Introduction to surgery of the shoulder Flashcards
Why is shoulder pain important?
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
Risk factors for shoulder pain
Sports related injuries
Traumatic injuries
Degenerative conditions
Work related conditions
Common shoulder symptoms
Pain
Stiffness
Weakness
Instability
Causes of shoulder pathology
Glenohumeral joint: arthritis, instability, frozen shoulder
Rotator cuff: tears, bursitis/ impingement/ calcific tendonitis
Bone trauma
Biceps, pec major
What stabilises the glenohumeral joint?
Rotator cuff (dynamic)
Capsule and labrum (static)
Rotator cuff muscles
Anterior shoulder
- supracapularis muscle
- supraspinatous muscle
Posterior shoulder
- teres minor muscle
- infraspinatous muscle
Rotator cuff role
Stabilise the GHJ
Provide a fulcrum for power muscles to move arm
- deltoid pec major
- trapezius
- lat dorsi
- teres major
Rotator cuff disorders
Subacromial impingement
Rotator cuff tears
Calcific tendonitis
Subacromial impingement
Common
Pain on abduction and rotation of arm
Felt over deltoid
Causes of subacromial impingement
Extrinsic
- bony spurs
Intrinsic
- tendinopathy/ cuff weakness
Treatment for subacromial impingement
Non surgical
- activity modification
- physiotherapy
Surgical
- subacromial decompression
- debridement of bony and soft tissue impinging areas
Rotator cuff tears
Most common- supraspinatus/ infraspinatus
Weakness and pain
Tendon degeneration is normal
15% in 60s have a full thickness tear
Repair if symptomatic
Glenohumeral disorders
Arthritis
Frozen shoulder
Instability
Glenohumeral arthritis
Osteoarthritis
Rheumatoid arthritis
Post traumatic arthritis
Symptoms of arthritis
Stiffness
Crepitus and grinding
Pain at rest and at night
Pain with activity
Types of shoulder replacement
Anatomic
- fulcrum for power muscles provided by rotator cuff
Reversed
- creates a mechanical fulcrum for power muscles
Frozen shoulder
Stiffness and pain
Loss of passive motion
X ray is normal
40-60 years old
Females
Diabetics
Pathology: inflamed thickened capsule
Frozen shoulder treatment
Non surgical
- natural history is to resolve over 2 years
- injections
- hydrodilatation
Surgical
- capsular release and manipulation
Shoulder instability
95% anterior dislocations
Younger age= higher change of recurrence
Anterior labral tear
Risk factors
- collision sports
- hyperlaxity
Surgical treatment of shoulder instability
Arthroscopic stabilisation- labral repair
Open stabilisation- capsule tightening
Bony procedures- augmenting glenoid
Traumatic injuries
Bony trauma
- fractures
- dislocation
Soft tissue trauma
- biceps problems
- pec major rupture
Shoulder trauma
Fractures
Dislocations
Soft tissue injuries
