Proximal Humeral and Clavicle Fractures

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Questions and Answers

What is the primary treatment for a proximal humeral fracture?

Surgery immediately

Rest and education to stop throwing (correct)

Ice and heat application

Physical therapy only

What type of stress fracture does 'Little Leaguer's Shoulder' usually present as?

Salter Harris Type I or II (correct)

Compound fracture

Simple bone fracture

Salter Harris Type III

What imaging findings are expected in a case of 'Little Leaguer's Shoulder'?

Dislocation of the humerus

Soft tissue swelling

Widening of the growth plate and demineralization (correct)

Fracture line

What is a common cause of proximal humeral fractures in the elderly?

Fall onto an outstretched hand (FOOSH) (D) Signup and view all the answers

What is the recommended initial treatment period for a stable nondisplaced proximal humeral fracture?

2 weeks of immobilization followed by exercises (D) Signup and view all the answers

Which demographic is most affected by proximal humeral fractures due to osteoporosis?

Elderly women (A) Signup and view all the answers

What complication is associated with proximal humeral fractures in the elderly?

Rotator cuff tears (C) Signup and view all the answers

During what phase does a stress fracture occur in 'Little Leaguer's Shoulder'?

Deceleration phase of throwing (C) Signup and view all the answers

What is the risk when reintroducing stress after a proximal humeral fracture?

Risk of re-injury must be carefully managed (C) Signup and view all the answers

Interventions after the initial immobilization of a stable nondisplaced fracture include:

Gentle AAROM exercises and strengthening (B) Signup and view all the answers

What is the most common cause of clavicle fractures?

Falling onto the shoulder (A) Signup and view all the answers

Which of the following is NOT a common fracture classification of the clavicle?

Group II: proximal 1/3rd (D) Signup and view all the answers

What characterizes a Grade III AC joint injury?

Tear of both AC and CC ligaments with dislocation (C) Signup and view all the answers

What is the typical healing time for clavicle fractures in adults?

8-12 weeks (A) Signup and view all the answers

Which condition is primarily associated with pain at night and painful movement of the shoulder?

Subacromial impingement (B) Signup and view all the answers

Which tendon is primarily involved in a mallet finger injury?

Extensor tendon (B) Signup and view all the answers

How is rotator cuff tear incidence related to age?

Commonly affects individuals over 60 (D) Signup and view all the answers

What is a prominent symptom of pronator teres syndrome?

Vague anterior elbow pain (B) Signup and view all the answers

What is the primary treatment for Grade II AC joint injuries?

Conservative management with a sling (B) Signup and view all the answers

Which test can be used to diagnose Dequervain’s syndrome?

Finkelstein's test (C) Signup and view all the answers

What happens during an Anterior Interosseous Nerve entrapment?

Inability to make an OK sign (A) Signup and view all the answers

Which of the following is NOT a common symptom of radial tunnel syndrome?

Numbness in the forearm (C) Signup and view all the answers

What is a common treatment for Jersey finger?

Surgical referral (D) Signup and view all the answers

Which muscle is momentarily compromised during a mallet finger injury?

Extensor digitorum (A) Signup and view all the answers

What is a common symptom of degenerative tears?

Pain (B) Signup and view all the answers

Which test is used for diagnosing carpal tunnel syndrome?

Phalen’s Test (A), Tinel’s Test (B) Signup and view all the answers

What is a potential consequence of Bennet’s fracture?

Articular incongruity leading to degenerative joint disease (A) Signup and view all the answers

Which treatment is appropriate for a displaced middle or proximal phalange fracture?

Closed reduction with aluminum splint (C) Signup and view all the answers

Gamekeeper's thumb involves an injury to which anatomical structure?

Ulnar collateral MCP ligament (D) Signup and view all the answers

What common test is used to identify arthritis in the CMC joint of the thumb?

CMC Grind Test (C) Signup and view all the answers

Which condition is characterized by compression of the brachial plexus and/or subclavian artery?

Thoracic outlet syndrome (B) Signup and view all the answers

What is the most common site of osteoarthritis in the hand?

CMC joint of the thumb (D) Signup and view all the answers

What is the appropriate treatment for a partial tear of the ulnar collateral ligament?

Spinting for 2-3 weeks (C) Signup and view all the answers

What is a classic symptom of Dupuytren's Contracture?

Contracture of palmar fascia (C) Signup and view all the answers

Which of the following is often the result of a scaphoid fracture?

Poor blood supply leading to non-union (C) Signup and view all the answers

Which of the following best describes carpal instability?

Dorsal intercalated segment instability (C) Signup and view all the answers

What is the common presentation of a radial nerve injury?

Weakness of finger and wrist extensors (D) Signup and view all the answers

Which type of fracture involves the neck of the fifth metacarpal?

Boxer's fracture (A) Signup and view all the answers

What type of force is primarily responsible for a proximal humeral fracture in children involved in throwing sports?

Powerful medial rotation and adduction traction force (C) Signup and view all the answers

Which phase of throwing is most critical for the development of 'Little Leaguer's Shoulder'?

Deceleration phase (C) Signup and view all the answers

What is the main imaging finding associated with 'Little Leaguer's Shoulder'?

Widening of the growth plate (D) Signup and view all the answers

What age group is most likely to experience proximal humeral fractures due to osteoporosis?

Elderly individuals (D) Signup and view all the answers

Which complication is commonly associated with proximal humeral fractures in the elderly?

Rotator cuff tears (A) Signup and view all the answers

In young athletes, what is the primary aspect of rehabilitation after a 'Little Leaguer's Shoulder' injury?

Improvement of ROM, strength, and endurance (B) Signup and view all the answers

What initial treatment method is recommended for a stable nondisplaced proximal humeral fracture?

Short-term immobilization using a sling (A) Signup and view all the answers

What is a significant risk when reintroducing throwing stress after an injury like 'Little Leaguer's Shoulder'?

Reinjury to the shoulder (A) Signup and view all the answers

What is the initial treatment for proximal humeral fractures in elderly individuals?

Period of immobilization followed by AAROM exercises (D) Signup and view all the answers

What is a common symptom of carpal tunnel syndrome?

Pain in the thumb (A), Thenar atrophy (C) Signup and view all the answers

Which test is used to assess the presence of Dupuytren's Contracture?

No specific test (B) Signup and view all the answers

What is the recommended initial treatment for a complete tear of the ulnar collateral ligament?

Surgical repair (D) Signup and view all the answers

What is the typical presentation of a Bennett's fracture?

Fracture-dislocation of the 1st CMC joint (C) Signup and view all the answers

Which statement accurately describes arthritis in relation to the hand?

Bouchard's nodes are associated with osteoarthritis (D) Signup and view all the answers

What is the treatment strategy for an undisplaced middle phalange fracture?

Buddy taping (B) Signup and view all the answers

Which nerve is typically affected by cubital tunnel syndrome?

Ulnar nerve (D) Signup and view all the answers

What is the primary complication associated with a scaphoid fracture?

Avascular necrosis (B) Signup and view all the answers

What is the first step in treating a boxer’s fracture?

Closed reduction and immobilization in flexion (A) Signup and view all the answers

Which anatomical structure is primarily affected in Gamekeeper's thumb?

Ulnar collateral ligament (C) Signup and view all the answers

What is a significant outcome of untreated thoracic outlet syndrome?

Compression of subclavian artery (B), Decreased blood flow to the forearm (D) Signup and view all the answers

What technique is commonly used to diagnose scapho-lunate dissociation?

X-ray evaluation (A) Signup and view all the answers

What is indicated by ventral intercalated segment instability (VISI)?

Lunato-triquetrum dissociation (C) Signup and view all the answers

What is a common presentation seen in radial nerve injury?

Weakness of wrist extensors (A) Signup and view all the answers

What is the common clinical presentation of a shoulder fracture?

Pain, swelling, and tenderness (D) Signup and view all the answers

What percentage of clavicle fractures occur from falls onto the shoulder?

87% (B) Signup and view all the answers

Which group of clavicle fractures is the most common?

Group I: middle 1/3rd (B) Signup and view all the answers

What is the typical treatment for a Grade I AC joint injury?

Sling for 5-7 days and NSAIDs (D) Signup and view all the answers

What type of trauma primarily causes a Grade III AC joint injury?

Direct trauma with complete displacement (A) Signup and view all the answers

What is a common risk for clavicle fractures regarding healing?

Delayed bone fusion (A) Signup and view all the answers

Which condition is associated with pain during certain arm movements and limited internal rotation?

Subacromial impingement (A) Signup and view all the answers

What is the primary symptom of a rotator cuff tear in older individuals?

Chronic pain (C) Signup and view all the answers

Deltoid and trapezius attachments are damaged in which grade of AC joint injury?

Grade III (A) Signup and view all the answers

What is the common method for treating mallet finger?

Splinting for 8 weeks (D) Signup and view all the answers

Which symptom is a defining characteristic of pronator teres syndrome?

Weakness in the thumb and fingers (C) Signup and view all the answers

What is a common complication associated with delayed healing of clavicle fractures?

Nonunion or malunion (D) Signup and view all the answers

What kind of injury involves forced passive extension of the finger?

Jersey finger (B) Signup and view all the answers

What special test is used for assessing subacromial impingement?

Neer impingement test (D) Signup and view all the answers

What mechanical force is primarily responsible for 'Little Leaguer’s Shoulder' injuries?

Powerful medial rotation and adduction traction force (B) Signup and view all the answers

What is a potential complication of a proximal humeral fracture in elderly individuals?

Rotator cuff tears (C) Signup and view all the answers

Which age group is most likely to be affected by proximal humeral fractures due to osteoporosis?

Elderly individuals over 65 (B) Signup and view all the answers

During which phase of throwing does 'Little Leaguer's Shoulder' usually develop?

Deceleration phase (B) Signup and view all the answers

What is considered an essential part of rehabilitation for young athletes recovering from 'Little Leaguer's Shoulder'?

Gradual reintroduction of throwing stress (B) Signup and view all the answers

What imaging finding is characteristic of 'Little Leaguer's Shoulder'?

Widening of the growth plate (B) Signup and view all the answers

In elderly patients, what is the recommended initial immobilization period for stable nondisplaced proximal humeral fractures?

2 weeks (B) Signup and view all the answers

What rehabilitation goals should be prioritized after a proximal humeral fracture has healed?

Restore range of motion, strength, endurance, and proprioception (C) Signup and view all the answers

What type of fracture classification is commonly seen in 'Little Leaguer's Shoulder'?

Salter Harris Type I or II (C) Signup and view all the answers

What is the primary symptom associated with degenerative tears?

Pain and clicking (C) Signup and view all the answers

What does Phalen’s test specifically assess?

Carpal tunnel syndrome (D) Signup and view all the answers

What is the typical treatment for a complete tear of the ulnar collateral ligament?

Surgical repair (C) Signup and view all the answers

What is associated with Dupuytren’s Contracture?

Contracture of palmar fascia (A) Signup and view all the answers

What is the recommended treatment for a boxer’s fracture?

Closed reduction and immobilization in flexion (B) Signup and view all the answers

What is a common complication of Bennet’s fracture?

Articular incongruity (C) Signup and view all the answers

What does Gamekeeper's Thumb result from?

Tear of ulnar collateral ligament (A) Signup and view all the answers

Which of the following is a common symptom of subacromial impingement?

Pain with movement of the anterior deltoid (D) Signup and view all the answers

What is the main treatment approach for Grade III AC joint injuries?

Surgical intervention (C) Signup and view all the answers

What is the most common missed fracture on radiograph?

Scaphoid fracture (B) Signup and view all the answers

What is the primary purpose of the CMC Grind Test?

To assess osteoarthritis (B) Signup and view all the answers

What is the typical healing duration for scapular fractures?

4-6 weeks (A) Signup and view all the answers

What anatomical structure is involved in thoracic outlet syndrome?

Brachial plexus and subclavian artery (B) Signup and view all the answers

In which demographic is pronator teres syndrome most commonly observed?

Office workers and musicians (D) Signup and view all the answers

What is a key finding in a patient with anterior interosseous nerve entrapment?

Inability to perform the OK sign (D) Signup and view all the answers

What characterizes Dorsal intercalated segment instability (DISI)?

Scapho-lunate dissociation (A) Signup and view all the answers

What injury mechanism is commonly associated with mallet finger?

Sudden passive forced flexion of the finger (C) Signup and view all the answers

What is typically seen in Heberden's nodes?

Bony enlargements at the DIP joints (C) Signup and view all the answers

What condition can lead to weakness of pinch due to a neglected tear?

Gamekeeper's Thumb (B) Signup and view all the answers

What condition primarily affects the APL and EPB tendons?

Dequervain's syndrome (C) Signup and view all the answers

Which muscle is typically affected by radial tunnel syndrome?

Brachioradialis (D) Signup and view all the answers

In a typical case of jersey finger, which tendon is primarily injured?

Flexor digitorum profundus (D) Signup and view all the answers

What is a peculiar symptom of posterior interosseous nerve syndrome?

Weakness of the finger extensors (D) Signup and view all the answers

What is the common treatment for IP collateral injuries?

Immobilization in extension for 3 weeks (A) Signup and view all the answers

What is a typical finding in rotator cuff tear among older patients?

Chronic full-thickness tears that are often irreparable (A) Signup and view all the answers

Study Notes

Proximal Humeral Fracture

Little Leaguer's Shoulder: A stress fracture at the proximal humeral growth plate, usually caused by powerful medial rotation and adduction forces during throwing motions.
Elderly Fractures: Commonly occur in individuals with osteoporosis, often from minimal trauma like a fall. Most are non-displaced.
Fracture Patterns: Displaced or nondisplaced, involving the surgical neck.
Treatments: Non-displaced fractures are typically treated conservatively; displaced fractures might require surgical intervention (e.g., ORIF, hemi-arthroplasty, TSA). Initial period of immobilization (sling) may be recommended for 2 weeks for stable, non-displaced fractures, increasing to 4 weeks for unstable fractures. Rehabilitation focuses on restoring range of motion (ROM), strength, endurance, and proprioception. Introducing stress back into the process, like throwing, needs careful management. Possible complications include rotator cuff tears, axillary nerve damage, and stiffness.

Clavicle Fractures

Cause: Direct blow to the shoulder from a fall, or impact, such as in a tackle in football. Falls onto the shoulder are the most common cause.
Incidence: Most common fracture of the shoulder girdle. Highest incidence among children and adolescents.
Classification: Grouped based on location (middle 1/3, distal 1/3, medial 1/3).
Additional details: 87% occur from falls onto the shoulder, 7% direct impact, 6% FOOSH. Healing time ranges from 6-9 weeks in children, to 8-12 weeks in adults.

ACJ Pathology/Sprains

Types: Grade I (sprain, no dislocation), Grade II (AC ligament tear and CCL sprain, mild dislocation), Grade III (AC and CC ligament tear, true dislocation).
Grade I Treatment: Sling for 5-7 days, NSAIDs and physical therapy for 1-2 weeks.
Grade II Treatment: Sling for 2 weeks, NSAIDs and physical therapy for 3 weeks.
Grade III Treatment: Sling for 4-6 weeks, NSAIDs and physical therapy for 6-8 weeks. Goal of treatment is to minimize nonunion and malunion.

Scapular Fractures

Prevalence: Account for 1% of all fractures, 5% of shoulder fractures.
Cause: Usually a direct blow and/or fall onto the scapula in activities like a contact sport.
Additional details: 1% of all fractures and 5% of shoulder fractures; commonly treated nonoperatively with 7-10 days of sling immobilization and then PROM/AAROM exercises progressing to strengthening, once sufficient radiographic healing is confirmed.

Subacromial Impingement

Cause: Progressive orthopedic conditions due to biomechanical faults or structural abnormalities (acromion shape).
Symptoms: Night pain, pain with movement (anterior/lateral deltoid/arm), loss of GH IR, painful arc, tender points over rotator cuff tendons.
Treatment: Typically non-operative with 7-10 days of sling immobilization and then PROM/AAROM exercises progressing to strengthening, once sufficient radiographic healing is confirmed.
Additional details: often treated with rest and rehabilitation.

Rotator Cuff Tear

Demographics: Most common in people 60-80+.
Symptoms: Pain, weakness in external rotation, and sometimes in lifting and reaching overhead.
Classification: Group I (chronic, > 60 yo), Group II (acute > 1 cm, chronic < 60 yo), Group III (tendinopathy, partial thickness, small < 1 cm full thickness).
Treatment: Varies depending on tear size and patient factors, can include conservative treatment (rest, activity modification, stretching, strengthening), or surgical repair.
Additional details: Partial thickness tears are more common than full thickness tears.

Internal (Posterior) Impingement

Cause: In overhead athletes, during AB/ER (cocking phase); impingement between the posterosuperior labrum and the undersurface of the supra/infraspinatus tendons.
Symptoms: Pain and/or instability that can manifest in the overhead athletes.
Additional details: Often involves repetitive overhead activities.

Painful Long Head of the Biceps

Cause: Often secondary condition to other problems like rotator cuff issues or instability; related to the biceps tendon attachments, possibly to the glenohumeral joint (GHJ) labrum.
Symptoms: Pain, and potential "Popeye" deformity.

Slap Tear

Types: Classified by location and degree of tear (Type I to IV).
Symptoms: Pain, sometimes accompanied by clicking/catching sensations during range of motion, potentially increased or decreased passive movements.
Treatment: May include conservative or surgical approaches, depending on the severity and other factors.

Bankart Tear

Cause: Often from an anterior shoulder dislocation resulting from a severe force onto the shoulder.
Classification: Determined by the extent of damage incurred.
Symptoms: Pain, clicking/snapping in the joint, and loss of motion.

Anterior Instability

Key Features: Assess for posterior capsule shortness, restricted GHJ posterior glide, and loss of IR ROM.
Cause: Repetitive overhead activities, leading to microtrauma or acute anterior dislocation.
Classification: Classified based on underlying causes and clinical presentation.
Symptoms: Can include pain, apprehension, and difficulty with certain activities (e.g., reaching overhead).

Multidirectional Instability

Cause: Classified into atraumatic or traumatic.
Symptoms: Various depending on patient and the underlying issue. May include shoulder clicking/catching.
Additional details: Usually in teenagers.

Adhesive Capsulitis

Demographics: More common in middle-aged women (40-60 years old), but it can occur in men and other age groups. Those with diabetes or thyroid issues are at higher risk.
Cause: Elevated cytokine levels, causing inflammation and scarring of the rotator cuff interval, superior GH ligament, and coracohumeral ligament.
Classification: Stages I (pre-adhesive), II (freezing), III (frozen), IV (thawing).
Additional details: Increases to 10-40% in patients with diabetes or thyroid dysfunction. Treatment includes various modalities (manual therapy, progressive loading) which can facilitate restoration of ROM, and other factors.

Distal Forearm Fracture

Colles Fracture: A distal radius break from fall onto outstretched hand.
Smith's Fracture: A distal radius break from fall onto backward-facing hand.
Treatments: Closed reduction, casts/splinting, and physical therapy (some non-displaced). ORIF (open reduction internal fixation) for complex/displaced fractures.

Monteggia Fracture/Dislocation

Cause: Hyperextension-pronation injury involving radial head dislocation and midshaft ulna fracture.
Assessment: High suspicion of radial nerve damage.
Treatment: Reduction and stabilization for alignment and recovery.

Fracture of Radius and Ulna

Direct/Indirect Injuries: Distinguish by location and force behind the injury.
Treatment: Reduction and stabilization for proper alignment and recovery.

Olecranon Fracture

Characteristics: Fracture of the olecranon process of the ulna; often caused by forceful contraction of the triceps (avulsion).

Distal Humerus Fracture

Cause: High-energy trauma (younger) vs. low energy trauma (older).
Types: Intra-articular and extra-articular.
Treatment: Varies dependent on specific fracture type and severity. Potentially ORIF.

Radial Head Fracture

Types: Classified by level and extent of displacement in the bone.
Treatment: Depends on the specific fracture type and severity (splinting, ORIF, arthroscopy).

Lateral Epicondylitis/Osis/Algia (Tennis Elbow)

Cause: Repetitive use of forearm/wrist extensor muscles; overuse.
Symptoms: Pain over the lateral epicondyle of the humerus, pain with forearm/wrist extensor use.
Treatment: Typically conservative (rest, activity modification, icing/heating, physical therapy).

Medial Epicondylitis/Osis/Algia (Golfers Elbow)

Cause: Repeated strain on forearm/wrist flexor muscles.
Symptoms: Pain along the medial epicondyle of the humerus, pain with flexor muscle use.
Treatment: Conservative interventions (rest, physical therapy, etc.).

Ulnar Collateral Ligament Tear

Cause: Trauma or repetitive use; activities straining the UCL.
Symptoms: Pain/instability of elbow/wrist.
Treatment: Varies, noninvasive or invasive depending on severity/location.

Ulnar Nerve Transposition

Cause: Repeated pressure on ulnar nerve from the elbow joint leading to compression.
Treatment: Surgical relocation of the ulnar nerve to reduce pressure.

Posterior Elbow Dislocation

Mechanism: Often due to fall on an outstretched hand.
Treatment: Closed reduction, immobilization (e.g., bracing, splinting).
Assessment: Evaluate ligaments, joint alignment, associated nerves & blood vessels.

Little League Elbow

Cause: Overuse injury affecting medial elbow in young throwers.
Features: Medial epicondyle growth plate widening.
Treatment: Rest, avoid throwing activities, and physical therapy.

Osteochondritis Dessicans (OCD)

Cause: Repetitive stress causing separation of cartilage from bone.
Features: Can appear in different locations within the joint.
Treatment: Non-operative or surgical, based on location and severity.

Bursitis

Features: Inflammation of bursa sac caused by injury or overuse.

Nursemaid's Elbow

Cause: Radial head subluxation from force on the humerus.
Treatment: Often non-surgical reduction in clinic.

Distal Biceps Tear

Cause: Either traumatic or degenerative process. May relate to overuse or sudden force.

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Description

This quiz explores the common types of proximal humeral fractures, including those related to Little Leaguer's Shoulder and elderly injuries. It also covers clavicle fractures, their causes, incidence, and classification methods. Test your understanding of treatment approaches and fracture patterns relevant to shoulder injuries.