Proximal Humeral and Clavicle Fractures Quiz

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Questions and Answers

What is a common symptom associated with degenerative tears?

Swelling in the wrist

Numbness in fingers

Reduced range of motion

Pain and clicking (correct)

What is the primary cause of a 'Little Leaguer's Shoulder' injury?

Age-related degeneration of cartilage

Overuse from running

Direct blow to the shoulder

Powerful medial rotation and adduction traction force (correct)

Which special test is specifically used for Carpal Tunnel Syndrome?

Phalen’s Test (correct)

Tinel’s Test

Finklestein’s Test

Ulnar Collateral Ligament Stress Test

What does imaging typically show in a proximal humeral fracture in young athletes?

Widening of the growth plate and demineralization Signup and view all the answers

What is the primary concern with a scaphoid fracture?

Poor blood supply to the area Signup and view all the answers

What is the recommended initial treatment for a proximal humeral fracture in the elderly?

Initial immobilization with a sling Signup and view all the answers

In the case of Dupuytren’s Contracture, what is a common treatment option?

Surgical removal of involved fascia Signup and view all the answers

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

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

What should be done for a displaced phalange fracture?

Surgical intervention or ORIF Signup and view all the answers

What complication can arise from a proximal humeral fracture?

Rotator cuff tears Signup and view all the answers

What condition is indicated by weakness of pinch following an untreated tear?

Gamekeeper’s thumb Signup and view all the answers

Which phase of throwing is most implicated in 'Little Leaguer's Shoulder' injuries?

Deceleration phase Signup and view all the answers

Which fracture is characterized by posterior angulation and depression of the metacarpal head?

Boxer’s fracture Signup and view all the answers

For which condition is the CMC Grind Test used?

Arthritis of the thumb Signup and view all the answers

What is a common presenting symptom of 'Little Leaguer's Shoulder'?

Acute shoulder pain during throwing Signup and view all the answers

What is a common treatment goal during rehabilitation for a proximal humeral fracture in young athletes?

Improve range of motion and strength Signup and view all the answers

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

Splint for 2-3 weeks Signup and view all the answers

Which is a common feature of arthritis affecting the PIP joint?

Bouchard's nodes Signup and view all the answers

What additional intervention is necessary when reintroducing stress after a proximal humeral fracture?

Gradual increase of throwing activities Signup and view all the answers

In elderly patients, what event commonly leads to proximal humeral fractures?

Falls from standing height or direct blows Signup and view all the answers

What is a potential complication of treating Bennet’s fracture improperly?

Articular incongruity leading to DJD Signup and view all the answers

How can an ulnar nerve entrapment in a valgus deformity be addressed?

Surgical intervention Signup and view all the answers

What is the most common reported fracture of the shoulder girdle?

Clavicle fracture Signup and view all the answers

What is the primary goal of treatment for clavicle fractures?

Minimize the risk of nonunion and malunion Signup and view all the answers

In which grade of ACJ pathology is there a true dislocation involving damage to the deltoid and trapezius attachments?

Grade III Signup and view all the answers

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

8-12 weeks Signup and view all the answers

Which of the following tests indicates positive signs of subacromial impingement?

Neer Impingement Test Signup and view all the answers

What movement is commonly painful when tested in cases of subacromial impingement?

Abduction Signup and view all the answers

What describes the mechanism of injury for mallet finger?

Sudden passive forced flexion Signup and view all the answers

Which grade of ACJ injury requires surgical treatment?

Grade III Signup and view all the answers

What is a common symptom associated with radial tunnel syndrome?

Pain with resisted supination Signup and view all the answers

What test is most indicative of a rotator cuff tear?

Jobe Empty Can Test Signup and view all the answers

What condition is characterized by an inability to make an 'OK' sign?

Anterior interosseous nerve entrapment Signup and view all the answers

Which of the following is NOT a classification for shoulder fractures?

Group III: proximal 1/3rd Signup and view all the answers

What is the first line treatment for Dequervain’s Syndrome?

Splinting Signup and view all the answers

Study Notes

Proximal Humeral Fracture

Fracture at the proximal humeral growth plate
Common in throwing sports, caused by forceful medial rotation and adduction
Salter Harris Type I or II stress fracture
Imaging shows growth plate widening and metaphyseal demineralization
Symptoms include acute shoulder pain, especially while throwing
Elderly patients often experience this fracture with minimal trauma, due to osteoporosis

Proximal Humeral Fracture in Elderly

Common in women, twice as much as men
Usually occurs with minimal trauma (e.g., falls)
Frequently non-displaced
Non-displaced fractures are often treated conservatively
Displaced or intra-articular fractures may require ORIF (open reduction and internal fixation), hemi-arthroplasty, or total shoulder arthroplasty

Clavicle Fractures

Most common shoulder girdle fracture
Usually caused by a direct blow or fall onto the affected shoulder (e.g., football tackle)
Most common in children and adolescents (often from falls)
87% occur from falls onto the shoulder, 7% from direct impact.
6% from falls onto the forearm
Classified into three groups based on location (middle 1/3rd, distal 1/3rd, medial 1/3rd)

ACJ Pathology/Sprains (Acromioclavicular Joint)

Grade I: AC ligaments sprain, no displacement
Grade II: AC ligament tear, CCL ligament sprain, mild-moderate displacement
Grade III: AC and CCL ligament tears, true dislocation, damage to surrounding soft tissues

Scapular Fractures

1% of all fractures and 5% of shoulder fractures
Progressive conditions impacting biomechanics and structures.
Age group between 45-64.

Subacromial Impingement

Progressive condition related to biomechanical and structural issues
Can cause 44-65% of shoulder pain
Night pain or pain with arm movement (anterior/lateral deltoid)
Associated with loss of GH IR.
Can be diagnosed through physical exam and special tests

Rotator Cuff Tear

Affects a significant portion of individuals (20-28% aged 60-69, 31-41% >70, 51-62% >80)
Partial tears are more frequent than full thickness tears
May become symptomatic years after initial discovery
Screening for tears involves evaluating absence of night pain, painful arc, and impingement signs and symptoms

Internal (Posterior) Impingement

Impingement between the posterosuperior labrum, supra/infraspinatus tendons, and glenoid
Overhead athletes and individuals with scapular dyskinesia are at higher risk.
Symptoms may appear gradually or suddenly, associated with pain and functional limitations.

Painful Long Head of the Biceps

Biceps tendon instability, secondary to other conditions
Often from rotator cuff related pathology or instability
Tendinopathy: a common cause (less than 5% of cases are primary)
Scapular dyskinesia, GHJ hypermobility, or capsular inflammation may contribute.

SLAP Tear

Superior labral tear, anterior to posterior (10-2 o'clock position)
Typically associated with rotator cuff tears and other labral pathologies
Type I: often associated with other conditions, Type III/IV more associated with traumatic instabilities

Bankart Tear

Detachment of inferior labrum (3-7 o'clock)
Commonly from anterior shoulder dislocations

Anterior Instability

Results from repetitive overhead activities and microtraumatic events.
Often associated with posterior capsule shortness and restricted glenohumeral posterior glide.

Multidirectional Instability

Common in teenage females
Characterized by apprehension, posterior apprehension and hyperabduction.
Often repetitive overuse injuries in overhead athletes and individuals with scapulothoracic dyskinesia and proprioception deficits.

Adhesive Capsulitis

"Frozen shoulder" affecting 1% of general population, high prevalence between 40-60 years old
Related to inflammation and scarring of the rotator cuff interval
Primarily affects ER motion of the GHJ
Classified into 4 stages, progressing from mild synovitis to stiffness.

Distal Forearm Fracture

Dorsal fracture of distal radius (often with volar displacement)
Results from falls with wrist hyperextension and forearm supination.
Often treated with closed reduction and casting.

Colle's Fracture

A type of distal radius fracture
Commonly occurs from falling onto an outstretched hand with wrist extended.

Monteggia Fracture/Dislocation

Results from hyperextension/pronation injury
Associated with radial head dislocation and mid-shaft ulnar fracture.

Fractures of Radius and Ulna (Direct/Indirect)

Direct: transverse fracture at the same level on both bones
Indirect: spiral or oblique fractures at different levels on both bones

Olecranon Fracture

Common location - metaphyseal, epiphyseal or physeal
Fracture types- longitudinal, transerve or oblique
Often related to falls/high-energy trauma.

Distal Humerus Fracture

Commonly seen in high-energy trauma
Intercondylar fractures are common
Often non-displaced fractures in older population; displaced in younger
Neurovascular examination is essential.

Radial Head Fracture

Most common type of elbow fracture (1/3 of all elbow fractures)
Classified into three types (I, II, and III), based on displacement.

Posterior Elbow Dislocation

Second most commonly dislocated elbow joint
Often results from person-to-person contact, or direct blow to the posterior aspect
Neurovascular assessment is critical
Requires early reduction.

Lateral Epicondylitis (Tennis Elbow)

Common cause of elbow pain
Results from overuse of wrist extensors and repetitive strain

Medial Epicondylitis (Golfer's Elbow)

Pain over common flexor tendon
Common cause of elbow pain resulting from overuse of forearm flexor muscles.

Ulnar Collateral Ligament Tear

Common in throwing athletes
Can be caused by repetitive stress on the medial aspect of the elbow.

Ulnar Nerve Transposition

Often seen with repetitive pronation and supination of the forearm (e.g., in occupations using screwdrivers).

Other Pathologies

Mallet finger, jersey finger, IP collateral injury, Dequervain's syndrome, TFCC tear, and others (details of these other injuries are found in the OCR report)
Dupuytren's contracture is a thickening of the palmar fascia.

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Description

Test your knowledge on proximal humeral and clavicle fractures, their causes, symptoms, and treatment options. This quiz covers key concepts related to fractures in sports and the elderly. Understand the significance of growth plate injuries and common shoulder fractures.