Disease - Shoulder Trauma

Question 1

What are the potential things that can go wrong with joints?

Answer 1

IDDIINT
Inherited
Developmental
Degenerative
Inflammatory
Infective
Neoplastic
Traumatic

Question 2

What is neuropraxia?

Answer 2

The nerve is asleep due to crushing

Usually recovers in 6 months

Question 3

Axonotmesis?

Answer 3

Crushed axons or stretched nerves, most common type in closed wounds and recovers in a few weeks

Question 4

Nerometsis?

Answer 4

The whole nerve is severed or avulsed due to a laceration and may not recover.

Question 5

Anterior dislocation of the AC joint

Answer 5

Most common

Caused by a posterior force being applied whilst the shoulder and elbow are at 90degrees

Question 6

Posterior dislocation of the AC joint

Answer 6

~5%
Occurs when an anterior force is applied
The humeral head is turning internally and being pushed under the acromion
Surgery often has limited success and it is often a sign of neurological condition - weakened muscles

Question 7

Inferior dislocation of the AC joint

Answer 7

Very rare

Caused by hyper abduction of the arm

Question 8

What is the difference between an anterior and posterior AC joint dislocation on an AP x-ray?

Answer 8

Anterior the head of the humerus is visible, posterior it is not but need a lateral x-ray to confirm.

Question 9

Rotator cuff tendonitis - Dx and Tx?

Answer 9

Dx - painful arc syndrome, early rising scapula, pain is worse at night and radiates to the upper arm.
Tx - NSAIDs or steroid injection.

Question 10

Torn rotator cuff muscles - Dx and Tx?

Answer 10

Dx - loss of initial arm elevation, struggle with abduction

Tx - surgery in young but not possible in elderly/RA patients

Question 11

Calcific tendonitis and bursitis - Ix and Tx?

Answer 11

Ix - x-ray to iidentify the calcium phosphate in tendon

Tx - Corticosteroids or aspiration under x-ray/USS

Question 12

Frozen shoulder (adhesive capsulitis) - Dx and Tx?

Answer 12

Dx - complete immobile shoulder
Tx - NSAIDs, anaesthetic/corticosteroid injection, surgery (arthroscopic release) to cut the tight, limiting muscle and sew.
If untreated it should recover in 1-2 years.

Question 13

What is a Bankart lesion?

Answer 13

Where the anterior part of the labrum is seperated from the glenoid = anterior glenoid is now bare and much more likely to dislocate at that point.

Question 14

Hills-Sachs lesion?

Answer 14

The (relatively) soft humeral head is dented (4mm) in an anterior dislocation.
When the posterior, superior humeral head (medially rotated) impacts against the anterioinferior glenoid rim
Change in shape = more likely to dislocate at a smaller angle of rotation.

Question 15

Indications that a Hills-Sachs legion has occured?

Answer 15

White head
Latrogenic or thromba in artery
Wrist drop due to radial nerve damage
Rotator cuff mitigates the effects of gravity in arm movements