injuries to the shoulder Flashcards
anterior dislocations of the shoulder joint
- visable deformity/swelling
- restricted movement of the shoulder
- 90-95% anterior dislocation, weak joint on inferior aspect so dislocates anteroinferiorly
- occurs when hand is behind head and force pushes humeral head out of socket => bankart lesion (glenoid labrum torn off)
- posterior aspect of humerus becomes jammed against glenoid fossa =. dent =. Hill-Sachs lesion
posterior dislocation of the shoulder
- due to violent muscle contraction
- arm is internally rotated and adducted
- flattening of shoulder with prominent coracoid process
inferior dislocation of the arm
- more rare than anterior and posterior
- head of humerus inferior to the glenoid
- occur when arm is fully extended over the head
recurrent dislocation
damage to stabilising tissue around shoulder
consequences of damaging the auxilla artery
- occur in 10-40% of dislocations
- wraps arounf humerus head, supplies deltoid muscle and overlying skin
- can recover
rotator cuff muscles
occur within dislocation of the shoulder muscle
clavicle fracture
- 80% occur in middle third
- can treat mainly without surgery
- reasons for surgical help:
- complete/severe displacement (severe - puncture skin)
- open fracture
- floating shoulder
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what happens to the position of the arm and the clavicular fragments in a displaced mid clavicular fracture
- sternocleiodomastoid muscle elevelates medial segment
- trapezius muscle cant hold lateral segment up so shoulder drops
- arm pulled medially via pectoralis major
rotator cuff muscles
- tear in any of the rotator cuff muscles (supraspinous, infraspinous, subcapularis and teres minor)
- supraspinatus tendon more affected
- most rotator cuff tears are chronic due to age related degeneration
degenerative - microtrauma model
age related tendon degeneration, compounded by chronic microtrauma results in partial tendon tears –> full rotator tears
- repetitive overhead lifting // recurrent lifting
- clinical presentation = anterolateral shoulder pain radiating down the arm
- pain in shoulder when they lean on thier elbow and push down and when reaching forward
- weakness of shoulder abduction
impingement syndrome
- supraspinatus tendon impinges (rubs/catches) on coraco-acromial arch => irritation and inflammation
- shoulder is abducted or flexed the space between humerus and coracoacromial arch is narrowed = > pain and reduced motion
- acute or gradual onset of osetophte is formed
- dull and long pain (popping of shoulder)
- painful arc (60 and 120 degrees)
muscles and their actions
calcific supraspinatus tendinopathy
- presence of macroscopic deposits of hydroxyapatite in the tendon of supraspinatus
- aggrevated by abducting or flexing arm above the shoulder
- mechanical systems occur due to physical presence of large deposit = stiffness/ snapping sensation
cause:
1) regional hypoxia = tenocytes turned into chondrocytes = lay down cartilage in tendon = calcium deposits formed via endochondrial ossification
during reabsorption they are the most painful
treat:
rest and analgesia
adhesive capsulitis (frozen shoulder)
- painful and disabling
- glenohumeral joint inflammed and stiff = restricted movement and chronic pain
- severe pain and sleep deprivation over long periods
risk factors:
- female
- epilepsy
- diabetes mellitus
- cardiovascular disease
treatment:
physiotherapy
manipulation => breaks up adhesion and scar tissue to restore motion
osetoarthritis
- mainly people > 50
- mainly affects acromioclavicular joints
treatments:
activity modification
nutritional supplements
steroid injections => reduce swelling and alleviate stiffness
arthroscopy = surgery that can can remove loose pieces of damaged cartialage
