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CM Clinical Symposia > Frozen shoulder > Flashcards

Frozen shoulder Flashcards

1
Q

Prevalence

A

20-30% elderly, >70% rotator cuff disease

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2
Q

4 joints in skeleton

A
  1. Glenohumeral
  2. Acromioclavicular
  3. Sternoclavicular
  4. Scapulothoracic
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3
Q

Glenohumeral joint

A

Superior, middle, inferior ligaments

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4
Q

Acromioclavicular

A

Fibrous, little movement, full abduction, adduction and flex, interacts with subacromial space (acromioclavicular and coracoclavicular joints)

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5
Q

Sternoclavicular

A

Rotates with elevation 30-40

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6
Q

Scapulothoracic

A

Lies against posterior lateral thoracic wall, origin for rotator cuff muscles, deltoid and trapezius

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7
Q

What affects stability?

A

Capsule, labrum, ligaments, rotator cuff muscles, long head biceps

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8
Q

Imbalance of muscle strength/hypermobility >

A

Higher risk of impingement/tendonopathy

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9
Q

Adduction

A

Pec major and lat dorsi

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10
Q

Flexion

A

Pec major and deltoid

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11
Q

Extension

A

Lat dorsi, teres major and deltoid

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12
Q

Lateral rotation

A

Infraspinatus, teres minor

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13
Q

Medial rotation

A

Pec major, lat dorsi, deltoid , subscapularus

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14
Q

Subacromial bursa

A

Between supraspinatus tendon and acromion

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15
Q

Injury shoulder >

A

Rotator cuff injury, stress capsule, bicipital tendinitis, instability, tear

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16
Q

Adhesive capsulitis

A

Deep aching

17
Q

Inspection

A
  • Swelling/deformity
  • Neck position
  • Muscle wasting
  • Asymmetry of scapulohumeral rhythm
  • Scapula winging
  • Tendon rupture - biceps
18
Q

Tests

A
  • Stability - draw test, sulcus sign

- Apprehension

19
Q

Problems at joint/capsule

A

Arthritis, capsulitis (frozen shoulder)

20
Q

Problems at tendons

A

Rotator cuff tendinopathy, bicipital tendinitis, calcific tendinitis

21
Q

Adhesive capsulitis/Frozen shoulder

A

Painful global restriction of GH movements in all planes (active and passive), absence of joint degeneration

22
Q

Frozen shoulder prevalence

A

2-3%, rare M

23
Q

Frozen shoulder precipitated by

A

Trauma, MI, CVA

24
Q

Frozen shoulder associations

A
  • Diabetes (10-20%, risk increases with duration)
  • Thyroid disease
  • Lung disease (TB, Ca)
  • Cardiac disease/surgery
25
Q

Frozen shoulder painful

A

Ache, night pain, spasm

26
Q

Frozen shoulder adhesive

A

Pain, stiffness, restriction

27
Q

Frozen shoulder resolution

A

Less pain, gradual resolution

28
Q

Pathophysiology

A

Increased incidence in DM - microvascular disease, abnormal collagen repair, predisposition to infection

29
Q

Histology

A

Increased fibrous tissue, fibroblasts, type 3 collagen, vascularity increase in inflammation, synovial cells

30
Q

Genetic

A

Increase in trisomy 7 and 8 in fibroblasts

31
Q

Pathophysiology

A

Early - neuropathic pain with allodynia

Late - dupytrens in histology

32
Q

Treatment

A

Corticosteroids - reduce symptoms, capsular distension (enlarge), manipulation under anaesthetic

33
Q

Investigations

A
  • Usually clinical diagnosis
  • Radiography - GH disease/calcific tendinitis, neoplasm
  • Arthrography
  • Ultrasonography
34
Q

Rotator cuff tendonitis

A

Common cause of shoulder pain, degeneration > dysfunction and impingement

35
Q

History for Rotator cuff tendonitis

A

Painful arc, deltoid, trauma, night-time pain, reduced function, occupation

36
Q

Rotator cuff tendonitis examination

A

Painful arc, reduced active, better passive movements, impingement

37
Q

Rotator cuff tendonitis pathophysiology (Neer)

A
  • Oedema and haemorrhage
  • Fibrosis and tendonitis
  • Tendon degeneration, bony change, tendon rupture
38
Q

Imagining

A
  • Plain radiography
  • Ultrasonography
  • MRI
  • Arthrography
  • Arthroscopy

CM Clinical Symposia (24 decks)

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