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Orthopedics > Common Musculoskeletal Problems: Shoulder > Flashcards

Common Musculoskeletal Problems: Shoulder Flashcards

1
Q

Which muscles comprise the rotator cuff? Can you state their origin, insertion, action and innervation?

A 
Superiorly:
Supraspinatus: 
- Supraspinous fossa
- Superior + middle fact of greater tuberosity
- Abduction
- Suprascapular nerve (C5)
Posteriorly: 
Infraspinatus
- Infraspinous fossa
- Posterior facet of greater tuberosity
- External rotation
- Suprascapular nerve (C5-C6)
Teres minor
- Middle lateral border of scapula
- Inferior facet of greater tuberosity
- External rotation
- Axillary nerve (C5)
Anteriorly:
Subscapularis
- Subscapular fossa
- Lesser tuberosity or humeral neck
- Internal rotation
- Upper + lower sub scapular nerve (C5-C6)
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2
Q

List the differential diagnoses for ‘shoulder’ pain

A
  1. Rotator cuff tendonitis
    - Worse at night
    - Radiates to upper arm
  2. Muscular neck pain
    - Does not radiate to upper arm
  3. Cervical nerve root pain
    - Associated with pins & needles or neurological signs in the arm
  4. Adhesive capsulitis
  5. Early inflammatory arthritis
  6. Polymyalgia rheumatica
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3
Q

True or false: Shoulder pain is more common in diabetic patients than in the general population

A

True

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4
Q

What is the most common cause of shoulder pain at all ages?

A

Rotator cuff (supraspinatus) tendonosis

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5
Q

Describe the typical features of rotator cuff tendonosis

A
  1. Pain radiates to upper arm
  2. Pain made worse by arm abduction and elevation (often limited)
  3. Painful arc syndrome
  4. Scapula rotates earlier than usual during elevation
  5. Passive elevation reduces impingement, less painful
  6. May be associated with subacromial bursitis
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6
Q

What is ‘painful arc syndrome’?

A

Pain worse during middle of range of abduction of shoulder (70-120 degrees) in rotator cuff tendonitis and impingement, and prevention of active abduction (first 90 degrees) in the rotator cuff tears.

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7
Q

True or false: in adhesive capsulitis, severe pain immobilises the joint, although some rotation is retained

A

False - this is true of rotator cuff tendonosis

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8
Q

True or false: X-rays or US are 1st line in the investigation of rotator cuff tendonosis

A

False - only necessary when tendonosis is persistent or Dx is uncertain

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9
Q

What is the relevance of osteoathritis in rotator cuff tendonosis?

A

Acromioclavicular osteophytes increase risk of impingement and may need to be removed surgically

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10
Q

What are the treatment options for rotator cuff tendonosis?

A
  1. Analgesics
  2. NSAIDs
  3. Physiotherapy
    - Helps persistent stiffness
  4. Steroid injection into subacromial bursa
    - For severe pain
    - US-guided
    - 10% develop worse pain in first 24-48hrs
    - 70% improve over 5-20 days and mobilise joint themselves
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11
Q

What are the 3 main risk factors for a torn rotator cuff?

A
  1. Trauma
    Occurs spontaneously in:
  2. Old age
  3. Rheumatoid arthritis
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12
Q

What are the typical features of a torn rotator cuff?

A
  1. No active abduction of arm

2. Once elevated, arm can be held in place by deltoid muscle

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13
Q

What is the drop arm test?

A

Tests for supraspinatus tears. Patient’s shoulder passively abducted to 90 degrees. Examiner releases the patient’s arm with instructions to slowly lower the arm. +Ve if the patient is unable to lower his or her arm in a smooth, controlled fashion.

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14
Q

What are the treatment options for a torn rotator cuff?

A
  1. Surgical repair (young)

2. Arthroscopic repair (old, RA)

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15
Q

List 4 causes of adhesive capsulitis

A
  1. Rotator cuff lesions
  2. Hemiplegia
  3. Chest or breast surgery
  4. Myocardial infarction

True ‘frozen’ shoulder is uncommon

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16
Q

Describe the features of a true ‘frozen’ shoulder. How does it differ from rotator cuff tendonosis?

A
  1. Severe pain
  2. Complete loss of all shoulder movements, including rotation

In rotator cuff tendonosis

  • Pain limits movement
  • Some rotation is maintained
17
Q

In calcific tendonosis, where are the calcium pyrophosphate deposits typically seen?

A

Just proximal to the greater tuberosity

18
Q

How does calcific tendonosis typically present?

A
  1. Acute or chronic recurrent shoulder pain
  2. Restriction of movement
  3. Asymptomatic - incidental finding on X-ray
19
Q

What are the treatment options for calcific tendonosis?

A 
1. Local steroid injection
If pain persists...
2. Aspiration 
3. Break up deposit under US
4. Arthroscopic removal - rare
20
Q

What is the main complication of calcific tendonosis?

A

Subacromial bursitis - shedding of crystals into subacromial bursa

21
Q

How does calcific bursitis typically present?

A
  1. Severe shoulder pain
  2. Restricted movement
  3. Warmth
  4. Swelling
22
Q

What is the differential diagnosis of calcific bursitis?

A
  1. Gout
  2. Pseudogout
  3. Septic arthritis
23
Q

X-ray of the shoulder shows a diffuse opacity in the bursa. What is the diagnosis?

A

Calcific bursitis

24
Q

What are the treatment options for calcific bursitis?

A
  1. Aspiration

2. Local steroid injection

25
Q

Identify the muscle and name its action and innervation.

  • Origin: supraspinous fossa
  • Insertion: superior + middle fact of greater tuberosity
A

Supraspinatus

  • Arm abduction
  • Suprascapular nerve (C5)
26
Q

Identify the muscle and name its action and innervation.

  • Origin: infraspinous fossa
  • Insertion: posterior facet of greater tuberosity
A

Infraspinatus

  • External rotation
  • Suprascapular nerve (C5-C6)
27
Q

Identify the muscle and name its action and innervation.

  • Origin: middle lateral border of scapula
  • Insertion: inferior facet of greater tuberosity
A

Teres minor

  • External rotation
  • Axillary nerve (C5)
28
Q

Identify the muscle and name its action and innervation.

  • Origin: subscapular fossa
  • Insertion: lesser tuberosity or humeral neck
A

Subscapularis

  • Internal rotation
  • Upper + lower sub scapular nerve (C5-C6)

Orthopedics (18 decks)

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