– See: Anterior Approach to the Humerus Axillary Approach: Posterior Approach Posterior Approach to Humerus Surgical Approach for Proximal Humeral Fractures Positioning and Draping: supine or beach chair; small soft bolster is placed beneath the shoulder blades to protract the shoulder; head is stabilized to prevent hyperextension and subsequent brachial plexus palsy; place patient in … Read more
– PreOp Planning: – consider NG tube and foley catheter; – have proper sized C-collar available for post operative care; – position: supine w/ halter cervical traction (3-5 lbs) w/ head turned slightly to the right; – consider placing a rolled towel between the … Read more
– See: Rotator Cuff Tear – Discussion: – see abductors of the shoulder; – common tendon covering top, front, & back of humeral head; – 4 muscles fuse to form this tendon: (subscapularis, supraspinatus,, infraspinatus, teres minor;) – supraspinatus – lies … Read more
– Discussion: – proximal humerus ossifies from four centers: head, shaft, and both tubercles, which unite at age 19 to 20; – frx in adult life tend to occur along old epiphyseal lines; – depression between tubercles, bicipital groove, contains long head of biceps; – tubercles also … Read more
Anatomy & Sites of Compression of Cubital Tunnel – Discussion: – cubital tunnel extends from medial epicondyle to olecranon; – it serves as the major contraint for the ulnar nerve as it passes behind the elbow; – w/ flexion the cubital tunnel becomes taunt, and with extension the cubital tunnel becomes lax; – aponeurotic roof … Read more
– vascular supply to the humeral head – Two Part Articular Segment Displacement: – fracture plane is through the anatomic (not surgical neck); – anatomic neck represents the old eiphyseal plate; – surgical neck represents the weakened area below the tuberosities and head approximately 2 cm distal to the … Read more
– RA criteria: (if 5 out of following are present for > 6 weeks); – morning stiffness; – pain on motion, or tenderness in at least one joint; – swelling (soft tissue thickening or fluid, not bony overgrowth alone) in at least one joint; – swelling of at … Read more
– Discussion: – anesthesia: insist on general anesthesia rather than regional anesthesia for the following reasons: – it is essential that the patient not move during delicate portions of the case; – it is often helpful to paralyze the patient during the fracture … Read more
– See: SC Joint Injury – Medial SC Joint Injury: – injury is due separation of proximal clavicular physis rather than dislocation; – need to determine if proximal clavicular metaphysis (distal fragment) is anterior or posterior; – anterior and superior displacement of medial end of clavicle or x-ray appearance … Read more
– Technique – decreases interscalene space by tensing anterior and middle scalenes; – arm of the affected side placed on the sitting patients thigh with forearm supinated; – turn head to the affected side; – extend neck and hold breath; – positive test is obliteration … Read more