MSK Shoulder Teaching Flashcards
what is the most common cause of anterior dislocation
FOOSH with abduction and externally rotated arm
what are the neurovascular risks of shoulder dislocation
axillary nerve damage
vascular damage
what other complications can happen from shoulder dislocation
Bankart lesion
Hill Sachs
associated fractures
rotator cuff injury
what is a Bankart lesion
avulsion injury of the glenoid labrum
A tear in the labrum leads the shoulder joint less stable, so the humeral head may move around
what is a hill-sach lesion
compresion fracture of the humeral head
when would you do a MRI for a rotator cuff tear
40-60 years old
to assess cuff integrity
what associated fractures can occur from a shoulder dislocation
proximal humeral head #
greater tuberosity #
occur during high energy dislocations
dont attempt to relocate
requires urgent surgery
how do you assess/manage nerve injury from shoulder dislocation
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
what extra information should be gained during shoulder dislocation Hx
mechanim of injury
hand dominance
functional status: occupation, use of shoulder
previous dislocation
FHx of joint laxity
what analgesia may be used for relocation of the shoulder
fentanyl, ketamine, etomidate, propofol
or intraarticular lidocaine
what are the different techniques for shoulder reduction
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
what should be done post attempt at reduction
XR
if irreducible requires opertation
what factors can affect repeat dislocation
inversely proportional to age
higher energy injury
damage of surrounding structures
more active lifestyle
how long is immobilisation generally required post dislocation
under 30 - 3 weeks
over 30 - 1-2 weeks
can start sports after 12 weeks
requires #clinic follow up
what are the surgical options for repeat dislocation
Latarjet - transfers the coracoid anteriorly to support the labarum
offered to under 25, those with Bankart lesions, high demand athletes or traumatic dislocations.
what can cause frozen shoulder
idiopathic
trauma
diabetes - 1/3
what is the pathology of frozen shoulder
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
what are the different ‘phases’ of frozen shoulder
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
what is the management for frozen shoulder
physio
NSAIDs
steriod injections
surgical: manipulation under anaesthesia, arthroscopic capsular release, saline distention
what are different causes for chronic vs acute subacromial pain
chronic:
tendon degradation, rubs against coracoid
supraspinatous most commonly
acute - tendon rupture
how would you expect subacromial pain to present (history and examination)
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
what does the empty watering can test assess
supraspinatous
which imaging is suitable for subacromial pain
MRI
can classify tendon tears and their thickness
what conservative management is available for subacromial pain
6 weeks of physiotherapy
NSAIDs
joint injections - no more than 2 as suspected to cause tendon damage
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
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
management of acromioclavicular joint dislocation
almost always conservative - RICE, and 6 weeks of physio
ORIF if needed
