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MSK > Regional Adult Orthopedics - Shoulder > Flashcards

Regional Adult Orthopedics - Shoulder Flashcards

1
Q

What type of joint is the shoulder joint?

A

ball and socket synovial joint

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2
Q

What is the shoulder joint made up of?

A

humeral head and the scapular glenoid

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3
Q

What is the shoulder girdle made up of?

A

the scapula, the clavicle, the proximal humerus

Deltoid, muscles of rotator cuff (Supraspinatous, Infraspinatous, Teres Minor, Subscapularis)

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4
Q

the shoulder joint is dependent on the surrounding musculature for stability with the rotator cuff muscles providing an essential role

A

T

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5
Q

Which muscles are external rotators of the shoulder?

A

infraspinatus and teres minor are external rotators

on the outside IT rotates!

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6
Q

What does SITS represent in anatomy?

A

The supraspinatous, infraspinatous and teres major attaching to the greater tubercle of the humerus

The subscapularis attaching the the lesser tubercle

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7
Q

Subscapularis attaches to the lesser tuberosity and is the principal internal rotator.

A

T

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8
Q

Which muscles are responsible for abduction?

A

Supraspinatus is responsible for initiation of abduction

Deltoid takes over after first 15 degrees

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9
Q

Collectively the rotator cuff muscles serve the crucial function of pulling the humeral head into the glenoid to do what?

A

provide a stable fulcrum for the powerful deltoid muscle to abduct the arm

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10
Q

Rotator cuff instability can lead to what condition? Where?

A

glenohumeral OA

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11
Q

young adult with pain in shoulder

A

instability

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12
Q

middle aged pain in shoulder

A

rotator cuff tears (grey hair, cuff tear) and frozen shoulder

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13
Q

Ancient with pain in shoulder

A

glenohumeral OA

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14
Q

What is impingement syndrome?

A

he tendons of the rotator cuff (predominantly supraspinatus) are compressed in the tight subacromial space during movement producing pain.

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15
Q

painful arc (60-120 degrees)
pain in upper arm
Tenderness lateral edge of acromion
+ve Hawkin’s Kennedy

A

Impingement syndrome

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16
Q

What are possible causes of impingement syndrome?

A
  • Inflamed subacromial bursa (tendonitis subacromial bursitis)
  • Acromioclavicular OA with inferior osteophyyte
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17
Q

Treatment impingement syndrome?

A

NSAIDs, analgesics, physiotherapy and subacromial injection of steroid

Cases which do not improve with these interventions may benefit from subacromial decompression surgery

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18
Q

subacromial decompression surgery can be open or keyhole

A

T

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19
Q

The tendons of the rotator cuff can tear with minimal or no trauma as a consequence of degenerate changes in the tendons.

A

T

20
Q

> 40 yrs old
sudden jerk while holding bus rail
pain and weakness in shoulder after incident
Wasting supraspinatous

A

ROTATOR CUFF TEAR

21
Q

At least 20% of over 60 year olds have asymptomatic cuff tears due to tendon degeneration

A

T

22
Q

Which muscle in rotator cuff usually tears?

A

Supraspinatous

23
Q

Weakness of initiation of abduction suggests ?

A

Supraspinatous torn

24
Q

Weakness of internal rotation suggests?

A

subscapularis tear

25
Q

Weakness of external rotation suggests?

A

Infraspinatous tear

26
Q

The optimal treatment for rotator cuff tears is mostly conservative

A

F

controversial

27
Q

How can you confirm rotator cuff tear?

A

Ultrasound or MRI

28
Q

Non operative treatment for rotator cuff tears?

A

physiotherapy to strengthen up the remaining cuff muscles which can compensate
Subacromial injections help with pain

29
Q

Operative treatment for rotator cuff tears? Cons?

A

Rotator cuff repair with subacromial decompression

  • However tendon is usually diseased and failure occurs in 1/3
  • large tears may be irrepable
30
Q

Aged 50

Diabetic

painful and stiff shoulder

Loss of external rotation

A

Adhesive capsulitis (frozen shoulder)

31
Q

Time evolution of adhesive capsulitis?

A

pain will subside as stiffness increases

Stiffness “thaws out” with time

everything clears up within 2 yrs

32
Q

Which other disease also features thickened fascial tissue and is assoc with frozen shoulder?

A

Dupuytren’s disease

33
Q

Treatment of frozen shoulder?

A

Physiotherapy and analgesics

Glenohumeral steroid injections

If P. can’t tolerate functional loss recovery catalysed by manipulation under anaesthetic or division of capsule (improves motion)

34
Q

Acute onset severe shoulder pain

A

acute calcific tendonitis

35
Q

What causes acute calcific tendonitis

A

calcium deposition in the supraspinatus tendon

36
Q

How to confirm acute calcific tendonitis?

A

calcium deposite can be seen on xray just proximal to the greater tuberosity

37
Q

Acute calcific tendonitis is sself‐limitin

A

T

calcification resorbs = pain eases

38
Q

What does instability involve? What are the two subtypes of instability?

A

painful abnormal translational movement or subluxation and/or recurrent dislocation

traumatic/atraumatic

39
Q

Traumatic shoulder dislocations always settle with conservative management

A

F

MAY stabilise with rest and physio (more likely the older you are)

40
Q

In traumatic shoulder dislocations age at time of first dislocation predicts the likelihood of further dislocations with 80% re‐dislocation rate in under 20s and 20% re‐dislocation rate in over 30s

A

T

41
Q

How do you treat recurrent dislocations in traumatic instability?

A

Bankart repair - reattaches the labrum and capsule to the anterior glenoid which was torn off in the first dislocation.

42
Q

What is the main cause of atraumatic instability? What conditions precipitate this?

A

Ligamentous laxity - Ehler Danos, Marfans (can be idiopathic)

43
Q

Bankart repair can be used to treat recurrent dislocations from atraumatic instability

A

F

Treatment is difficult as soft tissue procedures may not work.

44
Q

Traumatic instability usually results in anterior dislocation while atraumatic instability is usually recurrent multidirectional

A

T

45
Q

What other conditions can cause referred pain to the shoulder? (2)

A

angina pectoris and diaphragmatic irritation (biliary colic, hepatic or subphrenic abscess)

MSK (8 decks)

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