Intro to Shoulder Surgery

Question 1

What are common shoulder symptoms?

Answer 1

• Pain
• Stiffness
• Weakness
• Instbaility

can be a combination of all

Question 2

What are the rotator cuff muscles?

Answer 2

• Subscapularis
• Infraspinatus
• Teres minor
• Supraspinatus*

*anterior shoulder

Question 3

Give an overview of the biomechanics of the rotator cuff muscles

Answer 3

• they work in force couples to force the humeral head against the glenoid
  
  • when they are not working properly the deltoid and the pec major can exert a force that causes instability of the humeral head
• they provide a Fulcrum for power muscle to move the arm
  
  • Deltoid, Pec major, Trapezius, Lat dorsi, Teres major
• if the rotator cuff muscles aren’t working when the power muscles are activated it could cause the humeral head to slide out of its glenoid joint

Question 4

What are risk factors for shoulder pain?

Answer 4

• Sports related injuries
• Traumatic injuries
• Degenerative conditions
• Work related conditions (scaffolding)

Question 5

What subacromial problems are there?

Answer 5

• AC joint Arthritis
• Rotator Cuff tears
  
  • results in bursitis and pain
• Calcific Tendonitis

Question 6

What is Subacromial Impingement?

Answer 6

• It’s a common symptom of another shoulder joint condition
• Pain on abduction & rotation of arm, Felt over deltoid
• Extrinsic cause
  
  • Bony spurs grow over time that dig into the tendon
• Intrinsic cause: (more common)
  
  • Tendinopathy: microstructure is effected
    
    • results in cuff weakness
    • allows the head of the humerus to migrate up slightly –> tendon impingement, bursitis and pain

Question 7

How is Subacromial Impingement treated?

Answer 7

Non-surgical: aims to strengthen the muscles coordinate the rotator cuff and centre the humeral head against the glenoid

• Activity modification
• Physiotherapy

Surgical: Arthroscopic (keyhole) surgery

• Subacromial decompression: physiotherapy is still important after surgery
  
  • Debridement of bony and soft tissue impinging areas

Question 8

Give an overview of Rotator Cuff tears

-cause, symptoms, aetiology

Answer 8

• Most common - supraspinatus/infraspinatus
  
  • Weakness & Pain
• Tendon degeneration is normal and eventually can lead to a tear
• 15% in 60s have a full-thickness tear
• Repair if symptomatic
  
  • acute tears (falls, full-thickness tears) usually do surgery
  • and tendon degeneration tear try and use non-operative treatment

Question 9

What Glenohumeral joint problems are there?

Answer 9

• Osteoarthritis
• Frozen shoulder
• Instability

Question 10

What types of Gelno humeral Arthritis are there?

Answer 10

• Osteoarthritis
• Rheumatoid Arthritis
• Post-traumatic arthritis
• Rotator cuff tear arthritis
  
  • badly and chronically torn
  • translation of the head away from the glenoid
  • results in secondary arthritis requires a shoulder replacement

Question 11

What are the symptoms of Arthritis?

Answer 11

• Stiffness
• Crepitus & grinding
• Pain at rest and at night
• Pain with activity

Question 12

What types of shoulder replacements are there?

Answer 12

• Anatomic
  
  • resurfacing the arthritic parts of the socket with plastic and the head with metal
  • fulcrum for power muscles still provided by rotator cuffs
  • can’t be done if there is a failure in the rotator cuff muscles
    
    • contraindicated in rotator cuff tear arthritis
• Reversed
  
  • creates a mechanical fulcrum for power muscles

Question 13

What is Frozen Shoulder?

• symptoms
• pathological cause
• aetiology/ risk factors

Answer 13

• Pathology: Inflamed thickened capsule
  
  • _​_idiopathic, posttraumatic, stroke
• Symptoms: Stiffness and Pain
  
  • and loss of PASSIVE motion (EXTERNAL ROTATION) - examiner can’t move the arm either
• X-ray normal
• 40-60 years old
• most commonly occurs in Females, Diabetics (difficult to treat)

Question 14

What is the treatment for Frozen Shoulder (Adhesive capsulitis)

Answer 14

Non-surgical

• Natural history is to resolve over 2 years - can be painful for patients
• Steroid Injections
• Hydrodilatation - trying to rupture the tight capsule

Surgical

• Capsular release and manipulation
  
  • arthroscopic capsular release - keyhole surgery to remove release the fibrous capsule and form a ring around the shoulder until muscle or bone can be seen

Question 15

What is Shoulder Instability

• aetiology/ risk factors

Answer 15

• in 95% of cases this is anterior dislocation of the join
• the Anterior labral ligament is torn (a Bankart lesion)
• the Younger age of first dislocation= higher chance of recurrence
• Risk factors
  
  • Collision sports
  • Hyperlaxity (younger patients)

Question 16

What is the treatment for Shoulder Instability?

Answer 16

Usually Surgical treatment

• Arthroscopic stabilisation - labral repair
• Open stabilisation - capsule tightening
• Bony procedures - augmenting glenoid

Question 17

What types of traumatic conditions are there?

Answer 17

Bony Trauma

• Fractures
• Dislocations

Soft Tissue Trauma

• Biceps Problems
• Pec Major Rupture

Question 18

What is the pathology in this individual?

• how can you tell?

Answer 18

Right shoulder Pec Major rupture

when they stand with hands-on-hips and squeeze

• the nipple drops lower
• and there is loss of contour of the axilla
• with bruising down the arm

Question 19

What pathology is seen in this image?

• how is it treated?

Answer 19

Proximal Humeral Fracture

• nails/ plates that go down the centre of the bone
• or other operative routes

Question 20

What pathology is seen in this image?

• How is it treated?

Answer 20

Acromioclavicular Joint Dislocation

• fix it down with sutures and anchors