Injuries of Clavicle, Shoulder and Arm MCQs

Answer- D. Four part Neer's classified proximal humerus fracture into 4 types, based on these four segments :

Clavicle fracture is commonly managed conservatively but in young female for cosmetic reasons, some surgeons prefer to perform plate fixation. But in case of young pregnant female, it is an absolute contraindication to operate any fracture in first trimester of pregnancy. Reference- Campbell operative procedure 13ᵗʰ edition, page-3054

Displacement and comminution have been shown to increase risk of non- union in nonoperative management. There are no significant differences between outcomes when using sling immobilization versus a figure-of-eight bandage. Reference- Fundamentals of Orthopaedics 1st edition, page no. 44

Falls after an electric shock/ epileptic fit or Extreme trauma can cause posterior shoulder dislocation. These etiologies are together called the triple E syndrome. Injury mechanism in electrical injury is similar to epileptic seizures, where the shoulder is forced to internal rotation, flexion and adduction. Classical deformity in posterior shoulder dislocation is adduction and internal rotation. This means that the patient will be unable to abduct or externally rotate his shoulder. Luxation erecta is another name for inferior dislocation of shoulder. Reference- The Shoulder volume 1, Charles A Rockwood, P 151

Patients with posterior shoulder dislocations are often overlooked as it is not associated with gross deformities or severe pain. Further posterior dislocation is also difficult to pick up on xrays. They usually present with a history of fall after electric shock, epileptic seizure or severe trauma. O/E, the shoulder would be locked in internal rotation and adduction and lack external rotation. Orthogonal radiographs (anterior-posterior and axillary lateral) are absolutely necessary for proper diagnosis. Posterior dislocation patients often have reverse Bankart and reverse Hill-Sachs lesions. Posterior dislocation is treated with closed reduction and immobilization Reference - Maheshwari Ortho 5 th edition page no 89

Abduction and external rotation is the position in which, most of the recurrent shoulder dislocations occur. For e.g. throwing a ball, playing a smash in badminton or volleyball, sleeping with hand under the head etc. Rarely a direct blow on the front of the shoulder can cause the head of the humerus to be pushed out posteriorly Reference - Essential Orthopaedics, Maheshwari, 5th ed. P 90

Shoulder impingement is treated conservatively in majority of the case. Surgical decompression is rarely indicated. Shoulder impingement results from compression of the rotator cuff between the Acromion process and the Humeral head. Supraspinatus us the most commonly affected tendon. Impingement can present with painful arc syndrome, where the initial 60 degrees and the final 60 degrees of shoulder abduction will be pain free. However the mid abduction i.e, between 60 and 120 degrees will be painful. Prolonged impingement can cause rotator cuff tears. The tests for impingement are - Neer's test and Hawkin's test. Reference: Miler's 8th Edition of Review of Orthopaedics, page no. 833

Global restriction of both active and passive movements of the shoulder is seen in post traumatic stiffness and adhesive capsulitis. In this patient the diagnosis is adhesive capsulitis because No history of trauma Normal x ray Presence of diabetes, which is the most important risk factor for adhesive capsulitis. Adhesive capsulitis is also called Periarthritis or Frozen shoulder It is an idiopathic condition characterized by global reduction in passive and active range of motion of shoulder due to fibrosis and adhesions in the capsule It is usually self limiting, but it takes a lot of time for that. It is usually treated conservatively with physiotherapy. Surgery is rarely indicated. Reference: Miler's 8th Edition of Review of Orthopaedics, page no. 858