Ortho week 2 - shoulder pain Flashcards by Ellie Kendall

What are the differences between mechanical Vs inflammatory pain regarding morning stiffness and activity ?

inflammatory
- morning stiffness >30mins
- pain better on activity

mechanical
- no morning stiffness
- pain worse on activity

How well did you know this?

Not at all

Perfectly

What are some special tests for a shoulder exam ?

empty can test
lift off test
scarf test
hawkins-kennedy test

How well did you know this?

Not at all

Perfectly

What does the ‘empty can test’ test for ?

supraspinatus muscle

How well did you know this?

Not at all

Perfectly

What does the ‘lift off test’ test for ?

subscapularis muscle

How well did you know this?

Not at all

Perfectly

What does the ‘scarf test’ test for ?

acromioclavicular joint (ACJ) pathology/integrity

How well did you know this?

Not at all

Perfectly

What does the ‘hawkins-kennedy test’ test for ?

supraspinatus impingement

How well did you know this?

Not at all

Perfectly

How do you do the emtpy can test ?

sit Pt upright
position Pt arm out at about 30°abduction and 30° forward
rotate arm so doursum faces forward
ask Pt to put down their thumb
apply force downwards and ask Pt to resist

click or pop in shoulder = biceps tendinitis

unable to resist = possible tear of tendon

How well did you know this?

Not at all

Perfectly

how do you do the lift off test ?

sit Pt upright or can stand
ask patient to place arm behind back so dorsum touches lumbar spine
stabilise/isolate the elbow
ask Pt to lift hand away from back
add resistance

pain/unable = subscapularis muscle injury or tear

How well did you know this?

Not at all

Perfectly

how do you do the scarf test ?

sit Pt upright
position hand on opposite shoulder
hold patient at opposite shoulder for stability
push pt arm across body (resistance)

pain across AC joint of shoulder = potential pathology

How well did you know this?

Not at all

Perfectly

how do you do the hawkins-kennedy test ?

sit Pt upright
position arm forward 90°, horizontally flexed at elbow and adducted 30°
medially rotate arm (downwards)

= can cause supraspinatus tendon impingement

How well did you know this?

Not at all

Perfectly

What are the muscles of the rotator cuff ?

SITS

Subscapularis
Infraspinatus
Teres minor
Supraspinatus

How well did you know this?

Not at all

Perfectly

What movement does the subscapularis muscle elicit ?

internal rotation

How well did you know this?

Not at all

Perfectly

What movement does the infraspinatus muscle elicit ?

external rotation

How well did you know this?

Not at all

Perfectly

What movement does the teres minor muscle elicit ?

external rotation

How well did you know this?

Not at all

Perfectly

What movement does the supraspinatus muscle elicit ?

abduction

How well did you know this?

Not at all

Perfectly

Which nerve supplies the deltoid muscle ?

axillary

How well did you know this?

Not at all

Perfectly

Which nerve supplies the subscapularis muscle ?

upper and lower subscapular nerves

Which nerve supplies the infraspinatus muscle ?

suprascapular nerve

Which nerve supplies the teres minor muscle ?

axillary nerve

Which nerve supplies the supraspinatus muscle ?

suprascapular nerve

What initial investigation would you do in a patient presenting with mechanical shoulder pain ?

2 view plain XR

What initial investigation would you do in a patient presenting to orthopaedic clinic ?

2 view plain XR

What are the treatment options in a rotator cuff tear injury ?

analgesia + physio therapy
steroid + local anaesthetic injection to joint
surgical repair

which option is used depends on Pt preference, occupation, general health and arthritic status

What must you consider in a patient who is eligible for steroid + local anaesthetic injection ?

diabetes ? injection can raise blood sugars and increase risk of infection
anticoagulation
systematically well - not on antibiotics
allergies

What do we inject joints with?

**steroid** - for inflammation reduction **local anaesthetic** - increase volume of injection and provide analgesia

What are some potential side effects of the steroid + local anaesthetic injection ?

- infection (1 in 10,000) - failure to work - pain - worsening symptoms temporarily - bruising - bleeding - skin dimpling

What impact does a steroid and local anaesthetic injection have on future management ?

no surgical intervention with implants allowed within 3 months minimum *due to higher risk of infection*

What are the 2 causes of rotator cuff tears?

degenerative or traumatic

What are tendons made of ?

type 1 collagen bundles

What are the three phases of tendon repair ?

1. inflammation 2. proliferation 3. remodelling

in the proliferative phase of tendon repair what types of collagen are found ?

type III collagen (new) is replaced with type I collagen (mature)

What type of areas are most common for tendon rupture ?

- hypovascular areas *e.g achilles* - areas high in type III *(new)* collagen *e.g after tendon damage and subsequent healing*

What are ligaments mainly made of ?

Type I collagen *like tendons*

What do tendons attach together ?

muscle to bone

What do ligaments attach together ?

bone to bone

What are the three phases of ligament repair ?

1. inflammation 2. proliferation 3. remodelling

What occurs in the remodelling phase of tendon and ligament repair ?

New Type III collagen is made in the proliferative phase, and it’s **turned into type I collagen** in the remodelling phase

What are the three ligaments of the Glenn-Humeral Joint called ?

- **Superior** Gleno-Humeral Ligament **(SGHL)** - **Middle** Gleno-Humeral Ligament **(MGHL)** - **Inferior** Gleno-Humeral Ligament **(IGHL)**

What is the socket called in the shoulder joint ?

The Glenoid

Which tendons are most commonly involved in a shoulder related tear injury ?

supraspinatus and/or infraspinatus tendons

If a tendon tear is asymptomatic, what are the treatment options ?

asymptomatic tears should not undergo treatment