O: Shoulder Disorders Flashcards
epi of shoulder instability?
teenage- 30yo, sporty
pathophysiology of shoulder instability?
occurs when lining of shoulder jt, ligaments or labrum become stretched/ torn/ detached allowing sub-laxation of ball of shoulder
types of shoulder instabilities?
anterior dislocation, posterior, labral tear
which of the 3 shoulder instabilities is most common?
anterior dislocation
T/F: posterior dislocation occurs with repeated motion e.g. throwing a baseball
F: Labral tears occur with repeated motion
s/s of shoulder instability
shoulder may give way, pain, dec ROM, holding arm, atraumatic laxity (chronic)
on x-ray where would an anterior dislocation show?
below glenoid fossa, posterior dislocation would be above glenoid fossa
what are 3 findings on exam for shoulder instability?
abnormal shoulder contour, tenderness, scapular winging
mx for dislocation?
analgesics, O2, sedation. reduce
what are the 3 methods to reduce shoulder dislocation?
Kocher Method
Hippocratic method
Stimson method
how long is rehab for shoulder dislocation?
2-3 week sling, physio
shoulder instability mx?
physio, 6 week sling/brace, 12 weeks no heavy lifting
main complications of shoulder dislocation and their mx?
labral lesion= Bankart arthroscopic repair
Fracture of humeral head
fracture of glenoid
RC tear
epi of rotator cuff impingement
<30yo, bilateral <5%
aetiology of rotator cuff impingement
intrinsic: tendon vascularity, watershed area, tendon degeneration, cuff dysfunction
extrinsic: type of acromion jt, coraco- acromial ligament, clavicular osteophyte
trauma
pathophysiology of impingement?
4 tendons pass under the acromio/ coracoacromial ligament, if space is narrowed then impingement of tendons can occur
s/s of rotator cuff impingement?
pain originating in sub-acromial space, painful arc, pain may radiate to upper arm, trapezius may be painful
special exam test for impingement?
hawkin’s, Jobe’s
ix for impingement
AP & garth x-ray views, MRI
conservative mx for impingement?
rest, pain, relief, physio, corticosteroid in subacromial space
surgical mx of impingement?
subacromial decompression, acromioplasty, CA ligament release- rehab is painful and slow
epigastric for rotator cuff tear?
50-60yo
types of rotator cuff tear?
acute traumatic and chronic attrition (RA, elderly)
s/s of rotator cuff tear?
weakness, pain
ix for RC tear?
examination (wasting, weakness, supraspinatous test, Gerber’s test, Horn Blowers)
imaging- MRI if stiff, USS if good ROM
mx of RC tear?
rest, analgesia, sling, physio, steroid injections
arthroscopic repair of RC is indicated in…
young, recover may take 6-9months
what is frozen shoulder?
condition of shoulder characterised by functional loss of active and passive shoulder ROM
epi of frozen shoulder?
40-60s, F>M, bilateral common, sudden onset and atraumatic
aetiology of frozen shoulder?
diabetes, Dupytren’s contracture, RC pathology, hemiplegia, chest/breast surgery
pathophysiology of frozen shoulder (adhesive capsulitis)
inflammatory process leading to fibroplastic proliferation of jt capsule > thickening & adherence of capsule to humerus
stages of frozen shoulder disease?
freezing (pain felt) > frozen (no ROM) > thawing (healing)
s/s of frozen shoulder?
gradual severe pain, decreased ROM
which ROM is significantly impaired with adhesive capsulitis?
external rotation <50% of normal
ix for frozen shoulder
arthroscopy (fibrinous synovitis & contraction) + exam
mx for frozen shoulder?
self-limiting (3-4yrs)- analgesia, physio, GH steroid injection
op- anaesthetic manipulation, arthroscopic capsular release
