O: Shoulder Disorders

Question 1

epi of shoulder instability?

Answer 1

teenage- 30yo, sporty

Question 2

pathophysiology of shoulder instability?

Answer 2

occurs when lining of shoulder jt, ligaments or labrum become stretched/ torn/ detached allowing sub-laxation of ball of shoulder

Question 3

types of shoulder instabilities?

Answer 3

anterior dislocation, posterior, labral tear

Question 4

which of the 3 shoulder instabilities is most common?

Answer 4

anterior dislocation

Question 5

T/F: posterior dislocation occurs with repeated motion e.g. throwing a baseball

Answer 5

F: Labral tears occur with repeated motion

Question 6

s/s of shoulder instability

Answer 6

shoulder may give way, pain, dec ROM, holding arm, atraumatic laxity (chronic)

Question 7

on x-ray where would an anterior dislocation show?

Answer 7

below glenoid fossa, posterior dislocation would be above glenoid fossa

Question 8

what are 3 findings on exam for shoulder instability?

Answer 8

abnormal shoulder contour, tenderness, scapular winging

Question 9

mx for dislocation?

Answer 9

analgesics, O2, sedation. reduce

Question 10

what are the 3 methods to reduce shoulder dislocation?

Answer 10

Kocher Method
Hippocratic method
Stimson method

Question 11

how long is rehab for shoulder dislocation?

Answer 11

2-3 week sling, physio

Question 12

shoulder instability mx?

Answer 12

physio, 6 week sling/brace, 12 weeks no heavy lifting

Question 13

main complications of shoulder dislocation and their mx?

Answer 13

labral lesion= Bankart arthroscopic repair
Fracture of humeral head
fracture of glenoid
RC tear

Question 14

epi of rotator cuff impingement

Answer 14

<30yo, bilateral <5%

Question 15

aetiology of rotator cuff impingement

Answer 15

intrinsic: tendon vascularity, watershed area, tendon degeneration, cuff dysfunction
extrinsic: type of acromion jt, coraco- acromial ligament, clavicular osteophyte
trauma

Question 16

pathophysiology of impingement?

Answer 16

4 tendons pass under the acromio/ coracoacromial ligament, if space is narrowed then impingement of tendons can occur

Question 17

s/s of rotator cuff impingement?

Answer 17

pain originating in sub-acromial space, painful arc, pain may radiate to upper arm, trapezius may be painful

Question 18

special exam test for impingement?

Answer 18

hawkin’s, Jobe’s

Question 19

ix for impingement

Answer 19

AP & garth x-ray views, MRI

Question 20

conservative mx for impingement?

Answer 20

rest, pain, relief, physio, corticosteroid in subacromial space

Question 21

surgical mx of impingement?

Answer 21

subacromial decompression, acromioplasty, CA ligament release- rehab is painful and slow

Question 22

epigastric for rotator cuff tear?

Answer 22

50-60yo

Question 23

types of rotator cuff tear?

Answer 23

acute traumatic and chronic attrition (RA, elderly)

Question 24

s/s of rotator cuff tear?

Answer 24

weakness, pain

Question 25

ix for RC tear?

Answer 25

examination (wasting, weakness, supraspinatous test, Gerber’s test, Horn Blowers)
imaging- MRI if stiff, USS if good ROM

Question 26

mx of RC tear?

Answer 26

rest, analgesia, sling, physio, steroid injections

Question 27

arthroscopic repair of RC is indicated in…

Answer 27

young, recover may take 6-9months

Question 28

what is frozen shoulder?

Answer 28

condition of shoulder characterised by functional loss of active and passive shoulder ROM

Question 29

epi of frozen shoulder?

Answer 29

40-60s, F>M, bilateral common, sudden onset and atraumatic

Question 30

aetiology of frozen shoulder?

Answer 30

diabetes, Dupytren’s contracture, RC pathology, hemiplegia, chest/breast surgery

Question 31

pathophysiology of frozen shoulder (adhesive capsulitis)

Answer 31

inflammatory process leading to fibroplastic proliferation of jt capsule > thickening & adherence of capsule to humerus

Question 32

stages of frozen shoulder disease?

Answer 32

freezing (pain felt) > frozen (no ROM) > thawing (healing)

Question 33

s/s of frozen shoulder?

Answer 33

gradual severe pain, decreased ROM

Question 34

which ROM is significantly impaired with adhesive capsulitis?

Answer 34

external rotation <50% of normal

Question 35

ix for frozen shoulder

Answer 35

arthroscopy (fibrinous synovitis & contraction) + exam

Question 36

mx for frozen shoulder?

Answer 36

self-limiting (3-4yrs)- analgesia, physio, GH steroid injection
op- anaesthetic manipulation, arthroscopic capsular release