xray

NHx

Convincing association with development of osteoarthritis

- arthritic changes beginning at radial styloid

- progress to scaphocapitate & capitolunate 

Nalebuff Classification

Type I - Boutonniere 

- commonest

- MP flexion /  IP hyperextension

- usually EPB rupture with EPL subluxation

Type II

- Boutonniere & Swan Neck

- doesn't exist according to Nalebuff

Conditions

1.  PIPJ Synovitis

- synovectomy via dorsomedial approach

2.  Flexor tenosynovitis

- may cause trigger finger

- trial HCLA

- remove synovits but don't release A1 pulley

- will worsen ulna drift

3.  DIPJ

- rarely affects

Definition

Scapho-lunate advanced collapse

- caused by malalignment of scaphoid on radius

- due to scapholunate disruption

Most common cause of wrist OA

Pathology

1.  Radio-scaphoid degenerative changes

- from abnormal flexion of scaphoid

Definitions

Massive tear 

1.  > 5cm 

- retracted to humerus / glenoid margin

2.  At least 2 complete tendons

- lose SS / IS or SS / SC

Classification

Epidemiology

Rare 

- 2% of acute dislocations

Often missed

- < 1/ 52 25%

- < 6/52 25%

- < 6/12 25%

- > 6/12 25%

Aetiology

Epidemiology

Traumatic initial cause in 95%

M:F 2:1

Age of initial dislocation inversely related to recurrence rate

- patients younger than 20 have a redislocation rate of 90%

- between 20 - 40 years, redislocation rate of 60%

- patients > 40 years have a 10% rate of dislocation but a higher rate of cuff tears (up to 40% in patients > 60yrs)

Anatomy & Stability

1. Passive Stabilisers

Epidemiology

Most common form of shoulder instability

- young males 

- M:F = 2:1

Aetiology

Indirect ER and abduction moment on arm

- disruption of anterior stabilisers

History

Initial injury

- severe pain in shoulder

Aetiology

Post-traumatic (type III clavicle fractures)

Idiopathic

4 patterns 

1. OA with osteophytes 

-  contribute to impingement

2. Osteolysis with resorption & gross osteoporosis 

Definition

Injury to ulnar collateral ligament of thumb MCPJ

Aetiology

Initial description

- chronic laxity of British gamekeeper's thumb's 

- no specific trauma

- secondary to breaking pheasant's neck

Acute trauma

- snow ski

- ball games

Valgus / forced abduction

Anatomy

UCL