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MSK Week 5 2017/18 > 3: Shoulder pathologies and upper limb nerve entrapment > Flashcards

3: Shoulder pathologies and upper limb nerve entrapment Flashcards

1
Q

What are five common shoulder pathologies?

A

Instability

Cuff impingement

Cuff tear

Frozen shoulder

Arthritis

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2
Q

What shoulder pathology do patients tend to get in their 20-30s?

A

Instability

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3
Q

What shoulder pathology do patients tend to get in their 30-40s?

A

Impingement

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4
Q

What shoulder pathology do patients tend to get in their 60s onwards?

A

Arthritis

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5
Q

The shoulder joint is the most ___ joint in the body.

A

mobile

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6
Q

Is the shoulder joint stable?

A

In terms of bones, no

But muscles provide a lot of stability

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7
Q

Which four joints make up the shoulder girdle?

A

Sternoclavicular

Acromioclavicular

Scapulothoracic (not a real joint)

Glenohumeral

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8
Q

What is a static stabiliser of the shoulder found in the glenoid fossa?

A

Labrum

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9
Q

What are the four rotator cuff muscles?

What movements are they responsible for?

A

Supraspinatus - first 15 degrees of abduction

Infraspinatus - external rotation

Teres minor - adduction and internal rotation

Subscapularis - adduction and internal rotation

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10
Q

What are the four extrinsic muscles of the shoulder?

A

Deltoid

Trapezium

Pec major

Latissimus dorsi

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11
Q

What are the six movements performed at the shoulder?

A

Flexion / extension

Internal / external rotation

Abduction / adduction

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12
Q

What type of patient tends to get shoulder instability?

A

Teenagers - 30s

Sporty

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13
Q

What is the usual mechanism of shoulder instability?

A

Trauma causing subluxation / dislocation

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14
Q

(Anterior / posterior) dislocations are the most common.

A

Anterior

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15
Q

What are some unusual causes of posterior dislocation?

A

Seizures

Electrocution

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16
Q

What is a sign of dislocation on X-ray?

A

Increased space between humeral head and glenoid

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17
Q

What is a long-term consequence of shoulder instability?

A

Recurrent subluxations/dislocations

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18
Q

Shoulder instability can be caused by ligamentous laxity - in which diseases is this seen?

A

Ehlers-Danlos syndrome

Marfan’s syndrome

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19
Q

Which sign of shoulder instability may be seen on examination?

What is this caused by?

A

Sulcus sign

Inferior instability of shoulder joint

think posterior dislocation (not common)

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20
Q

How is an acute shoulder dislocation treated?

A

Analgesia

Oxygen

Sedation

REDUCTION BY MANIPULATION

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21
Q

What methods can be used to reduce a shoulder dislocation?

A

Kocher method

Hippocratic method

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22
Q

How is a shoulder dislocation treated post-reduction?

A

Sling

Analgesia

Movement - physiotherapy

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23
Q

What imaging is used to visualise shoulder dislocations?

A

X-rays (AP)

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24
Q

If a patient is having recurrent shoulder dislocation, what imaging method is used to investigate?

A

MRI

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25
Q

What is a Bankart lesion?

Why is MRI used to identify it?

A

Tear in labrum which shoulder can dislocate into repeatedly

Soft tissue lesion - labral tear

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26
Q

What is a Hill Sachs lesion?

A

Fracture in humeral head which may predispose to recurrent dislocation

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27
Q

All patients with shoulder instability receive ___.

A

physiotherapy

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28
Q

Is shoulder instability operated on?

A

No

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29
Q

The risk of recurrent shoulder dislocation (increases / decreases) with age.

A

decreases

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30
Q

How long should patients wait before they get back to contact sports following a shoulder dislocation?

A

6 months

31
Q

Impingement syndrome pain originates from the ___ ___.

A

subacromial space

32
Q

Impingement can be either ___ or ___.

A

intrinsic - problem with rotator cuff muscles themselves

extrinsic - pressure from elsewhere

33
Q

What are some possible rotator cuff pathologies causing impingement syndrome?

A

Tendonitis (+/- calcinosis)

Bursitis

Cuff tear

34
Q

Many cuff tears are ___.

A

asymptomatic

35
Q

Inability to REACH/STRETCH to pick up things is a typical presentation of what?

A

Impingement syndrome

Polymyositis

36
Q

Painful arc syndrome is a type of rotator cuff ___.

A

impingement

37
Q

What test can be used to diagnose impingement?

A

Hawkins-Kennedy test

Painful arc on abduction

38
Q

What is seen on X-ray of a patient with impingement syndrome?

A

Calcification of humeral head, subacromial space

39
Q

What other scans can be used in patients with impingement?

A

Ultrasound

MRI

both show soft tissue swelling, fluid, muscle damage

40
Q

How is impingement syndrome treated?

A

Rest

Analgesia

Physiotherapy

2x steroid injections in subacromial space

41
Q

What is removed in decompression surgery for shoulder impingement?

A

Subacromial bursae

Bits of acromion

CA ligament

42
Q

What is a major symptom following shoulder surgery for impingement?

A

Pain

43
Q

Gray hair = ___ ___.

A

cuff tear

44
Q

Who tends to get rotator cuff tears?

A

Older patients (50s-60s)

45
Q

Most rotator cuff tears are (acute / chronic).

A

chronic

46
Q

People with rotator cuff tears complain of ___ and ___.

A

weakness

pain

47
Q

What may be seen on examination of someone with a rotator cuff tear?

A

Muscle wasting

Weakness (reduced passive movement, normal active movement)

48
Q

What is reduced in the X-ray of someone with a rotator cuff tear?

A

Subacromial space

49
Q

What bony landmark of the humerus is reduced in patients with rotator cuff tears?

A

Greater tuberosity

50
Q

Apart from X-ray, what imaging can be used to view rotator cuff tears?

A

MRI

51
Q

How are rotator cuff tears treated?

A

Rest

Analgesia

Sling

PHYSIOOOOO

surgery if required

52
Q

Why are acute rotator cuff tears treated more urgently than chronic ones?

A

Shoulder function may be preserved with treatment

53
Q

Is there any difference in outcome between keyhole and open shoulder surgery?

A

No

54
Q

How long do people with rotator cuff injuries spend recovering compared to those with impingement?

A

Longer

55
Q

What is the likelihood of a repaired rotator cuff muscle re-tearing?

A

30-40%

56
Q

Who tends to get frozen shoulders?

A

Females aged 40-50

57
Q

What conditions are associated with frozen shoulder?

A

Diabetes

Endocrine disease

Lipid disease

Dupuytren’s

58
Q

What contracts and thickens in frozen shoulder?

A

Gleno-humeral ligament

reduces joint space, eventually causing synovitis

59
Q

What is the natural progression of frozen shoulder?

A

Freezing (0-6 months, pain disrupting sleep and daily life)

Frozen (less pain, moreso stiffness)

Thawing (movement returns)

60
Q

How long does frozen shoulder take to resolve?

A

3-4 years

61
Q

What MUST be obtained before you can diagnose a patient with frozen shoulder?

Why?

A

X-ray

OA and locked posterior dislocation also limit external rotation

62
Q

Apart from the generic rest, analgesia, physio treatment, what non-operative treatment is available for frozen shoulder?

A

Fluroscopic something

popping capsule with air

63
Q

Frozen shoulder has a (sudden / gradual) onset.

A

sudden

64
Q

The likely shoulder pathology in those over 60 is…

A

arthritis

65
Q

What kinds of arthritis can affect the shoulder?

A

OA

RA

Post-traumatic arthritis

66
Q

Glenohumeral joint arthritis sets in (acutely / chronically) and causes what kind of pain?

A

chronic

Pain at rest and at night

67
Q

Arthritic GH joints will also be ___.

A

stiff

68
Q

What are the four signs of GH joint OA on X-ray?

A

Loss of joint space

Osteophytes

Sclerosis

Subchondral cysts

69
Q

How is GH joint RA treated?

A

Analgesia

Physiotherapy

Steroid injections

+/- DMARDS, Biologics

70
Q

What is the operative route for treating GH joint arthritis?

A

Total shoulder replacement or arthroplasty e.g resurfacing, partial replacement

71
Q

In which neuropathy is the

a) median nerve
b) ulnar nerve

compressed?

A

a) Carpal tunnel

b) Cubital tunnel

72
Q

Carpal tunnel syndrome is more common in (men / women).

A

women

73
Q

What are some conditions associated with carpal tunnel syndrome?

A

Pregnancy

Diabetes

Hypothyroidism

RA

MSK Week 5 2017/18 (12 decks)

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