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Y4 MSK > Ortho week 2 - shoulder pain > Flashcards

Ortho week 2 - shoulder pain Flashcards

1
Q

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

A

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

mechanical
- no morning stiffness
- pain worse on activity

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2
Q

What are some special tests for a shoulder exam ?

A
  • empty can test
  • lift off test
  • scarf test
  • hawkins-kennedy test
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3
Q

What does the ‘empty can test’ test for ?

A

supraspinatus muscle

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4
Q

What does the ‘lift off test’ test for ?

A

subscapularis muscle

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5
Q

What does the ‘scarf test’ test for ?

A

acromioclavicular joint (ACJ) pathology/integrity

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6
Q

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

A

supraspinatus impingement

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7
Q

How do you do the emtpy can test ?

A
  • 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

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8
Q

how do you do the lift off test ?

A
  • 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

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9
Q

how do you do the scarf test ?

A
  • 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

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10
Q

how do you do the hawkins-kennedy test ?

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

= can cause supraspinatus tendon impingement

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11
Q

What are the muscles of the rotator cuff ?

A

SITS

Subscapularis
Infraspinatus
Teres minor
Supraspinatus

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12
Q

What movement does the subscapularis muscle elicit ?

A

internal rotation

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13
Q

What movement does the infraspinatus muscle elicit ?

A

external rotation

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14
Q

What movement does the teres minor muscle elicit ?

A

external rotation

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15
Q

What movement does the supraspinatus muscle elicit ?

A

abduction

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16
Q

Which nerve supplies the deltoid muscle ?

A

axillary

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17
Q

Which nerve supplies the subscapularis muscle ?

A

upper and lower subscapular nerves

18
Q

Which nerve supplies the infraspinatus muscle ?

A

suprascapular nerve

19
Q

Which nerve supplies the teres minor muscle ?

A

axillary nerve

20
Q

Which nerve supplies the supraspinatus muscle ?

A

suprascapular nerve

21
Q

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

A

2 view plain XR

22
Q

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

A

2 view plain XR

23
Q

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

A
  • 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

24
Q

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

A
  • diabetes ? injection can raise blood sugars and increase risk of infection
  • anticoagulation
  • systematically well - not on antibiotics
  • allergies
25
Q

What do we inject joints with?

A

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

26
Q

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

A
  • infection (1 in 10,000)
  • failure to work
  • pain
  • worsening symptoms temporarily
  • bruising
  • bleeding
  • skin dimpling
27
Q

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

A

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

28
Q

What are the 2 causes of rotator cuff tears?

A

degenerative or traumatic

29
Q

What are tendons made of ?

A

type 1 collagen bundles

30
Q

What are the three phases of tendon repair ?

A
  1. inflammation
  2. proliferation
  3. remodelling
31
Q

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

A

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

32
Q

What type of areas are most common for tendon rupture ?

A
  • hypovascular areas e.g achilles
  • areas high in type III (new) collagen e.g after tendon damage and subsequent healing
33
Q

What are ligaments mainly made of ?

A

Type I collagen like tendons

34
Q

What do tendons attach together ?

A

muscle to bone

35
Q

What do ligaments attach together ?

A

bone to bone

36
Q

What are the three phases of ligament repair ?

A
  1. inflammation
  2. proliferation
  3. remodelling
37
Q

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

A

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

38
Q

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

A
  • Superior Gleno-Humeral Ligament (SGHL)
  • Middle Gleno-Humeral Ligament (MGHL)
  • Inferior Gleno-Humeral Ligament (IGHL)
39
Q

What is the socket called in the shoulder joint ?

A

The Glenoid

40
Q

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

A

supraspinatus and/or infraspinatus tendons

41
Q

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

A

asymptomatic tears should not undergo treatment

Y4 MSK (11 decks)

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