Disorders of the shoulder Flashcards
What are common shoulder conditions for <35 year olds?
- Glenohumeral dislocations/instability (traumatic or atraumatic)
- ACJ dislocations/instability
- Clavicle fractures
What are common shoulder conditions of >35 year olds?
- Shoulder impingement
- Proximal humeral fractures
- Adhesive capsulitis
- Osteoarthritis (glenohumeral, acromioclavicular)
Describe a traumatic anterior dislocation
- Tear of glenoid labrum and stretch of glenohumeral ligaments
- (+/-) anterior glenoid rim fracture
- (+/-) posterior humeral head impaction fracture
What contributes to the instability of the glenohumeral joint (making it prone to dislocations)?
- Glenoid fossa is shallow compared to a bigger Humeral head
- Weak inferiorly (other aspects strengthened by ligaments)
What is the common mechanism and presentation for a (traumatic) anterior dislocation?
Mechanism: fall (direct or indirect)
Presentation: Pain, deformity (arm externally rotated and slight abduction), loss of function
What is a Bankart lesion?
A piece of glenoid labrum torn off due to the force of the humeral head popping out of the socket
What is a Hill-Sachs lesion
A dent in the posterolateral humeral from humeral head being jammed against glenoid fossa
What is the treatment for a traumatic anterior dislocation?
- Manipulation under sedation
- Often undergo surgery eventually
What is the common mechanism and presentation for a posterior dislocation?
Mechanism : epileptic seizures, electrocution and falls
Presentation: locked arm in internal rotation and adduction, ‘light bulb’ sign (x-ray)
What are the most common complications of shoulder dislocation?
- Recurrent dislocation (damage to the stabilising tissues)
- Damage to the axillary artery
- Damage to the axillary nerve
- Rotator cuff muscle tears
Describe what happens in a clavicle fracture (mid-clavicular)
- Sternal fragment raises up
- Acromial fragment goes inferolaterally (Pectoralis major + trapezius)
What is the common mechanism and presentation for a clavicle fracture?
Mechanism: Falls
Presentation: pain, swelling, tenderness, bruising
How are most clavicle fractures treated?
Conservatively (without suregery) e.g. using a sling
What are some indications that show the need for surgical fixation for a clavicle fracture?
- Complete displacement
- Tenting of the skin with risk of puncture
- Open fractures
- Neurovascular compromise
- Floating shoulder
What are local complications of a clavicle fracture?
- Pneumothorax
- Injury to surrounding neruovascular structures (suprascapular and supraclavicular nerves)
What is a rotator cuff tear?
A tear of one or more of the tendons of the four rotator cuff muscles (SITS) - usually the supraspinatus
What are the most common causes of a rotator cuff tear?
- Age-related degeneration
- Recurrent lifting (e.g. carpenter)
- Sports with overhead motion (e.g. volleyball)
Describe the degenerative-microtrauma model
Proposes that age-related tendon degeneration with chronic microtrauma results in partial tendon tears that develop into full tears
- inflammatory cells come
- oxidative stress leads to tenocyte apoptosis
What are some common presentations of rotator cuff tears?
- Anterolateral shoulder pain (often radiating down the arm)
- Pain-restricted movement above horizontal position
- Weakness of shoulder abduction
What are some symptomatic treatment for a rotator cuff tear?
- Physiotherapy
- Injections
- Subacromial decompression
What is an impingement syndrome?
When the supraspinatous tendon rubs on the coraco-acromial arch leading to irritation and inflammation
What causes an impingement syndrome?
Narrowing of the space between head of humerus and coracoacromial arch (thickening of ligaments, inflammation of tendon or subacromial osteophytes)
How does an impingement syndrome present?
- Dull pain that lingers
- Weakness
- Reduced range of motion (painful arc = 60-120°)
- Grinding or popping sensation
What is a calcific supraspinatus tendinopathy?
Macroscopic deposits of hydroxypatite in the tendon of supraspinatus
What is adhesive capsulitis (frozen shoulder)?
Inflammation and stiffness of the glenohumeral joint capsule causing chronic pain and restriction
List some risk factors for adhesive capsulitis (frozen shoulder)
- Female
- Epilepsy with tonic seizures
- Diabetes
- Thyroid disease
- Breast cancer
- Parkinson’s disease
- Cardiovascular disease
What is the treatment for adhesive capsulitis (frozen shoulder)?
- Physiotherapy
- Analgesia with anti-inflammatory anaesthesia
- Manipulation under anaesthesia
Describe osteoarthritis in the shoulder joint
Wearing down of the cartilage in the glenohumeral joint
What are some treatments for osteoarthritis?
- Activity modification
- Analgesia and anti-inflammatories (NSAIDs)
- Steroid injections
- Hyaluronic acid injections
- Total shoulder replacement (hemiarthroplasty)
