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Ortho > Chapter 27- The Shoulder > Flashcards

Chapter 27- The Shoulder Flashcards

1
Q

What is a bankart lesion?

A

After acute traumatic dislocation the anterior capsule and labrum is torn from the anterior aspect of the glenoid

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2
Q

Only 10% of dislocations are posterior, what are the warning signs for a posterior dislocation

A

Shoulder does not abduct or rotate after injury. Painful arm is held by the side unable to externally rotate

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3
Q

Acute treatment of traumatic anterior dislocation

A

Young athlete: surgical

Adults: immobilize in immobilizer

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4
Q

Treatment of recurrent traumatic anterior dislocation

A

Surgical repair or reconstruction

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5
Q

What are the options for surgical repair of recurrent traumatic anterior dislocations

A
  • bankart repair: repair of the glenoid Avulsion
  • capsular shift: tightening of the redundant and stretched capsule
  • Latarjet: bony procedure if bone changes apparent
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6
Q

What are symptoms of instability of the shoulder joint?

A
  • feeling of shoulder wanting to sublux
  • episodes of dislocation
  • impingement syndrome
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7
Q

What is the cause of shoulder instability in a young patient

A

Multidirectional instability- relative weakness of rotator cuff and scapula muscles and capsular laxity leading to humeral head subluxation and impingement

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8
Q

What sign demonstrates inferior subluxation of the shoulder joint

A

Sulcus sign

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9
Q

Treatment of atraumatic dislocation (involuntary)

A

Physiotherapy retraining shoulder girdle muscles

Consider capsuloplasty

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10
Q

Treatment of chronic Persistent dislocation

A

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

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11
Q

When is a dislocation deemed chronic?

A

After 7 days

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12
Q

What is the cause of impingement/ rotator cuff syndrome/ supraspinatus tendinitis?

A

Dysfunction of rotator cuff muscles –> upriding of humoral head –> compression and attrition of rotator cuff tendons

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13
Q

what are the symptoms of supraspinatus tendinitis?

A
  • 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
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14
Q

Signs of supraspinatus tendinitis

A
  • 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
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15
Q

treatment of supraspinatus tendinitis in the acute phase

A

NSAIDS
Physiotherapy
up to three cortisone injections

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16
Q

If conservative treatment of impingement fails, what is the next step in management ?

A

Acromioplasty

17
Q

Name and describe the test used for biceps tendinitis

A

Yergason test- supination of the forearm against resistance. Pain located anteriorly in the bicipital groove is a positive yergason test.

18
Q

surgical treatment of biceps tendinitis

A

tenotomy or tenodesis

19
Q

Treatment of calcific tendinitis

A
  • cortisone injection into the painful area
  • Ultrasound guided aspiration may help
  • release of the calcium deposit in surgery (rare)
20
Q

What is the additional sign seen in rotator cuff tears NOT seen in impingement syndrome?

A

WEAKNESS on resisted movement of supraspinatus and infraspinatus

21
Q

What is seen on Xray in a significant rotator cuff tear

A

Humeral head is elevated

22
Q

Treatment of a rotator cuff tear

A

Acromioplasty and repair of the torn tendons

23
Q

name the tests used for subscapularis tears

A

belly press test and Gerber’s lift off test

24
Q

Signs on examination of acromioclavicular joint arthritis

A
  • 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
25
Q

Treatment of acromioclavicular joint arthritis

A

NSAID and analgesics
Cortisone injection- repeat 2/3 times
Excision of the lateral end of the clavicle if conservative treatment fails

26
Q

Which two conditions are associated with adhesive capsulitis?

A

-Diabetes and thyroid disease

27
Q

Treatment of adhesive capsulitis

A
  • 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
28
Q

Causes of Glenohumeral arthritis

A
  • Septic- acute or TB
  • Inflammatory- RA
  • Degenerative
29
Q

Treatment of glenohumeral arthritis

A

NSAID
Drainage of sepsis - arthroscopic or open
debridement
athroplasty- shoulder replacement for non infective arthritis

Ortho (41 decks)

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