Clinical conditions of the shoulder Flashcards
What causes winging o the scapula
Damage o the long thoracic nerve usually caused my trauma
What is axillary lymphadenopathy
Enlargement of the axillary lymph nodes
What causes axillary lymphadenopathy
- infection of the upper limb which can cause lymphangitis
- infections of the pectoral region and breast
- leukaemia or lymphoma
- metastasis from malignant melanoma in the upper limb
Lymph nodes of axillary
APICAL
Anterior
Posterior
Infraclavicular
Central
Apical
Lateral
Spinal nerve roots for five major brachial plexus branches
3 musketeers assassinated 4 mice 5 rats and 2 unicorns
Musculocutaneous C5, C6, C7
Axillary C5, C6
Median C6,7,8,T1
Radial C5, 6, 7,8, T1
Ulnar C8 T1
Insertion of the muscles a the intertubercular sulcus of the humerus
A lady between 2 majors
Latissimus Dorsi inserts between teres major on the medial lip nod pectoralis major on the lateral lip
What neuromuscular structures are at risk in fracture of the surgical neck of the humerus
Axillary nerve
Posterior circumflex artery
Sensation in the regimental made area impaired
What will damage to the axillary nerve lead to
Paralysis of the deltoid and teres minor
Therefore difficultly performing abduction of the affected limb
Muscles in the anterior compartment of the arm are …..
And are innervated by…..BBC
Musculocutaneous nerve
Biceps bracii
Brachialis
Coracobrachialis
What direction does the shoulder dislocate usually and why
Aneroinferiorly because it is weak at its inferior aspect
Anterior because the head of the humerus sits anterior to the glenoid fossa
When does anterior dislocation occur
When the individual has their arm positioned in abduction and external rotation
Hand behind head
What is a Bankart lesion
The force of the humeral head popping out of the socket often causes part of the glenoid labrum to be torn off.
What is a Hill-Sachs lesion
When the humeral head is dislocated anteriorly, the tone of the infraspinatus and teres minor muscles means that the posterior aspect of the humeral head becomes jammed against the anterior lip of the glenoid fossa (see image below). This can cause a dent (indentation fracture) in the posterolateral humeral head
When do posterior dislocations occur
Violent muscle contractions
- epileptic seizure
- electrocution
- lightning strike
When arm is flexed across body and post posteriorly
How can you look for dislocations in the shoulder
Light bulb sign- the projection of the humeral head becomes more rounded in a posterior dislocation - abnormal
Scapular y shaped view- head of the humerus should be directly within the glenoid fossa
Where do clavicle fracture occur mostly
80% in the middle third of the clavicle
What can cause a clavicle fracture
Fall onto outstretched hand or onto shoulder
What are some indications for surgical fixation in clavicle fracture
- complete displacement
- severe displacement- tenting of skin
- open fracture
- neurovascular compromise
- fracture with imposed uncle
- paring shoulder clavicle fracture with ipsilateral fracture of glenoid neck
What is impingement syndrome
Occurs when the supraspinatus tendon impinges on the coracobrachialis-acromial arch leading to irritation and inflammation
When do you feel pain in impingement syndrome
When the shoulder is abducted or flexed as the space becomes narrowed
Worsened with shoulder overhead movement
What is calcific supraspinatus tendinopathy
Presence of macroscopic deposits of hydroxyapatite in the tendon of supraspinatus
What is thought to be the cause of calcific supraspinatus tendinopathy
-regional
hypoxia leads to tenocytes being transformed into chondrocytes and laying down
cartilage in the tendon. Calcium deposits are then formed through a process
resembling endochondral ossification.
Adhesive capsulitis
Frozen shoulder
capsule of the glenohumeral joint becomes inflamed and stiff, greatly restricting movement and causing chronic pain
Risk factors of frozen shoulder
• Female gender
• Epilepsy with tonic seizures (i.e. sudden muscle contractions)
• Diabetes mellitus (the theory is that glucose molecules bond to the capsular
90
collagen)
- Trauma to the shoulder
- Connective tissue disease
Treatment of frozen shoulder
Physiotherapist
Analgesia
Anti-inflammatory meds
Treatment of OA of shoulder
activity modification (avoiding activities that precipitate symptoms), analgesia, and anti-inflammatories (NSAIDs). Some patients report a benefit from taking nutritional supplements e.g. glucosamine and chondroitin sulfate.
