Chapter 27- The Shoulder Flashcards
What is a bankart lesion?
After acute traumatic dislocation the anterior capsule and labrum is torn from the anterior aspect of the glenoid
Only 10% of dislocations are posterior, what are the warning signs for a posterior dislocation
Shoulder does not abduct or rotate after injury. Painful arm is held by the side unable to externally rotate
Acute treatment of traumatic anterior dislocation
Young athlete: surgical
Adults: immobilize in immobilizer
Treatment of recurrent traumatic anterior dislocation
Surgical repair or reconstruction
What are the options for surgical repair of recurrent traumatic anterior dislocations
- bankart repair: repair of the glenoid Avulsion
- capsular shift: tightening of the redundant and stretched capsule
- Latarjet: bony procedure if bone changes apparent
What are symptoms of instability of the shoulder joint?
- feeling of shoulder wanting to sublux
- episodes of dislocation
- impingement syndrome
What is the cause of shoulder instability in a young patient
Multidirectional instability- relative weakness of rotator cuff and scapula muscles and capsular laxity leading to humeral head subluxation and impingement
What sign demonstrates inferior subluxation of the shoulder joint
Sulcus sign
Treatment of atraumatic dislocation (involuntary)
Physiotherapy retraining shoulder girdle muscles
Consider capsuloplasty
Treatment of chronic Persistent dislocation
Refer
Less than three weeks : attempt reduction
After three weeks: may not be reducible even by surgery. If painless leave alone. If painful: excise humoral head, arthrodesis, arthroplasty
When is a dislocation deemed chronic?
After 7 days
What is the cause of impingement/ rotator cuff syndrome/ supraspinatus tendinitis?
Dysfunction of rotator cuff muscles –> upriding of humoral head –> compression and attrition of rotator cuff tendons
what are the symptoms of supraspinatus tendinitis?
- Pain on abduction but especially when the arm is abducted and internally rotated
- Radiation down to the deltoid insertion
- Night pain
- Difficulty with activities of daily living
Signs of supraspinatus tendinitis
- Tenderness over the rotator cuff tendons
- Painful arc between 60 and 120
- Pain on resisted movement of supraspinatus and infraspinatus
- Positive impingement sign and test
treatment of supraspinatus tendinitis in the acute phase
NSAIDS
Physiotherapy
up to three cortisone injections
If conservative treatment of impingement fails, what is the next step in management ?
Acromioplasty
Name and describe the test used for biceps tendinitis
Yergason test- supination of the forearm against resistance. Pain located anteriorly in the bicipital groove is a positive yergason test.
surgical treatment of biceps tendinitis
tenotomy or tenodesis
Treatment of calcific tendinitis
- cortisone injection into the painful area
- Ultrasound guided aspiration may help
- release of the calcium deposit in surgery (rare)
What is the additional sign seen in rotator cuff tears NOT seen in impingement syndrome?
WEAKNESS on resisted movement of supraspinatus and infraspinatus
What is seen on Xray in a significant rotator cuff tear
Humeral head is elevated
Treatment of a rotator cuff tear
Acromioplasty and repair of the torn tendons
name the tests used for subscapularis tears
belly press test and Gerber’s lift off test
Signs on examination of acromioclavicular joint arthritis
- Patients points to the ACJ as the site of the pain
- There is pain at 150- 180 degrees of abduction
- Tenderness is felt directly over the ACJ and there is pain on cross-body adduction
Treatment of acromioclavicular joint arthritis
NSAID and analgesics
Cortisone injection- repeat 2/3 times
Excision of the lateral end of the clavicle if conservative treatment fails
Which two conditions are associated with adhesive capsulitis?
-Diabetes and thyroid disease
Treatment of adhesive capsulitis
- most cases resolve without treatment within 18 months - 2 years
- careful explanation
- Intra-articular injections with local anaesthetic and steroid may have some benefit in the early stage
- Amitryptilline if sleep affected
- Gentle physiotherapy- encourage active motion
- Manipulation or arthroscopic release in resistant cases
Causes of Glenohumeral arthritis
- Septic- acute or TB
- Inflammatory- RA
- Degenerative
Treatment of glenohumeral arthritis
NSAID
Drainage of sepsis - arthroscopic or open
debridement
athroplasty- shoulder replacement for non infective arthritis
