2

Questions and Answers

Which surgical option involves transferring the coracoid process to enhance stability?

Coracoid process transfer to distal transfer (correct)

Primary Coracoclavicular Fixation

Distal Clavicle Excision

Primary AC joint fixation

What is a common procedure for addressing AC joint instability?

Primary AC joint fixation (correct)

Coracoclavicular ligament repair

Shoulder arthroscopy

Rotator cuff repair

Which of these is NOT a recognized surgical option for AC joint instability?

Distal Clavicle Excision with CC ligament reconstruction

Total shoulder replacement (correct)

Primary Coracoclavicular Fixation

Coracoid process transfer to distal transfer

The primary goal of Primary Coracoclavicular Fixation is to:

Reconstruct shoulder stability Signup and view all the answers

Which procedure focuses on the excision of the distal clavicle?

Distal Clavicle Excision with CC ligament reconstruction Signup and view all the answers

What does CC ligament reconstruction aim to support?

Coracoclavicular integrity Signup and view all the answers

In assessing treatment options for joint dislocation, which factor is crucial?

Mechanism of injury Signup and view all the answers

Which condition could be a result of AC joint dislocation?

Brachial plexus injuries Signup and view all the answers

Which of the following is typically prioritized before surgery in AC joint dislocation cases?

Diagnostic imaging Signup and view all the answers

Which symptom is commonly associated with AC joint dislocation?

Deformity at the shoulder Signup and view all the answers

Which surgical option primarily involves stabilization through fixation of the coracoclavicular ligaments?

Primary Coracoclavicular Fixation Signup and view all the answers

Which mechanism of injury is most likely to result in an acromioclavicular joint dislocation?

Direct fall onto the shoulder Signup and view all the answers

Which of these conditions is least likely to occur as a consequence of AC joint dislocation?

Sternoclavicular joint dislocation Signup and view all the answers

In evaluating a patient with suspected AC joint dislocation, which diagnostic tool is most effective?

X-ray imaging Signup and view all the answers

During surgical repair of AC joint instability, which technique involves removing a portion of the clavicle?

Distal Clavicle Excision with CC ligament reconstruction Signup and view all the answers

What common symptom might indicate an acromioclavicular joint dislocation?

Localized shoulder pain with deformity Signup and view all the answers

What is a distinctive feature of brachial plexus injuries compared to AC joint dislocation?

Loss of motor and sensory function in the arm Signup and view all the answers

Which of the following surgical options is fundamentally aimed at restoring function without transferring muscles?

Primary AC joint fixation Signup and view all the answers

Which risk factor most commonly contributes to clavicle fractures?

High-impact sports activities Signup and view all the answers

Which surgical procedure is considered most effective for chronic AC joint instability?

Distal Clavicle Excision with CC ligament reconstruction Signup and view all the answers

In cases of severe brachial plexus injury, consideration should be given to primary above-elbow amputation.

True Signup and view all the answers

Angiography of the limb is primarily used to repair clavicle fractures.

False Signup and view all the answers

The exploration of the brachial plexus is only necessary if the limb shows signs of vascular compromise.

False Signup and view all the answers

Most brachial plexus injuries result from direct trauma to the shoulder area.

True Signup and view all the answers

Management options for sternoclavicular joint dislocation generally do not include surgical intervention.

False Signup and view all the answers

An initial exploration of the brachial plexus can provide immediate insights into potential nerve damage.

True Signup and view all the answers

A common symptom of sternoclavicular joint dislocation is dyspnea.

True Signup and view all the answers

Direct injuries to the upper limb are more commonly associated with a 'fall on an outstretched hand' than indirect injuries.

False Signup and view all the answers

The brachial plexus originates from the thoracic spine.

False Signup and view all the answers

Limited range of motion is a complaint associated with clavicle fractures.

True Signup and view all the answers

A common mechanism of injury for sternoclavicular joint dislocation is a fall onto the wrist.

False Signup and view all the answers

The glenohumeral joint is involved in shoulder range of motion but is not reinforced by a joint capsule.

False Signup and view all the answers

A thorough distal neurovascular exam is essential for diagnosing a clavicle fracture.

True Signup and view all the answers

Sternoclavicular joint dislocation is completely unrelated to rib fractures.

False Signup and view all the answers

A fall on the outstretched hand is a common mechanism of injury leading to a clavicle fracture.

True Signup and view all the answers

Brachial plexus injuries are rarely associated with clavicle fractures.

False Signup and view all the answers

Comminuted fractures are a typical type of injury caused by a direct blow to the clavicle.

True Signup and view all the answers

Clinical evaluation alone is sufficient to diagnose a clavicle fracture without the need for radiographic examination.

False Signup and view all the answers

A severe injury to the brachial plexus always necessitates primary above-elbow amputation.

False Signup and view all the answers

Clavicle fractures are among the most frequently associated injuries with brachial plexus damage.

True Signup and view all the answers

Exploration of the brachial plexus is only required if no preceding bone injuries are present.

False Signup and view all the answers

The brachial plexus can be injured due to direct trauma from clavicle fractures.

True Signup and view all the answers

Amputation of the limb is the immediate response to any brachial plexus injury.

False Signup and view all the answers

The stability of the shoulder joint is rarely affected by injuries to the brachial plexus.

False Signup and view all the answers

A radial nerve injury resulting in wrist drop is commonly associated with fractures of the radius.

False Signup and view all the answers

Nerve conduction studies (NCS) and electromyography (EMG) are used as initial management for closed radial nerve injuries.

True Signup and view all the answers

Neuropraxia accounts for approximately 50% of radial nerve injuries associated with humeral fractures.

False Signup and view all the answers

Recovery from radial nerve injury can take as long as 18 months for full restoration of function.

False Signup and view all the answers

Immediate exploration and repair are indicated in cases of open fractures when radial nerve injury is present.

True Signup and view all the answers

Function restoration should be considered after 6 months if no recovery has occurred following a radial nerve injury.

False Signup and view all the answers

Sternoclavicular joint dislocation is commonly associated with rib fractures.

False Signup and view all the answers

A common mechanism of injury for sternoclavicular joint dislocation is falling onto the shoulder.

True Signup and view all the answers

Brachial plexus injuries can occur as a result of direct trauma to the shoulder area.

True Signup and view all the answers

Clavicle fractures are unlikely to be associated with brachial plexus damage.

False Signup and view all the answers

Direct injuries to the upper limb are more commonly associated with indirect mechanisms of injury than with falls.

False Signup and view all the answers

A thorough distal neurovascular exam is essential for diagnosing a clavicle fracture.

True Signup and view all the answers

Immediate exploration and repair are required for any brachial plexus injury.

False Signup and view all the answers

Recovery from a radial nerve injury can take up to 18 months for full restoration of function.

True Signup and view all the answers

Comminuted fractures are a common type of injury caused by indirect trauma to the clavicle.

False Signup and view all the answers

Neuropraxia accounts for the majority of radial nerve injuries associated with humeral fractures.

True Signup and view all the answers

Sternoclavicular joint dislocation can lead to respiratory difficulties.

True Signup and view all the answers

A common mechanism of injury for clavicle fractures is falling directly on the shoulder.

False Signup and view all the answers

Brachial plexus injuries frequently occur due to indirect trauma to the shoulder.

False Signup and view all the answers

Neuropraxia is a common type of injury resulting from a brachial plexus trauma.

True Signup and view all the answers

Exploration of the brachial plexus is justified only if vascular compromise is evident.

True Signup and view all the answers

Clavicle fractures are often accompanied by symptoms of limited range of motion.

True Signup and view all the answers

Amputation of the arm is the typical response to a brachial plexus injury.

False Signup and view all the answers

A fall on an outstretched hand is associated with an increased risk of clavicle fractures.

True Signup and view all the answers

Direct trauma to the upper limb is less likely to be associated with acromioclavicular joint dislocation.

False Signup and view all the answers

Immediate exploration and repair are required for all radial nerve injuries.

False Signup and view all the answers

What is the primary reason for performing Distal Clavicle Excision with CC ligament reconstruction?

To stabilize the acromioclavicular joint Signup and view all the answers

Which mechanism of injury is most often linked to sternoclavicular joint dislocation?

Direct blow to the shoulder Signup and view all the answers

In diagnosing a clavicle fracture, what is the most useful initial assessment tool?

Radiographic examination Signup and view all the answers

Which surgical option is focused on the dynamic stabilization of the AC joint through muscle transfer?

Coracoid process transfer to distal transfer Signup and view all the answers

What is a common symptom indicating a possible brachial plexus injury?

Loss of sensation in the hand Signup and view all the answers

Which condition is least likely to be a direct consequence of AC joint dislocation?

Wrist sprain Signup and view all the answers

When addressing a severe brachial plexus injury, what is the most appropriate immediate response?

Surgical exploration Signup and view all the answers

Which factor is critical to consider before proceeding with surgical options for AC joint instability?

Severity of the dislocation Signup and view all the answers

What typical symptom may suggest the presence of a clavicle fracture?

Intense pain at the joint Signup and view all the answers

In the context of brachial plexus injuries, which statement is true regarding recovery?

Recovery time typically exceeds 12 months for full restoration. Signup and view all the answers

What is the recommended timeframe for undertaking closed reduction in a posterior SC dislocation?

2-3 days post-injury Signup and view all the answers

What is a potential complication of a posterior SC dislocation?

Compression of large vessels Signup and view all the answers

Which management technique is typically implemented for a shoulder dislocation that remains symptomatic after initial conservative treatment?

Surgical intervention Signup and view all the answers

What immobilization method is generally used for majority unstable conditions following reduction?

Sling immobilization for 6 weeks Signup and view all the answers

Which of the following is NOT a treatment option for a posterior SC dislocation?

Physical therapy only Signup and view all the answers

What is the primary purpose of using a sling or figure-of-eight bandage in managing shoulder dislocation?

To maintain proper joint alignment Signup and view all the answers

What symptom is commonly associated with persistent posterior SC dislocation after initial treatment?

Decrease in shoulder mobility Signup and view all the answers

In which situation is surgical intervention most likely indicated following a shoulder dislocation?

After 2 weeks of conservative treatment failure Signup and view all the answers

What is the primary concern related to management of a posterior SC dislocation?

Maintaining blood circulation Signup and view all the answers

Why might a prolonged sling immobilization be necessary in shoulder dislocation cases?

To stabilize the joint during healing Signup and view all the answers

What is the primary nonoperative treatment option for acromioclavicular joint dislocation?

Application of a sling and harness Signup and view all the answers

Which surgical technique is considered most reliable for treating severe acromioclavicular joint dislocations?

Reduction and ligament reconstruction with tendon graft Signup and view all the answers

When considering treatment options for types III - VI acromioclavicular joint dislocation, which option is controversial?

Primary AC joint fixation Signup and view all the answers

Which of the following describes a nonoperative approach to managing acromioclavicular joint dislocation?

Conducting closed reduction followed by immobilization Signup and view all the answers

In what situation is excision of the distal clavicle indicated for acromioclavicular joint dislocation?

When there is chronic instability Signup and view all the answers

Which statement best describes the role of short-term sling usage in treating acromioclavicular joint dislocation?

It assists in maintaining reduction during healing Signup and view all the answers

What is the initial goal of operative treatment for severe acromioclavicular dislocations?

Stabilization of the joint through surgical fixation Signup and view all the answers

Which of the following is NOT a common treatment method for managing types III - VI acromioclavicular joint dislocations?

Rehabilitation exercises from the start Signup and view all the answers

What surgical procedure may be necessary for a limb that is flail?

Shoulder arthrodesis Signup and view all the answers

What management protocol should be followed for patients often polytraumatized with scapulothoracic dissociation?

ATLS protocols Signup and view all the answers

Which condition often necessitates radical intervention in managing severe brachial plexus injuries?

Primary above-elbow amputation Signup and view all the answers

Which mechanism of injury is commonly associated with shoulder injuries?

Fall on an outstretched hand Signup and view all the answers

What is a key characteristic of scapulothoracic dissociation in the context of trauma management?

Patients are often polytraumatized Signup and view all the answers

What is a surgical option for AC joint instability that involves the coracoid process?

Coracoid process transfer to distal transfer Signup and view all the answers

Which procedure aims to fix the acromioclavicular joint directly without transferring muscle?

Primary AC joint fixation Signup and view all the answers

What is the primary function of the CC ligament in shoulder mechanics?

To stabilize the acromioclavicular joint Signup and view all the answers

What surgical option involves excising part of the clavicle to relieve joint instability?

Distal Clavicle Excision with CC ligament reconstruction Signup and view all the answers

Which mechanism of injury is likely to result in an AC joint dislocation?

Direct trauma from a fall onto the shoulder Signup and view all the answers

Which of the following surgeries focuses on restoring the position of the clavicle to improve stability?

Coracoid process transfer to distal transfer Signup and view all the answers

What treatment option is designed to reinforce the coracoclavicular ligament's support?

Primary Coracoclavicular Fixation Signup and view all the answers

What does the stabilization technique of distal clavicle excision primarily address?

Acromioclavicular joint discomfort Signup and view all the answers

Which of the following methods would be least likely used for managing AC joint dislocation?

Conservative physical therapy Signup and view all the answers

In cases of AC joint dislocation, which fixation method is particularly effective in restoring anatomical alignment?

Primary AC joint fixation Signup and view all the answers

Which ligaments provide horizontal stability to the acromioclavicular joint?

Superior and inferior ac ligaments Signup and view all the answers

What does the presence of a 'step-off' indicate in an acromioclavicular joint dislocation?

Complete tear of acromioclavicular ligaments Signup and view all the answers

Which type of acromioclavicular joint dislocation involves less than 50% vertical displacement?

Type II Signup and view all the answers

Which type of acromioclavicular dislocation has the clavicle displaced posteriorly through the trapezius muscle?

Type IV Signup and view all the answers

What is the recommended treatment for Type I and Type II acromioclavicular injuries?

Nonoperative: ice and protection Signup and view all the answers

What anatomical structures are disrupted in a Type V acromioclavicular joint dislocation?

Both AC and CC ligaments Signup and view all the answers

Which of the following is a common associated injury with anterior shoulder dislocation?

Rotator cuff tear Signup and view all the answers

How much displacement occurs in the CC interspace during a Type III dislocation?

25-100% Signup and view all the answers

What is a potential complication of delayed reduction of an anterior shoulder dislocation?

Avascular necrosis of the humeral head Signup and view all the answers

What is the primary goal of the initial management of an anterior shoulder dislocation?

Immediate reduction of the dislocated shoulder Signup and view all the answers

What does a Type VI acromioclavicular dislocation entail regarding the clavicle's position?

Clavicle displaced inferior to the acromion Signup and view all the answers

Which muscles are typically detached in a Type V acromioclavicular dislocation?

Deltoid and trapezius muscles Signup and view all the answers

Which imaging modality is considered the best for evaluating associated soft-tissue pathology in shoulder dislocations?

MRI Signup and view all the answers

What is the primary stabilization role of the coracoclavicular ligaments?

Ensuring vertical stability to the acromioclavicular joint Signup and view all the answers

Which treatment technique involves controlling the scapula during reduction of shoulder dislocation?

Hippocrate's Method Signup and view all the answers

In older patients, what could indicate a serious injury following a shoulder dislocation?

Inability to lift the arm Signup and view all the answers

Which nerve is often affected in anterior shoulder dislocation leading to deltoid paralysis?

Axillary nerve Signup and view all the answers

What is the typical duration for immobilization after shoulder dislocation reduction?

3-4 weeks Signup and view all the answers

A Hill-Sachs Lesion is characterized by which type of injury?

Impression fracture of the humeral head Signup and view all the answers

The best approach for managing a bony Bankart lesion associated with anterior shoulder dislocation is:

Surgery for repair if significant Signup and view all the answers

What is a common consequence of delayed reduction in an anterior shoulder dislocation?

Avascular necrosis of the head of the humerus Signup and view all the answers

In cases of anterior shoulder dislocation, which imaging modality is considered best for evaluating associated soft-tissue injuries?

MRI Signup and view all the answers

How does immobilization in external rotation post-reduction benefit a patient's condition?

Ensures optimal positioning of the humeral head Signup and view all the answers

Which rotator cuff injury is particularly common in older patients with shoulder dislocation?

Subscapularis tear Signup and view all the answers

What is the primary reason for performing a detailed neurovascular exam in a patient with shoulder dislocation?

To assess potential vascular or nerve injury Signup and view all the answers

What anatomical structure is associated with the 'bony bankart' lesion?

Glenoid rim Signup and view all the answers

Which technique is NOT commonly used for the immediate reduction of shoulder dislocation?

Swan's method Signup and view all the answers

What characterizes a Hill-Sachs lesion?

Impression fracture of the humeral head Signup and view all the answers

Why are older patients particularly at risk for vascular injuries associated with shoulder dislocations?

Higher incidence of atherosclerosis Signup and view all the answers

What is the recurrency rate of anterior dislocation in patients over the age of 40?

10-15% Signup and view all the answers

What is the primary goal of nonoperative treatment for acromio-clavicular joint dislocation?

Reduce dislocation and maintain clavicle position Signup and view all the answers

Which treatment option is considered most reliable for types III - VI acromio-clavicular joint dislocations?

Tendon graft support for ligament reconstruction Signup and view all the answers

What is a key characteristic of operative treatment for acromio-clavicular joint injuries?

It includes methods like excision of the distal clavicle Signup and view all the answers

What common mechanism of injury often leads to acromio-clavicular joint dislocation?

A direct blow to the shoulder Signup and view all the answers

Which of the following is NOT typically included in the nonoperative treatment options for acromio-clavicular joint dislocation?

Corticosteroid injections Signup and view all the answers

In the context of joint dislocation treatment, which aspect is considered controversial?

Indication for surgical fixation Signup and view all the answers

Which ligament is primarily reconstructed in a surgical procedure for acromio-clavicular joint dislocations?

Coracoclavicular ligament Signup and view all the answers

Which nonoperative treatment option is aimed at maintaining the reduction of the clavicle in dislocations?

Application of a supportive harness Signup and view all the answers

What ligaments provide vertical stability in the acromio-clavicular joint?

Coracoclavicular ligaments Signup and view all the answers

What indicates a complete tear of AC ligaments during a physical exam?

Presence of 'step-off' Signup and view all the answers

Which type of acromio-clavicular joint dislocation involves a greater than 50% vertical displacement?

Type III Signup and view all the answers

What is the primary surgical concern with Type IV acromio-clavicular dislocation?

Displacement of the clavicle posteriorly Signup and view all the answers

Which types of acromio-clavicular joint dislocations are typically treated non-operatively?

Type I and Type II Signup and view all the answers

What characteristic is associated with Type V acromio-clavicular dislocation?

Clavicle displaced 100-300% Signup and view all the answers

In the context of shoulder anatomy, what role do the deltoid and trapezius muscles play in acromio-clavicular injuries?

Maintaining shoulder complex alignment Signup and view all the answers

What is a common mechanism of injury for acromio-clavicular joint damage?

Fall onto an outstretched hand Signup and view all the answers

Which treatment method is recommended for managing Types I and II acromio-clavicular joint injuries?

Ice and protection Signup and view all the answers

Which ligaments are predominantly affected in Type III acromio-clavicular joint dislocation?

AC and CC ligaments Signup and view all the answers

What is the potential consequence of a flail limb in shoulder injuries?

Need for shoulder arthrodesis or above-elbow amputation Signup and view all the answers

In cases of scapulothoracic dissociation, what must be considered during management?

The patient is often polytraumatized, requiring adherence to ATLS protocols Signup and view all the answers

Which structure is primarily evaluated in managing brachial plexus injuries?

Clavicle Signup and view all the answers

What mechanism of injury is most likely to affect the stability of the shoulder joint?

Direct trauma from a blunt object to the shoulder Signup and view all the answers

Which treatment option is most appropriate for severe injuries in the context of shoulder dislocations?

Surgical exploration and repair if indicated Signup and view all the answers

What is the main purpose of utilizing Primary AC joint fixation in surgical interventions?

To stabilize the AC joint by securing the clavicle Signup and view all the answers

Which surgical option best addresses the reconstruction of the coracoclavicular (CC) ligament in cases of AC joint instability?

Distal Clavicle Excision with CC ligament reconstruction Signup and view all the answers

What anatomical structure is primarily involved in the transfer during the Coracoid process transfer to distal transfer procedure?

Coracoid process Signup and view all the answers

Which surgical approach attempts to directly restore the structural integrity of both the acromioclavicular and coracoclavicular ligaments?

Primary Coracoclavicular Fixation Signup and view all the answers

When considering surgical options for AC joint instability, which procedure is more focused on addressing chronic cases rather than acute injuries?

Distal Clavicle Excision with CC ligament reconstruction Signup and view all the answers

Which of the following mechanisms is most likely to contribute to the need for surgical intervention for AC joint instability?

Direct trauma to the shoulder Signup and view all the answers

What is a significant reason for choosing to perform a Primary Coracoclavicular Fixation during surgery?

To secure the clavicle and cap the instability Signup and view all the answers

Which option would likely involve a dynamic muscle transfer to address instability in shoulder treatments?

Coracoid process transfer to distal transfer Signup and view all the answers

In the context of surgical options for AC joint injuries, which procedure is primarily aimed at immediate stabilization rather than reconstruction?

Primary AC joint fixation Signup and view all the answers

Shoulder arthrodesis is typically not indicated for flail limbs.

False Signup and view all the answers

Scapulothoracic dissociation often involves patients who are not polytraumatized.

False Signup and view all the answers

Above-elbow amputation is frequently considered in cases of severe brachial plexus injury.

True Signup and view all the answers

Complete tears of the AC ligaments will not show any 'step-off' in the AC joint.

False Signup and view all the answers

A fall on an outstretched hand is typically linked to clavicle fractures rather than direct trauma.

True Signup and view all the answers

Type V acromioclavicular joint injuries involve AC and CC ligaments disruption with a shoulder complex displaced inferiorly.

False Signup and view all the answers

The coracoclavicular ligaments are responsible for vertical stability of the AC joint.

True Signup and view all the answers

The brachial plexus is primarily located in the lumbar spine.

False Signup and view all the answers

Type III AC joint dislocations are characterized by AC ligaments being completely intact.

False Signup and view all the answers

Nonoperative treatment for Type I and II AC joint injuries can include ice and protection for 7 to 10 days.

True Signup and view all the answers

In a Type IV dislocation, the clavicle is displaced anteriorly through the trapezius muscle.

False Signup and view all the answers

A Hill-Sachs Lesion is an impression fracture of the humeral head associated with shoulder dislocations.

True Signup and view all the answers

The acromioclavicular joint can experience upward of 100% displacement in severe joint dislocations.

True Signup and view all the answers

A complete tear of coracoclavicular ligaments is a feature characteristic of Type I dislocations.

False Signup and view all the answers

The axillary nerve is primarily responsible for sensation over the lateral part of the shoulder and innervates the deltoid muscle.

True Signup and view all the answers

The deltoid and trapezius muscles are typically detached from the distal clavicle in Type VI injuries.

True Signup and view all the answers

Immediate reduction of an anterior shoulder dislocation should be performed within 48 hours to prevent avascular necrosis.

False Signup and view all the answers

Coracoclavicular ligament sprains can occur in Type II acromioclavicular joint injuries.

True Signup and view all the answers

Subscapularis tears are commonly associated with shoulder dislocation in older patients.

True Signup and view all the answers

MRI is the best modality to evaluate associated fractures following an anterior shoulder dislocation.

False Signup and view all the answers

The Stryker Notch View is specifically used to evaluate the bony bankart lesion during shoulder imaging.

True Signup and view all the answers

A gap palpated above the dislocated head of the humerus is indicative of a successful reduction.

False Signup and view all the answers

Vascular injuries following shoulder dislocation are more common in younger patients than in older patients.

False Signup and view all the answers

Heterotopic calcification previously referred to as myositis ossificans can occur as an early complication after shoulder dislocation.

False Signup and view all the answers

Recurrent dislocation of the shoulder is often linked to the patient's age and mechanism of injury.

True Signup and view all the answers

Nonoperative treatment for acromio-clavicular joint dislocation includes closed reduction and the application of a brace.

False Signup and view all the answers

The acromioclavicular joint is primarily stabilized by the rotator cuff muscles.

False Signup and view all the answers

Operative treatment for acromio-clavicular joint dislocation should always be the first option recommended.

False Signup and view all the answers

The acromio-clavicular joint can be treated effectively by excising the distal part of the clavicle.

True Signup and view all the answers

The brachial plexus is responsible for sensory and motor innervation of the upper limb.

True Signup and view all the answers

Comminuted fractures of the clavicle are considered a non-surgical injury.

False Signup and view all the answers

The primary technique for addressing acromio-clavicular dislocation involves reducing the dislocation followed by ligament reconstruction.

True Signup and view all the answers

A mechanism of injury commonly associated with AC joint dislocation is a direct blow to the shoulder.

True Signup and view all the answers

Brachial plexus injuries are typically a result of compression rather than direct trauma to the shoulder area.

False Signup and view all the answers

A common cause of sternoclavicular joint dislocation includes a fall onto the shoulder, not the wrist.

True Signup and view all the answers

Primary Coracoclavicular Fixation is aimed at restoring the integrity of the shoulder joint by reinforcing the acromioclavicular joint ligaments.

False Signup and view all the answers

Surgical reconstruction of the CC ligament is typically performed to address chronic AC joint instability.

True Signup and view all the answers

Primary fixation of the coracoclavicular ligament is an unquestionable elective procedure in all cases of joint dislocation.

False Signup and view all the answers

Limited range of motion is a potential symptom associated with injuries to the brachial plexus.

True Signup and view all the answers

Rotator cuff injuries can lead to decreased stability in the glenohumeral joint.

True Signup and view all the answers

In cases of brachial plexus injury, vascular compromise is not a concern.

False Signup and view all the answers

Immediate surgery is the standard treatment for all types of shoulder dislocations, including AC joint dislocations.

False Signup and view all the answers

A fall on an outstretched hand is a primary mechanism of injury for sternoclavicular joint dislocation.

True Signup and view all the answers

Nonoperative treatment for acromioclavicular joint dislocation includes short-term sling and early range of motion.

True Signup and view all the answers

Operative treatment options for acromioclavicular joint dislocation are universally accepted without controversy.

False Signup and view all the answers

The excision of the distal clavicle is a commonly employed method for treating AC joint dislocation.

True Signup and view all the answers

Reconstruction of the ligament is considered a reliable technique following dislocation of the acromioclavicular joint.

True Signup and view all the answers

Closed reduction and application of a harness is a form of conservative treatment for shoulder dislocations.

True Signup and view all the answers

Coracoclavicular ligament fixation is the least invasive surgical option for AC joint dislocation.

False Signup and view all the answers

A common treatment for types III - VI AC joint dislocation includes tendon graft support.

True Signup and view all the answers

Acromioclavicular joint dislocation treatment options do not involve any form of physical therapy.

False Signup and view all the answers

The acromioclavicular joint is located between the acromion and the clavicle.

True Signup and view all the answers

A common mechanism of injury for shoulder dislocations is a direct blow to the clavicle.

False Signup and view all the answers

Brachial plexus injuries can occur from both direct trauma and shoulder joint dislocation.

True Signup and view all the answers

Surgical intervention is never required in cases of AC joint dislocation.

False Signup and view all the answers

The coracoid process is involved in the stabilization of the shoulder joint.

True Signup and view all the answers

Distal clavicle excision is a procedure performed to treat some shoulder dislocations.

True Signup and view all the answers

Neuropraxia is a serious condition resulting in permanent nerve damage.

False Signup and view all the answers

Primary Coracoclavicular Fixation focuses on enhancing the stability of the acromioclavicular joint.

True Signup and view all the answers

A surgical option for AC joint instability involves the transfer of the distal clavicle to support the joint.

False Signup and view all the answers

The management of shoulder dislocations typically excludes any surgical options.

False Signup and view all the answers

The acromioclavicular joint relies on both superior/inferior and coracoclavicular ligaments for stability.

True Signup and view all the answers

A type IV acromioclavicular joint dislocation involves an intact coracoclavicular ligament.

False Signup and view all the answers

Treatment for Type I and Type II acromioclavicular joint dislocations typically involves surgery.

False Signup and view all the answers

A step-off deformity during examination suggests a partial tear of the acromioclavicular ligaments.

False Signup and view all the answers

The brachial plexus is primarily responsible for the motor and sensory functions of the upper limb.

True Signup and view all the answers

Type V acromioclavicular dislocation results in a complete separation between the clavicle and scapula.

True Signup and view all the answers

Coracoclavicular ligaments are only involved in horizontal stability of the acromioclavicular joint.

False Signup and view all the answers

Deltoid and trapezius muscles remain intact in Type III acromioclavicular joint dislocation.

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Vertical displacement of more than 50% characterizes Type II acromioclavicular joint dislocation.

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The stability of the shoulder is not significantly impacted by injuries to the brachial plexus.

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Shoulder arthrodesis may be necessary if the limb is flail.

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Scapulothoracic dissociation is typically diagnosed with clinical evaluation alone.

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The brachial plexus is primarily responsible for the motor control of the legs.

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A common mechanism of shoulder injury is a fall onto the wrist.

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In managing shoulder dislocations, following ATLS protocols is often unnecessary.

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A bony Bankart lesion is associated with glenoid rim fracture.

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Hill-Sachs lesion is characterized by an impression fracture on the humeral head.

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Rotator cuff tears are equally common in older and younger patients.

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Avascular necrosis of the humeral head can occur if a shoulder dislocation is not reduced in a timely manner.

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The axillary nerve is commonly affected by anterior shoulder dislocations.

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Immediate reduction of a dislocated shoulder should be performed within 48 hours to avoid complications.

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MRI is primarily used to evaluate associated fractures after a shoulder dislocation.

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Older patients often have an inability to lift their arm following a dislocation due to rotator cuff tears.

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An anterior shoulder dislocation can lead to recurrent dislocations especially in younger, high-demand individuals.

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The management of a shoulder dislocation typically involves immediate surgical intervention.

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Study Notes

Shoulder Injuries Overview

Majority of shoulder dislocations are unstable following surgical interventions; sling immobilization recommended for 6 weeks.
Persistent symptoms after conservative treatment may necessitate surgical options.

Posterior SC Dislocation

Rare incidence but potential for serious vascular compression.
Closed reduction recommended within 2-3 days post-injury, often coupled with sling or figure-of-eight bandage.
Avascular necrosis (AVN) occurrence ranges from 13-34%.

Proximal Humerus Fractures/Dislocations

Misdiagnosis often due to subtle degree of greater tuberosity displacement.
AVN is a significant complication in three- and four-part fractures.
Acromioclavicular (AC) joint injuries may require surgical repair of coracoclavicular (CC) ligaments with screws or sutures.

Acromioclavicular Joint Dislocation

Nonoperative management of displaced middle-third clavicle fractures results vary, with many patients experiencing significant functional impairments.

Associated Disabilities

Underestimated disabilities may occur in osteoporotic patients, including loss of motion and reduction.
Resultant complications include rotator cuff injuries, nerve damage (axillary, brachial plexus), AVN, or concurrent scapula and clavicle fractures.

Classification of Proximal Humerus Fractures

Neer classification outlines fractures:
- Two-part: anatomic neck or surgical neck
- Three-part: surgical neck plus either greater or lesser tuberosity
- Four-part: surgical neck plus both tuberosities and the head splits.

Radiographic Work-Up

Recommended imaging includes trauma series: true scapular AP, axillary views, and lateral views.
Additional imaging with CT scans for complex injuries, particularly helpful for 3D reconstructions.

Treatment Options for AC Joint Instability

Surgical interventions include:
- Coracoid process transfer (dynamic muscle transfer).
- Primary fixation of the AC joint and CC ligament.
- Distal clavicle excision coupled with ligament reconstruction.

Treatment for Types III - VI AC Joint Dislocations

Nonoperative: Closed reduction with sling and harness for clavicle support and early range of motion.
Operative treatments are contentious but may involve ligament reconstruction and tendon grafts.

Scapula Fractures

Typically associated with high-energy injuries, with complications like rib fractures or pneumothorax.
Diagnosis confirmed through radiographic studies, including scapula trauma series and CT scans for complex injuries.

Non-Operative and Operative Management of Scapula Fractures

Over 90% of scapular fractures are minimally displaced and treated conservatively in a sling for six weeks.
Follow-up X-rays every two weeks until six weeks; may take 6-12 months for full recovery.
Operative treatment indicated for articular fractures and significant displacement.

Closed Treatment Methods for Proximal Humerus

Techniques include sling application, hanging cast, or abduction pillow.
Closed treatment considerations vary with patient age and displacement severity.

General Anatomic Considerations

Shoulder anatomy includes key structures: sternum, clavicle, humerus, and scapula.
Important joints include SC, AC, GH joints, and the scapulothoracic joint for shoulder movement.
Muscles acting on the shoulder include rotator cuff components and primary shoulder movers.

Mechanisms of Upper Limb Injuries

Injuries most commonly arise from indirect trauma like falls on an outstretched hand.
Mechanism and resulting injury depend heavily on limb positioning during impact.

Radial Nerve Injury from Humeral Fractures

Found in 12% of humeral fractures, often resulting in wrist drop.
Distinguish between neuropraxia and laceration for management decisions.### Shoulder Dislocation Overview
Anterior shoulder dislocation often involves associated injuries such as bony Bankart lesions and Hill-Sachs lesions.
Common in older patients, where rotator cuff tears are prevalent following dislocation due to the "posterior mechanism" of shoulder instability.
Patients may present with an inability to lift the arm, requiring immediate assessment.

Clinical Presentation

Patients experience severe pain and hold the injured limb close to the trunk.
Typical position includes abduction of the shoulder and flexion at the elbow.
Physical examination reveals loss of shoulder contour, possibly with a visible anterior bulge of the humeral head, and a palpable gap above the dislocated humerus.
A thorough neurovascular examination is essential.

Imaging Techniques

Standard X-ray series include True AP, Axillary Lateral, Scapular Y, and Stryker Notch view for assessment.
CT scans are preferred for evaluating potential associated fractures.
MRI is best for assessing soft-tissue pathology, especially torn anterior labrum.

Management Strategies

Immediate reduction is critical to avoid avascular necrosis of the humeral head; techniques include Kocher’s, Hippocrate’s, Stimpson, and Milch methods.
Post-reduction imaging is mandatory to confirm proper alignment of the humeral head.
Following reduction, immobilization (3-4 weeks) in a collar and cuff is recommended, with the arm strapped to the trunk. External rotation during immobilization provides optimal outcome for anterior labrum reductions.

Associated Injuries

Bony injuries include Bankart and Hill-Sachs lesions, glenoid fractures, and greater tuberosity fractures.
Soft tissue injuries may comprise subscapularis tears and rotator cuff tears, particularly in older patients.
Potential vascular injuries include axillary artery damage, while nerve injuries may manifest as axillary nerve neuropraxia leading to deltoid paralysis.

Complications

Early complications include neurovascular injuries and axillary nerve injuries, while fractures of the neck of the humerus or tuberosities may occur.
Late complications are significant; they involve avascular necrosis, heterotopic calcification, and recurrent dislocations, with recurrence rates declining with age (80-92% in patients under 20 years, decreasing to 10-15% over 40).

Operative Treatments

Indications for surgery include irreducible shoulders, displaced greater tuberosity fractures, and significant glenoid rim fractures (greater than 5 mm).
Elective repairs are typically reserved for younger patients with recurrent instability.
Arthroscopic lavage remains a treatment option to remove hematoma and potentially reduce recurrence risk.

Acromioclavicular Joint Dislocation

Treatment options for Type III - VI dislocations include nonoperative methods like closed reduction and sling application.
Controversy exists regarding surgical options, which may include acromioclavicular fixation, coracoclavicular ligament fixation, or distal clavicle excision.

AC Joint Stability

The acromioclavicular joint relies on both superior/inferior acromioclavicular ligaments for horizontal stability and coracoclavicular ligaments for vertical stability.
Presence of "step-off" suggests complete disruption of acromioclavicular and partial coracoclavicular ligaments.

Acromioclavicular Joint Classification

Type I: Sprain of acromioclavicular ligament with joint intact.
Type II: AC joint disrupted with less than 50% vertical displacement.
Type III: All ligaments disrupted with obvious dislocation.
Type IV: AC joint dislocated with posterior displacement.
Type V: Complete disruption of AC and CC ligaments with significant disparity.
Type VI: Severe displacement below the acromion or coracoid.

Fractures of the Scapula

Scapulothoracic dissociation patients are usually polytraumatized, necessitating adherence to trauma protocols for optimal management.### Acromio-Clavicular Joint Dislocation
Horizontal stability is provided by the superior and inferior acromioclavicular (AC) ligaments.
Vertical stability comes from coracoclavicular ligaments.
Presence of “step-off” indicates a complete tear of AC ligaments and a partial tear of coracoclavicular ligaments.

Classification of AC Joint Dislocation

Type I:
- Sprain of acromioclavicular ligament.
- AC joint remains intact with coracoclavicular ligaments intact.
- Deltoid and trapezius muscles remain intact.
Type II:
- AC joint disrupted with less than 50% vertical displacement.
- Sprain of coracoclavicular ligaments with muscles intact.
Type III:
- Both AC and coracoclavicular ligaments disrupted.
- AC joint dislocated with shoulder complex inferiorly displaced.
- CC interspace significantly increased (25-100%).
Type IV:
- Disrupted AC and CC ligaments, clavicle displaced posteriorly through trapezius muscle.
- Deltoid and trapezius muscles detached from the distal clavicle.
Type V:
- Complete disruption of AC and CC ligaments.
- Severe displacement (100-300%) between clavicle and scapula.
- Muscles detached from distal half of the clavicle.
Type VI:
- Clavicle displaced inferior to either the acromion or coracoid process.
- Complete disruption of ligaments with muscle detachments.

Treatment Options for AC Joint Dislocation

Types I - II:
- Nonoperative: Ice and protection for 7-10 days until pain subsides.
Types III - VI:
- Nonoperative: Closed reduction with sling application to maintain clavicle reduction; short-term sling and early mobility.
- Operative: Techniques include primary fixation of AC joint or coracoclavicular ligaments, excision of distal clavicle, or ligament reconstruction with tendon graft.
- Controversial nature surrounding surgical treatment.

Surgical Options for AC Joint Instability

Coracoid process transfer as dynamic muscle transfer.
Primary fixation of AC and coracoclavicular joints.
Distal clavicle excision with reconstruction of CC ligaments.
In severe cases, shoulder arthrodesis or above-elbow amputation may be necessary.

Scapula Fractures and Management

Scapulothoracic dissociation is often associated with polytrauma; follow ATLS protocols.
May involve significant injuries such as glenoid rim fractures and rotator cuff tears.
Risk of "posterior mechanism" of instability in older patients.

Anterior Shoulder Dislocation - Clinical Picture

Patient experiences significant pain, holding the limb close to the trunk.
Shoulder presents as abducted with a flexed elbow; contour loss may appear as a step.
Palpable anterior bulge of the humeral head and gap above the dislocated head.

Anterior Shoulder Dislocation - Imaging

X-rays: shoulder trauma series includes True AP shoulder, Axillary Lateral, Scapular Y, and Stryker Notch View.
CT scan best for associated fractures; MRI suits evaluation of soft-tissue injuries like torn labrum.

Anterior Shoulder Dislocation - Management

Immediate reduction required within 24 hours to prevent avascular necrosis.
Techniques for reduction include Kocher’s, Hippocrates’, Stimpson, and Milch methods.
Post-reduction immobilization is crucial, strapped to the trunk for 3-4 weeks, preferably using external rotation.

Anterior Shoulder Dislocation - Associated Injuries

Bony: Bankart and Hill-Sachs lesions, glenoid or greater tuberosity fractures.
Soft tissue: Subscapularis tears and rotator cuff tears in older patients.
Vascular: Axillary artery injuries with atherosclerosis in older individuals.
Nerve: Axillary nerve neuropraxia can lead to deltoid paralysis.

Anterior Shoulder Dislocation - Complications

Early: Neurovascular injuries are rare; axillary nerve injuries may occur.
Late: High risk of avascular necrosis with delayed reduction, heterotopic calcification, and recurrent dislocations.
Recurrence rates vary significantly with age.

Anterior Shoulder Dislocation - Operative Treatment

Indications include irreducible dislocations and significant fractures.
Elective repairs typically for young patients; sometimes after a first-time dislocation in high-demand individuals.
Arthroscopic lavage may reduce recurrence risk post-dislocation.

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Test your knowledge on the treatment and assessment of proximal humerus fractures and dislocations. This quiz covers closed treatment methods, considerations for age, and displacement factors. Enhance your understanding of articular and glenoid fractures as well.