Disorders Of The Shoulder Flashcards
What type of shoulder dislocation is most common?
Anterior
Presentation on shoulder dislocation
Squaring of shoulder
What does a posterior shoulder dislocation look like on an x ray?
Why?
Light bulb sign
Humerus is internally rotated
What happens to the humerus in a posterior shoulder dislocation?
Internal rotation
Cause of posterior shoulder dislocation
Seizure
Electrocution
‘Electrical reasons - light bulb sign’
Where are clavicle fractures mainly located?
Middle third
Treatment of clavicle fracture
Plates + screws
When is treatment of clavicle fracture needed?
If nerve of muscles are compromised
What is the most common rotator cuff tear?
Supraspinous
List the rotator cuffs
SITS
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
What nerve is most at risk of damaged during anteriorshoulder dislocation?
Axillary nerve
Why is anterior shoulder dislocation more common than posterior?
Pull of muscles pull humeral head anteriorly
What blood supply is most at risk of damage in shoulder dislocation?
Suprascapular artery and vein
Action of supraspinatus
ABduction - first 15°
Innervation of supraspinatus
Suprascapular nerve C5-6
Action of infraspinatus
External rotation
Innervation of infraspinatus
Suprascapular nerve C5-6
Action of teres minor
External rotation
ABduction
Innervation of teres minor
Axillary nerve C5-6
Action of subscapularis
Internal rotation
ADduction
Innervation of subscapualris
Nerve to subscapularis C5-6
What position would the arm be in if the suprascapular nerve was damaged?
ADucted
Internally rotated
Innervation of infrascapular + supraspinatus
Nerve rots of Suprascapular nerve
C5-6
Nerve root of axillary nerve
C5-6
Causes of impingement syndrome
Tendinitis
Bursitis
Osteophytes
Presentation of impingement syndrome
Painful arc
Painful during shoulder ABduction
What is impingement syndrome?
Compression of rotator cuff in subacrominal space
What happens in calcified supraspinatus tendinopathy?
Calcium deposits in tendon
Common age range for calcified supraspinatus tendiopathy
20-40 year olds
Risk factor for calcified supraspinatus tendionopathy
Diabetics
What is seen on an x ray of a patient with osteoarthritis?
LOSS
Loss of joint space
Osteophytes
Subarticular sclerosis
Subcondral cysts
Risk factors of osteoarthritis
Age
Female > male
Obesity
Trauma to joint > secondary OA
What causes primary osteoarthritis?
Wear and tear
What causes secondary osteoarthritis?
Trauma to joint > predisposes to OA
Treatment of osteoarthritis
NSAIDs
Weight loss
Physiotherapy
Surgery
Surgical treatment of severe osteoarthritis in shoulder
Hemiarthroplasty
Reverse total shoulder replacement
What is a hemiarthroplasty?
Half joint replacement
What happens in a reverse total shoulder replacement?
Ball + socket swapped positions
What is adhesive capulitis?
Frozen shoulder
Shoulder capsule thickens > stiff + tight
Less synovial fluid
How long does freezing take in adhesive capulitis?
6-9 weeks
How long does frozen last for in adhesive capulitis?
4-6 months
How long does thawing take in adhesive capulitis?
6 months - 2 years
Where is pain located in adhesive capulitis
In all movements
Risk factors for adhesive capulitis
Diabetes
Hypo/hyperthyroidism
Female>male
Location of the supraspinatus muscle
Superior to the spine of the scapula
Location of the infraspinatus muscle
Inferior to the spine of the scapula
Posteriorly
Location of the teres minor muscle
Inferior to scapula + infraspinatus
Location of supscaularis muscle
Anterior surface of scapula
Why does a scapula fracture often not need fixation?
Surrounding muscles hold in place whilst healing occurs
What would damage to the axillary nerve cause?
- paralysis of deltoid + teres minor
- difficulty performing ABduction <90°
- sensation lost in regimental badge area
Presentation of biceps tendon rupture
- > 50 year olds
- hearing a snap
- elbow flexion produces a firm lump | due to unopposed contraction of biceps popeye sign
Why is there not a significant loss of weakness in biceps tendon rupture?
Action of brachialis + Supinators still intact
Causes of axillary lymphadenopathy
- Infection of upper limb, pectoral region or breast
- leukaemia
- lymphoma
- metastases
Risks associated with axillary lymph node dissection
- interruption of lymphatic drainage > lymphoedema
- damag to long thoracic nerve > winged scapula
- damage to thoracodorsal nerve
What is winged scapula due to?
- Long thoracic nerve damage
- loss of innervation to serratus anterior
- medial border of scapula not held against chest wall
Causes of winged scapula
- blunt trauma to neck or shoulder
- surgical trauma during mastectomy + axillary lymph node clearance
