4. Introduction to shoulder surgery

Question 1

Why is shoulder pain important?

Answer 1

3rd most common MSK consultation in GP
practice
1% adults each year visit GP with shoulder pain
25% of adults self reported prevalence of shoulder
pain

Question 2

Common shoulder symptoms

Answer 2

Pain
Stiffness
Weakness
Instability - dislocation

Question 3

Causes of shoulder pathology

Answer 3

Glenohumeral joint
• Arthritis, Instability, Frozen Shoulder
• Rotator Cuff
• Tears
• Bursitis/impingement/calcific tendonitis
• Bone Trauma
• Biceps, Pec Major

Question 4

Rotator cuff role

Answer 4

Stabilise the GHJ
Provide a FULCRUM for power muscles to move arm
Deltoid Pec major
Trapezius
Lat Dorsi
Teres major

Question 5

Rotator cuff muscles

Answer 5

infraspinatous
suprascapularis
infraspinatous
teres minor

Question 6

What stabilises the glenohumeral joint?

Answer 6

Not the bone
Rotator cuff is dynamic stabiliser
Capsule & labrum are static stabilisers

Question 7

Superficial power muscles

Answer 7

deltoid, pectoralis major, serratus anterior inferiorly

Question 8

Rotator cuff disorders

Answer 8

Subacromial Impingement
Rotator Cuff Tears
Calcific Tendonitis

Question 9

Subacromial impingement

Answer 9

Common
Pain on abduction & rotation of arm
Felt over deltoid
Cause:
Exrtrinsic
Bony spurs
Intrinsic:
Tendinopathy/cuff weakness

Question 10

Treatment for subacromial impingement

Answer 10

Non surgical
Activity modification
Physiotherapy
Surgical
Subacromial decompression
Debridement of bony and soft tissue impinging areas

Question 11

Rotator cuff tears

Answer 11

Most common - supraspinatus/infraspinatus
• Weakness & Pain
• Tendon degeneration is normal
• 15% in 60’s have a full thickness tear
• Repair if symptomatic

Question 12

Glenohumeral disorders

Answer 12

Arthritis
Frozen shoulder
Instability

Question 13

Glenohumeral arthritis

Answer 13

Osteoarthritis
Rheumatoid arthritis
Post traumatic arthritis

Question 14

Symptoms of arthritis

Answer 14

Stiffness
• Crepitus & grinding
• Pain at rest and at night
• Pain with activity

Question 15

Rotator cuff tear arthritis

Answer 15

Destabilises GHJ

Impingement on acromion

Question 16

Types of shoulder replacement

Answer 16

Anatomic: fulcrum for power muscles provided by rotator cuff
Reversed: creates a mechanical fulcrum for power muscles

Question 17

Frozen shoulder (adhesive capsulitis)

Answer 17

Stiffness and Pain
• Loss of PASSIVE motion (EXTERNAL ROTATION)
• X ray is normal
• 40-60 years old
• Females
• Diabetics
• Pathology
• Inflamed thickened capsule

Question 18

Frozen shoulder treatment

Answer 18

Non surgical
• Natural history is to resolve over 2 years
• Injections
• Hydrodilatation
• Surgical
• Capsular release and manipulation

Question 19

Shoulder instability

Answer 19

95% anterior dislocations
• Younger age = higher chance of recurrence
• Anterior labral tear (bankart lesion)
• Risk factors
• Collision sports
• Hyperlaxity

Question 20

Surgical treatment for shoulder instability

Answer 20

Arthroscopic stabilisation - labral repair
• Open stabilisation - capsule tightening
• Bony procedures - augmenting glenoid

Question 21

Shoulder trauma

Answer 21

Fractures
Dislocations
Soft tissue injuries

Question 22

Types of fracture

Answer 22

clavicle fractures, proximal humeral fractures, scapula fractures