Orthopedics 5th year, 2nd lecture (Dr. Ariwan)

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The lecture has been given on Dec. 8th, 2010 by Dr. Ariwan.

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Orthopedics 5th year, 2nd lecture (Dr. Ariwan)

  1. 1. Shoulder instability <ul><li>Shoulder stability depends on ( muscular, ligamentous, bony ) factors. </li></ul><ul><li>Chronic instability may cause recurrent dislocation or subluxation . </li></ul><ul><li>95% are anterior; others are posterior or multidirectional. </li></ul>
  2. 2. Recurrent Anterior Shoulder Dislocation <ul><li>Recurrent anterior dislocation caused by minimal daily activities (abduction, external rotation). </li></ul>
  3. 3. Pathology <ul><li>Usually follow traumatic anterior dislocation. </li></ul><ul><li>Glenoid labrum and capsule are avulsed anteriorely ( BANKART LESION ). </li></ul><ul><li>Stretched capsule anteriorely. </li></ul><ul><li>Indentation on the posterolateral surface of the femoral head ( HILL-SACHS LESION ). </li></ul>
  4. 4. Clinical features <ul><li>Usually the patient is a young man. </li></ul><ul><li>Previous history of acute dislocation that’s reduced and immobilized for a period; others have no traumatic dislocation. </li></ul><ul><li>Minimal daily activities which put the arm in abduction, extension, external rotation easily dislocate the joint (Throwing a ball, Serving at tennis, Swimming). </li></ul>
  5. 5. Examination <ul><ul><li>At dislocation {Arm held by the other hand, flattened lateral shoulder, and bulging of humeral head anteriorely}. </li></ul></ul><ul><ul><li>Between attacks { Apprehension test, Drawer test , Test for ligament laxity }. </li></ul></ul>
  6. 6. Investigations <ul><li>Clinical Diagnoses </li></ul><ul><li>Plain X-ray : AP- in internal rotation Hill-Sachs lesion. </li></ul><ul><li>CT- scan shows bony defect or laberal avulsion. </li></ul><ul><li>Arthroscopy : show laberal tear & for treatment. </li></ul>
  7. 7. Treatment <ul><li>Conservative : If infrequent, modification of activities. </li></ul><ul><li>Operative: Frequent painful dislocation or subluxation: </li></ul><ul><li>BANKART OPERATION: reattachment of avulsed labrum and capsule anteriorely (open or arthroscopic). </li></ul>
  8. 8. <ul><li>PUTTI- PLATT OPERATION: shortening the capsule and subscapulares by an overlapping repair (double breast). </li></ul><ul><li>BRISTOW OPERATION: Re- attaches the tip of coracoid process and attached muscles to glenoid anteriorely. </li></ul>
  9. 9. Orthopedic Problems of The Elbow <ul><li>Congenital radial head dislocation </li></ul><ul><li>Usually bilateral, part of other congenital anomalies. </li></ul><ul><li>Lump present in front of the joint, limit elbow flexion. </li></ul><ul><li>Commonly function is not severely affected. </li></ul>
  10. 10. <ul><li>X-ray shoes dome shaped radial head. </li></ul><ul><li>If sever limitation of elbow flexion excise radial head after skeletal maturity. </li></ul>
  11. 11. Cubitus Varus ( Gun- Stock Deformity) <ul><li>The forearm deviated medially over the arm. </li></ul><ul><li>Deformity most obvious when the elbow extended and the am abducted by the side . </li></ul>
  12. 12. <ul><li>Most common cause is malunited supracondylar facture in childhood. </li></ul><ul><li>Most of the time function is not affected. </li></ul><ul><li>If severe correct it by supracondylar valgus Osteotomy (lateral closing wedge). </li></ul>

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