MSK Shoulder Teaching

Question 1

what is the most common cause of anterior dislocation

Answer 1

FOOSH with abduction and externally rotated arm

Question 2

what are the neurovascular risks of shoulder dislocation

Answer 2

axillary nerve damage
vascular damage

Question 3

what other complications can happen from shoulder dislocation

Answer 3

Bankart lesion
Hill Sachs
associated fractures
rotator cuff injury

Question 4

what is a Bankart lesion

Answer 4

avulsion injury of the glenoid labrum
A tear in the labrum leads the shoulder joint less stable, so the humeral head may move around

Question 5

what is a hill-sach lesion

Answer 5

compresion fracture of the humeral head

Question 6

when would you do a MRI for a rotator cuff tear

Answer 6

40-60 years old
to assess cuff integrity

Question 7

what associated fractures can occur from a shoulder dislocation

Answer 7

proximal humeral head #
greater tuberosity #

occur during high energy dislocations
dont attempt to relocate
requires urgent surgery

Question 8

how do you assess/manage nerve injury from shoulder dislocation

Answer 8

axillary nerve most commonly affected
test regimental badge area
assess abduction past 15 degrees
assess before and after reduction

conservative management/ physio for 4 weeks
then nerve conduction studies
refer to nerve rehab centre

Question 9

what extra information should be gained during shoulder dislocation Hx

Answer 9

mechanim of injury
hand dominance
functional status: occupation, use of shoulder
previous dislocation
FHx of joint laxity

Question 10

what analgesia may be used for relocation of the shoulder

Answer 10

fentanyl, ketamine, etomidate, propofol

or intraarticular lidocaine

Question 11

what are the different techniques for shoulder reduction

Answer 11

scapular manipulation
traction/ countertraction
kocher - abduct and extend then bring across
hippocratic - foot in the axilla and pull
stimsons- prone with arm dangling and pull

Question 12

what should be done post attempt at reduction

Answer 12

XR
if irreducible requires opertation

Question 13

what factors can affect repeat dislocation

Answer 13

inversely proportional to age
higher energy injury
damage of surrounding structures
more active lifestyle

Question 14

how long is immobilisation generally required post dislocation

Answer 14

under 30 - 3 weeks
over 30 - 1-2 weeks

can start sports after 12 weeks

requires #clinic follow up

Question 15

what are the surgical options for repeat dislocation

Answer 15

Latarjet - transfers the coracoid anteriorly to support the labarum

offered to under 25, those with Bankart lesions, high demand athletes or traumatic dislocations.

Question 16

what can cause frozen shoulder

Answer 16

idiopathic
trauma
diabetes - 1/3

Question 17

what is the pathology of frozen shoulder

Answer 17

capule adheres to joint which limits movement
fibroblastic proliferation and myofibroblast change
most common in 40-70 year olds
there is global reduction is active and passive movements, especially external rotation

Question 18

what are the different ‘phases’ of frozen shoulder

Answer 18

1 - pain
2-9 months, constant progressive pain, still has movement

2- freezing
4-12 months, stiffening, gradual reduction in pain

3 - thawing
12-42 months, gradual improvement in range of motion

Question 19

what is the management for frozen shoulder

Answer 19

physio
NSAIDs
steriod injections

surgical: manipulation under anaesthesia, arthroscopic capsular release, saline distention

Question 20

what are different causes for chronic vs acute subacromial pain

Answer 20

chronic:
tendon degradation, rubs against coracoid
supraspinatous most commonly

acute - tendon rupture

Question 21

how would you expect subacromial pain to present (history and examination)

Answer 21

pain on top lateral side of shoulder
exaggerated by overhead activity
may not have Hx of trauma

loss of active movement due to pain but full passive movement

Question 22

what does the empty watering can test assess

Answer 22

supraspinatous

Question 23

which imaging is suitable for subacromial pain

Answer 23

MRI
can classify tendon tears and their thickness

Question 24

what conservative management is available for subacromial pain

Answer 24

6 weeks of physiotherapy
NSAIDs
joint injections - no more than 2 as suspected to cause tendon damage

Question 25

how do you decide the treatment options for subacromial pain

Answer 25

older, sedentary, chronic - trial conservative

active, young, acute - proceed straight to surgery (subacromial decompression or rotator cuff repair, or tendon transfer ) needs to be done within 6 weeks

Question 26

what is the presentation of acromioclavicular joint dislocation

Answer 26

common in athletes
superficial pain over AC joint
pseudo elevation of lateral clavicle
impaired mobility
scarf test

Question 27

management of acromioclavicular joint dislocation

Answer 27

almost always conservative - RICE, and 6 weeks of physio

ORIF if needed