Introduction to Surgery of the Shoulder Flashcards
Why is Shoulder Pain Important?
- … most common MSK consultation in GP practice
- …% adults each year visit GP with shoulder pain
- …% of adults self reported prevalence of shoulder pain
- 3rd most common MSK consultation in GP practice
- 1% adults each year visit GP with shoulder pain
- 25% of adults self reported prevalence of shoulder pain
Shoulder pain is the … most common MSK consultation in GP practice
Shoulder pain is the 3rd most common MSK consultation in GP practice
What % of adults each year visit GP with shoulder pain?
1% adults each year visit GP with shoulder pain
What % of adults self reported prevalence of shoulder pain?
25% of adults self reported prevalence of shoulder pain
Common Shoulder Symptoms
- Pain
- Stiffness
- Weakness
- Instability
The shoulder is an Inherently … Joint
The shoulder is an Inherently unstable Joint
Glenohumeral Joint Stability
- Static stabilisers - C… and L
- Dynamic stabilisers - … … Muscles
- Static stabilisers - Capsule and Labrum
- Dynamic stabilisers - Rotator Cuff Muscles
What are these muscles called?
Rotator cuff muscles (named based on position on scapula)
Anterior shoulder - … (rotator cuff muscle) - internal rotation
Anterior shoulder - subscapularis (rotator cuff muscle) - internal rotation
Posterior shoulder - …, …, … (rotator cuff muscles) - external rotation
Posterior shoulder - Supraspinatus, Infraspinatus, Teres minor (rotator cuff muscles) - external rotation
Rotator cuff muscles - Tendon - attachment to bones
Rotator Cuff Biomechanics
- Rotator cuff - work in … couples
- Not working - one of their roles keeps head … against glenoid, deltoid and pec cause instability type force on humeral head
- Rotator cuff - work in force couples
- A force couple is a system that exerts a resultant movement, but no resultant force. Two equal and opposite forces exert a purely rotation force. In the shoulder the body is the humeral head and the equal but opposite forces are the rotator cuff muscles.
- Not working - one of their roles keeps head pressed against glenoid, deltoid and pec cause instability type force on humeral head
Rotator Cuff Role
- Stabilise the … Joint
- Provide a … for power muscles to move arm
- Stabilise the Glenohumeral Joint
- Provide a FULCRUM for power muscles to move arm
Superficial ‘Power’ Muscles include
- Deltoid
- Pec major
Risk Factors for Shoulder Pain
- … related injuries
- … injuries
- … conditions
- … related conditions
- Sports related injuries
- Traumatic injuries
- Degenerative conditions
- Work related conditions
Causes of Shoulder Pain
- … space
- Can get … arthritis, Rotator cuff …, calcific …
-
Subacromial space - region underneath the acromion and humeral head - rotator cuff tendon reside
- Can get ACJ arthritis, Rotator cuff tears, calcific tendonitis
Subacromial region
can cause shoulder pain
Subacromial Impingement
- Is it Common?
- Pain on … & … of arm
- Felt over …
- Cause:
- Extrinsic
- … spurs
- Intrinsic:
- …/… weakness
- Extrinsic
- Common
- Pain on abduction & rotation of arm
- Felt over deltoid
- Cause:
- Extrinsic
- Bony spurs
- Intrinsic:
- Tendinopathy/cuff weakness
- Extrinsic
Treatment for Subacromial Impingement
- Non surgical
- … modification
- …therapy
- Surgical
- Subacromial …
- … of bony and soft tissue impinging areas
- Subacromial …
- Non surgical
- Activity modification
- Physiotherapy
- Surgical
- Subacromial decompression
- Debridement of bony and soft tissue impinging areas
- Subacromial decompression
Subacromial decompression is an operation on your shoulder which treats a condition called shoulder …
Subacromial decompression is an operation on your shoulder which treats a condition called shoulder impingement
An … is a type of keyhole surgery used to diagnose and treat problems with joints.
An arthroscopy is a type of keyhole surgery used to diagnose and treat problems with joints.
Rotator Cuff Tears
- Most common - …/…
- Weakness & Pain
- Tendon … is normal
- …% in 60’s have a full thickness tear
- Repair if …
- Most common - supraspinatus/infraspinatus
- Weakness & Pain
- Tendon degeneration is normal
- 15% in 60’s have a full thickness tear
- Repair if symptomatic
Most common Rotator cuff tears in which muscles?
supraspinatus/infraspinatus
Rotator cuff tears present with … and …
weakness and pain
Rotator cuff tears - …% in 60’s have a full thickness tear
15% in 60’s have a full thickness tear
Glenohumeral Joint Problems
- O..
- I…
- … shoulder
- Osteoarthritis
- Instability
- Frozen shoulder
Glenohumeral Arthritis
- O..
- R.. Arthritis
- Post … arthritis
- Osteoarthritis
- Rheumatoid Arthritis
- Post traumatic arthritis
Symptoms of Arthritis - Shoulder
- S…
- C.. & g…
- Pain at … and at …
- Pain with …
- Stiffness
- Crepitus & grinding
- Pain at rest and at night
- Pain with activity
Rotator cuff arthritis
Rotator cuff tear arthropathy is a type of shoulder arthritis that can develop after a massive and prolonged rotator cuff tear.
Rotator Cuff Tear Arthritis - 68yo retired nurse
Shoulder arthritis treatment is a shoulder …
Shoulder arthritis treatment is a shoulder replacement
Shoulder replacement
- Anatomic
- Fulcrum for power muscles provided by … …
- Reversed
- Creates a … fulcrum for power muscles
- Anatomic
- Fulcrum for power muscles provided by rotator cuff
- Reversed
- Creates a mechanical fulcrum for power muscles
Frozen Shoulder - Adhesive Capsulitis
- Pathology = … thickened …
- Presents with … and Pain, Loss of … motion (EXTERNAL ROTATION)
- X ray …
- Most common in …-… years old
- More common in …
- Especially common in D…
- Pathology = Inflamed thickened capsule
- Presents with Stiffness and Pain, Loss of PASSIVE motion (EXTERNAL ROTATION)
- X ray normal
- 40-60 years old
- More common in Females
- Especially common in Diabetics
Frozen Shoulder Treatment
- Non-…
- Natural history is to resolve over … years
- Injections
- Hydro…
- If fails - Surgical
- … release and manipulation
- Non surgical
- Natural history is to resolve over 2 years
- Injections
- Hydrodilatation
- If fails - Surgical
- Capsular release and manipulation
Arthroscopic capsular release is a surgical procedure to improve movement in the shoulder. A stiff shoulder may sometimes be called a ‘… shoulder’;
Arthroscopic capsular release is a surgical procedure to improve movement in the shoulder. A stiff shoulder may sometimes be called a ‘frozen shoulder’;
Shoulder Instability
- …% anterior dislocations
- … age = higher chance of recurrence
- Anterior labral tear (bankart lesion)
- Risk factors
- … sports
- Hyper…
- 95% anterior dislocations
- Younger age = higher chance of recurrence
- Anterior labral tear (bankart lesion)
- Risk factors
- Collision sports
- Hyperlaxity
95% of shoulder dislocations are … dislocations
95% of shoulder dislocations are anterior dislocations
… age = higher chance of recurrence of shoulder dislocation
Younger age = higher chance of recurrence of shoulder dislocation
Surgical Treatment for Shoulder Dislocation
- … stabilisation - labral repair
- Open stabilisation - … tightening
- Bony procedures - augmenting …
- Arthroscopic stabilisation - labral repair
- Open stabilisation - capsule tightening
- Bony procedures - augmenting glenoid
Arthroscopic stabilisation (key hole)
Traumatic Conditions - Shoulder
- Bony Trauma
- F…
- D…
- Soft Tissue Trauma
- … Problems
- Pec … Rupture
- Bony Trauma
- Fractures
- Dislocations
- Soft Tissue Trauma
- Biceps Problems
- Pec Major Rupture
Shoulder Trauma
- Fractures
- Dislocations
- Soft tissue injuries
Proximal Humeral Fractures
- Common
- Nails for treatment, or plates, or non operative
Acromioclavicular Joint Dislocations
- An AC joint separation, often called a shoulder separation, is a dislocation of the clavicle from the acromion.
- Issues with Shoulder blade movement
Anatomically, why is impingement of the supraspinatus tendon a common sports injury?
Shoulder impingement syndrome is the result of a vicious cycle of rubbing of the rotator cuff between your humerus and top outer edge of your shoulder.
Supraspinatus tendinopathy is a common source of shoulder pain in athletes that participate in overhead sports
