Shoulder Flashcards Preview

Phase II: Musculoskeletal > Shoulder > Flashcards

Flashcards in Shoulder Deck (35):
1

What is the commonest cause of shoulder pain in people aged 10-30?

Instability ➔ dislocations

2

What is the commonest cause of shoulder pain in people aged 40-60?

Shoulder impingement syndrome

3

What is the commonest cause of shoulder pain in people aged 60+?

Osteoarthritis

4

Define shoulder instability

Inability to maintain the humeral head in the glenoid fossa during function, associated with symptoms e.g. stiffness or pain

5

Describe the pathophysiology of shoulder instability

  • Structural causes:
    • Damage after major injury
    • Structural deficit predisposing to instability following minor injury
  • Muscle imbalance

6

Outline the Stanmore classification of shoulder instability

7

Differentiate shoulder laxity from shoulder instability

  • Laxity:
    • Asymptomatic hypermobile joint
    • Maintains the humeral head in the glenoid fossa
  • Instability:
    • Symptomatic e.g. stiffness or pain
    • Inability to maintain the humeral head in the glenoid fossa

8

How can shoulder joint instability be assessed?

  • Beighton test: hyper mobility/laxity
  • Apprehension test: assess anterior dislocation on forced external rotation
  • Shoulder relocation test: performed after +ve apprehension test,
    • Apply posterior pressure on humeral head

9

Outline the treatment options for shoulder instability

  • Analgesia
  • Assessment and acute reduction
  • Encourage early mobilisation
  • I (traumatic): Surgery
  • II (atraumatic) or III (muscle patterning): Rehabilitation ± surgery

10

Define joint dislocation and subluxation

Dislocation: complete disruption of the joint

Subluxation: partial dislocation followed by relocation

11

Describe the different types of shoulder dislocations

  • Anterior dislocation (95%):
    • Sports-related (young)
    • Fall on outstretched hand (older)
  • Posterior dislocation (2-4%):
    • Seizures and electric shock
    • Can occur with fall on outstretched hand, or trauma to anterior shoulder
  • Inferior dislocation (0.5%): Traumatic injury pushing arm downwards.

12

Give three symptoms of shoulder dislocation

  • Severe shoulder pain
  • Limited motion of the shoulder
  • Shoulder bruising or abrasion
  • Swelling

13

What signs may be seen with shoulder dislocation?

  • Swelling
  • Loss of normal contour of the shoulder
  • Sulcus sign: inferior instability
  • Deltoid muscle wasting: axillary nerve impingement
  • Arterial injury

14

What is the Lightbulb sign in regards to the shoulder?

  • Abnormal AP radiograph appearance of the humeral head
  • Posterior shoulder dislocation
  • Appears due to internal rotation.

15

Which nerve is most commonly affected with shoulder dislocations?

Axillary nerve

16

Provide three injuries associated with a traumatic shoulder dislocation?

  • Bankart lesion (90%):
    • Detachment of glenoid labrum from its antero-inferior surface
  • Hill-Sach lesion (66%):
    • Postero-lateral humeral head compression fracture
    • Humeral head impacts the anterior glenoid
  • SLAP lesion (5-7%):
    • Superior labral tear where the long head of biceps tendon attaches
  • Fracture dislocation
  • Rotator cuff tear: more often in older patients
  • Nerve injury

17

What is the probability of reoccurrence for shoulder dislocations in <20s

90%

Decreases to 25% for people in their 30s

18

List three stabilising factors of the shoulder joint

  • Glenoid and glenoid labrum
  • Glenohumeral ligaments
  • Joint capsule
  • Rotator cuff muscles
  • Negative intraarticular pressure
  • Friction

19

Define shoulder impingement syndrome

  • Supraspinatus tendonitis/subacromial bursitis
  • Occurs on elevation or internally rotation of the humerus
  • At 60-120o of abduction

May cause bicips tendonitis and rupture

20

What special test is diagnostic of shoulder impingement on examination?

21

Describe the management options of shoulder impingement syndrome

  • Rest; avoid excessive aggrevation
  • Paracetamol ± NSAIDs or codiene
  • Physiotherapy: recover normal range of motion
  • Steroid injection
  • Operative treatment
    • Subacromial decompression
    • Anterior acromioplasty: may remove calcification in tendon

22

Define adhesive capsulitis of the shoulder

  • Significantly restricted active and passive movements of the shoulder
    • Characteristic impaired external rotation
  • May be primary (idiopathic) or secondary

23

Name two associations of secondary adhesive capsulitis

  • Trauma
  • Rotator cuff injury
  • Thyroid dysfunction
  • Diabetes mellitus: 20% will have an episode
  • Cardiovascular disease

24

Describe the illness course of adhesive capsulitis of the shoulder

Progression through three overlapping phases

  1. Painful: Progressive diffuse shoulder pain lasting weeks-months
  2. Stiffness: Reducing ROM up to 1 year; improving pain
  3. Resolution: Weeks-months of gradually improving ROM

25

What movement will rule out adhesive capsulitis as a differential diagnosis?

Normal external rotation

26

Name two differential diagnoses for adhesive capsulitis of the shoulder

  • Polymyalgia rheumatica: acute onset in limb girdle
  • Pancoast tumour: systemic features, hoarse voice
  • Posterior dislocation: seizures and electric shocks

27

Describe the management for adhesive capsulitis of the shoulder

  • Encourage arm movement; avoid aggravating movements
  • Paracetamol ± NSAIDs or codiene; hot packs
  • Physiotherapy
  • Intra-articular corticosteroid injection
  • Surgery
    • Manipulation under anaesthesia
    • Shoulder arthroscopy

28

What is Os Acromiale?

What is its significance?

  • Developmental defect: failure to fuse the acromial process
  • Usually asymptomatic
  • May cause secondary shoulder impingement syndrome

29

What special tests assess rotator cuff integrity?

  • Empty can test: supraspinatus (abduction)
  • Infraspinatus test: infraspinatus (external rotation)
  • Horn blowers test: teres minor (external rotation)
  • Gerber's lift off test: subscapularis (internal rotation)
  • Drop arm test: 2+ tendon tear; esp. supraspinatus

30

What test can assess for acromioclavicular joint disorder

Scarf test

31

Name two complications of a proximal humeral fracture

  • Mal-union/non-union of humeral fracture
  • Avascular necrosis
  • Screw penetration
  • Nerve damage: axillary commonest
  • Adhesive capsulitis
  • Post-traumatic arthritis

32

How does acromioclavicular osteoarthritis present?

  • Pinpoint tenderness/pain over acromioclavicular joint
  • Painful arc between 170-180 degrees
  • Positive Scarf test
  • Swelling; stiffness; crepitus

33

Describe the pathophysiology of rotator cuff tear arthropathy

  • Rotator cuff tear no longer holds the humeral head in the glenoid
  • Humerus displaces superiorly and moves against the acromion

34

Differentiate between glenohumeral and acromioclavicular osteoarthritis

  • GH:
    • Pain centred in the back of shoulder
    • May intensify with changes in weather
    • Complain of deep ache
  • AC:
    • Pinpoint pain across AC joint
    • May radiate to neck.

35

Outline the treatment options for arthritis of the shoulder

  • Rest, activity modification, ice
  • Physiotherapy
  • Paracetamol ± NSAIDs or codeine
  • Corticosteroid injections
  • Surgical
    • GH OA: Arthroscopy; Arthroplasty
    • AC OA: Acromioplasty/subacromial decompression