Disorders of the shoulder

Question 1

What are common shoulder conditions for <35 year olds?

Answer 1

• Glenohumeral dislocations/instability (traumatic or atraumatic)
• ACJ dislocations/instability
• Clavicle fractures

Question 2

What are common shoulder conditions of >35 year olds?

Answer 2

• Shoulder impingement
• Proximal humeral fractures
• Adhesive capsulitis
• Osteoarthritis (glenohumeral, acromioclavicular)

Question 3

Describe a traumatic anterior dislocation

Answer 3

• Tear of glenoid labrum and stretch of glenohumeral ligaments
• (+/-) anterior glenoid rim fracture
• (+/-) posterior humeral head impaction fracture

Question 4

What contributes to the instability of the glenohumeral joint (making it prone to dislocations)?

Answer 4

• Glenoid fossa is shallow compared to a bigger Humeral head

- Weak inferiorly (other aspects strengthened by ligaments)

Question 5

What is the common mechanism and presentation for a (traumatic) anterior dislocation?

Answer 5

Mechanism: fall (direct or indirect)
Presentation: Pain, deformity (arm externally rotated and slight abduction), loss of function

Question 6

What is a Bankart lesion?

Answer 6

A piece of glenoid labrum torn off due to the force of the humeral head popping out of the socket

Question 7

What is a Hill-Sachs lesion

Answer 7

A dent in the posterolateral humeral from humeral head being jammed against glenoid fossa

Question 8

What is the treatment for a traumatic anterior dislocation?

Answer 8

• Manipulation under sedation

- Often undergo surgery eventually

Question 9

What is the common mechanism and presentation for a posterior dislocation?

Answer 9

Mechanism : epileptic seizures, electrocution and falls

Presentation: locked arm in internal rotation and adduction, ‘light bulb’ sign (x-ray)

Question 10

What are the most common complications of shoulder dislocation?

Answer 10

• Recurrent dislocation (damage to the stabilising tissues)
• Damage to the axillary artery
• Damage to the axillary nerve
• Rotator cuff muscle tears

Question 11

Describe what happens in a clavicle fracture (mid-clavicular)

Answer 11

• Sternal fragment raises up

- Acromial fragment goes inferolaterally (Pectoralis major + trapezius)

Question 12

What is the common mechanism and presentation for a clavicle fracture?

Answer 12

Mechanism: Falls
Presentation: pain, swelling, tenderness, bruising

Question 13

How are most clavicle fractures treated?

Answer 13

Conservatively (without suregery) e.g. using a sling

Question 14

What are some indications that show the need for surgical fixation for a clavicle fracture?

Answer 14

• Complete displacement
• Tenting of the skin with risk of puncture
• Open fractures
• Neurovascular compromise
• Floating shoulder

Question 15

What are local complications of a clavicle fracture?

Answer 15

• Pneumothorax

- Injury to surrounding neruovascular structures (suprascapular and supraclavicular nerves)

Question 16

What is a rotator cuff tear?

Answer 16

A tear of one or more of the tendons of the four rotator cuff muscles (SITS) - usually the supraspinatus

Question 17

What are the most common causes of a rotator cuff tear?

Answer 17

• Age-related degeneration
• Recurrent lifting (e.g. carpenter)
• Sports with overhead motion (e.g. volleyball)

Question 18

Describe the degenerative-microtrauma model

Answer 18

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

Question 19

What are some common presentations of rotator cuff tears?

Answer 19

• Anterolateral shoulder pain (often radiating down the arm)
• Pain-restricted movement above horizontal position
• Weakness of shoulder abduction

Question 20

What are some symptomatic treatment for a rotator cuff tear?

Answer 20

• Physiotherapy
• Injections
• Subacromial decompression

Question 21

What is an impingement syndrome?

Answer 21

When the supraspinatous tendon rubs on the coraco-acromial arch leading to irritation and inflammation

Question 22

What causes an impingement syndrome?

Answer 22

Narrowing of the space between head of humerus and coracoacromial arch (thickening of ligaments, inflammation of tendon or subacromial osteophytes)

Question 23

How does an impingement syndrome present?

Answer 23

• Dull pain that lingers
• Weakness
• Reduced range of motion (painful arc = 60-120°)
• Grinding or popping sensation

Question 24

What is a calcific supraspinatus tendinopathy?

Answer 24

Macroscopic deposits of hydroxypatite in the tendon of supraspinatus

Question 25

What is adhesive capsulitis (frozen shoulder)?

Answer 25

Inflammation and stiffness of the glenohumeral joint capsule causing chronic pain and restriction

Question 26

List some risk factors for adhesive capsulitis (frozen shoulder)

Answer 26

• Female
• Epilepsy with tonic seizures
• Diabetes
• Thyroid disease
• Breast cancer
• Parkinson’s disease
• Cardiovascular disease

Question 27

What is the treatment for adhesive capsulitis (frozen shoulder)?

Answer 27

• Physiotherapy
• Analgesia with anti-inflammatory anaesthesia
• Manipulation under anaesthesia

Question 28

Describe osteoarthritis in the shoulder joint

Answer 28

Wearing down of the cartilage in the glenohumeral joint

Question 29

What are some treatments for osteoarthritis?

Answer 29

• Activity modification
• Analgesia and anti-inflammatories (NSAIDs)
• Steroid injections
• Hyaluronic acid injections
• Total shoulder replacement (hemiarthroplasty)