MSK Shoulder Teaching Flashcards

1
Q

what is the most common cause of anterior dislocation

A

FOOSH with abduction and externally rotated arm

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2
Q

what are the neurovascular risks of shoulder dislocation

A

axillary nerve damage
vascular damage

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3
Q

what other complications can happen from shoulder dislocation

A

Bankart lesion
Hill Sachs
associated fractures
rotator cuff injury

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4
Q

what is a Bankart lesion

A

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

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5
Q

what is a hill-sach lesion

A

compresion fracture of the humeral head

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6
Q

when would you do a MRI for a rotator cuff tear

A

40-60 years old
to assess cuff integrity

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7
Q

what associated fractures can occur from a shoulder dislocation

A

proximal humeral head #
greater tuberosity #

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

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8
Q

how do you assess/manage nerve injury from shoulder dislocation

A

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

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9
Q

what extra information should be gained during shoulder dislocation Hx

A

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

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10
Q

what analgesia may be used for relocation of the shoulder

A

fentanyl, ketamine, etomidate, propofol

or intraarticular lidocaine

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11
Q

what are the different techniques for shoulder reduction

A

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

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12
Q

what should be done post attempt at reduction

A

XR
if irreducible requires opertation

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13
Q

what factors can affect repeat dislocation

A

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

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14
Q

how long is immobilisation generally required post dislocation

A

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

can start sports after 12 weeks

requires #clinic follow up

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15
Q

what are the surgical options for repeat dislocation

A

Latarjet - transfers the coracoid anteriorly to support the labarum

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

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16
Q

what can cause frozen shoulder

A

idiopathic
trauma
diabetes - 1/3

17
Q

what is the pathology of frozen shoulder

A

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

18
Q

what are the different ‘phases’ of frozen shoulder

A

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

19
Q

what is the management for frozen shoulder

A

physio
NSAIDs
steriod injections

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

20
Q

what are different causes for chronic vs acute subacromial pain

A

chronic:
tendon degradation, rubs against coracoid
supraspinatous most commonly

acute - tendon rupture

21
Q

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

A

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

22
Q

what does the empty watering can test assess

A

supraspinatous

23
Q

which imaging is suitable for subacromial pain

A

MRI
can classify tendon tears and their thickness

24
Q

what conservative management is available for subacromial pain

A

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

25
how do you decide the treatment options for subacromial pain
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
26
what is the presentation of acromioclavicular joint dislocation
common in athletes superficial pain over AC joint pseudo elevation of lateral clavicle impaired mobility scarf test
27
management of acromioclavicular joint dislocation
almost always conservative - RICE, and 6 weeks of physio ORIF if needed