle tendon unit (increase motor unit recruitment, hypertrophy)
  • Optimise proprioception
  • Improve endurance
8
Q

Conservative therapy is dependent on status of the rotator cuff. Intact cuff gives generally greater than __ % satisfactory results. Torn cuff gives generally __ % or worse results.

A

80, 50

9
Q

Rotator cuff treatment (initial non-operative)

A
  • activity modification
  • relieve inflammation - NSAID’s, cortisone
  • Physiotherapy … ROM, RC strengthening
10
Q

If rotator cuff tear, what functional movement must be avoided?

A

Internal rotation (hand to the back)

11
Q

When to start resisted rotator cuff strengthening?

A
3 months 
(once the collagen lays down load up the tissues)
12
Q

Adhesive Capsulitis is characterised by …

A

painful restriction of both active and passive shoulder motion that occurs in the absence of a known shoulder disorder.

13
Q

Glenohumeral instability: recurrence rate is highest in aged 20 - 30 yrs. T or F?

A

False

Recurrence rate is high in the younger age; aged 11-20yrs - 94%, aged 20-30yrs - 79%, aged > 40yrs - 10%

14
Q

why incidence of RC tear in older patient is higher than younger patient?

A

associated with degeneration, quality of tissue (prone to tear) [30% > 40yrs, 80% > 60yrs]

15
Q

Total shoulder joint replacement post-operation, when lying supine

A

use of a pillow under the elbow

16
Q

Even minimally displaced anatomical neck of humerus fractures have a significant risk of

A
avascular necrosis (AVN) of the humeral head
(due to damaged anterior & posteriot circumfles artery)
17
Q

The Open Reduction Internal Fixation (ORIF) of the distal humerus is an operation

A

that fixes fractures in the humerus that are generally difficult to secure with a cast or splint (external fixation).

18
Q

Shaft of Humerus fracture is usually treated …..

A

conservatively (with a supportive / hanging cast followed by supportive splint)

19
Q

Distal radius fracture is common in what group.

A

older, female (Colles fracture … dorsal (posterior) displacement of the wrist)

20
Q

Conservative Treatment of “Distal radius” fracture: __ - __ weeks in Long armed cast. __ - __ weeks in Short armed cast.

A

2 - 4 weeks (LAC)

4 - 6 weeks (SAC)

21
Q

Palpation of the Scaphoid tubercle and anatomical snuff box is sensitive or specific test?

A

100% Sensitive test

(Rule out) [74% Specificity]

22
Q

Goal of any rehabilitation programme should be “ _____ ______” of the patient

A

functional restoration

23
Q

Post-op RC cuff tear: one of the difficulties

A

weakness with arm elevation

24
Q

Post-op RC cuff tear: most Px encouraged to contimue exercise for at least?

A
a year
(return to sports = 6-9 months)
25
Q

Rehabilitation of RC should progress from ___=> ____ => ____

A

Passive => Active => muscle strengthening (resisted)

26
Q

What factors has an impact on the rehabilitaion of RC

A
  • surgical repair (open … deltoid detachment = 6-8weeks of no deltoid use; arthroscopic … no deltoid involvment = less painful)
  • size of the tear (>5cm = poor outcome; <1cm = quicker progression)
  • quality of the tissue
  • age
  • comobidities
27
Q

Why avoid IR after RC repair, and how many weeks are necessary to protect the repair of the tendon?

A
  • trying to avoid maximum tension on repaired RC (supraspinatus, infraspinatus, teres minor = ER, so stretch by IR)
  • 12 weeks
28
Q

Kellgran Lawrence scale

A
  • grade 0 - no radiographic features of OA are present
  • grade 1 - doubtful joint space narrowing (JSN) and possible osteophytic lipping
  • grade 2 - definite osteophytes and definite JSN
  • grade 3 - multiple osteophytes, definite JSN, sclerosis, possible bony deformity
  • grade 4 - large osteophytes, marked JSN, severe sclerosis and definitely bony deformity
29
Q

why Hemiarthroplasty for proximal humeral fracture?

A
  • cost effective
  • a less-invasive surgery
  • no risk of problems with an artificial socket