Regional Adult Orthopedics - Shoulder

Question 1

What type of joint is the shoulder joint?

Answer 1

ball and socket synovial joint

Question 2

What is the shoulder joint made up of?

Answer 2

humeral head and the scapular glenoid

Question 3

What is the shoulder girdle made up of?

Answer 3

the scapula, the clavicle, the proximal humerus

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

Question 4

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

Answer 4

T

Question 5

Which muscles are external rotators of the shoulder?

Answer 5

infraspinatus and teres minor are external rotators

on the outside IT rotates!

Question 6

What does SITS represent in anatomy?

Answer 6

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

The subscapularis attaching the the lesser tubercle

Question 7

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

Answer 7

T

Question 8

Which muscles are responsible for abduction?

Answer 8

Supraspinatus is responsible for initiation of abduction

Deltoid takes over after first 15 degrees

Question 9

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

Answer 9

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

Question 10

Rotator cuff instability can lead to what condition? Where?

Answer 10

glenohumeral OA

Question 11

young adult with pain in shoulder

Answer 11

instability

Question 12

middle aged pain in shoulder

Answer 12

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

Question 13

Ancient with pain in shoulder

Answer 13

glenohumeral OA

Question 14

What is impingement syndrome?

Answer 14

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

Question 15

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

Answer 15

Impingement syndrome

Question 16

What are possible causes of impingement syndrome?

Answer 16

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

Question 17

Treatment impingement syndrome?

Answer 17

NSAIDs, analgesics, physiotherapy and subacromial injection of steroid

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

Question 18

subacromial decompression surgery can be open or keyhole

Answer 18

T

Question 19

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

Answer 19

T

Question 20

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

Answer 20

ROTATOR CUFF TEAR

Question 21

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

Answer 21

T

Question 22

Which muscle in rotator cuff usually tears?

Answer 22

Supraspinatous

Question 23

Weakness of initiation of abduction suggests ?

Answer 23

Supraspinatous torn

Question 24

Weakness of internal rotation suggests?

Answer 24

subscapularis tear

Question 25

Weakness of external rotation suggests?

Answer 25

Infraspinatous tear

Question 26

The optimal treatment for rotator cuff tears is mostly conservative

Answer 26

F | controversial

Question 27

How can you confirm rotator cuff tear?

Answer 27

Ultrasound or MRI

Question 28

Non operative treatment for rotator cuff tears?

Answer 28

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

Question 29

Operative treatment for rotator cuff tears? Cons?

Answer 29

Rotator cuff repair with subacromial decompression - However tendon is usually diseased and failure occurs in 1/3 - large tears may be irrepable

Question 30

Aged 50 Diabetic painful and stiff shoulder Loss of external rotation

Answer 30

Adhesive capsulitis (frozen shoulder)

Question 31

Time evolution of adhesive capsulitis?

Answer 31

pain will subside as stiffness increases Stiffness "thaws out" with time everything clears up within 2 yrs

Question 32

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

Answer 32

Dupuytren’s disease

Question 33

Treatment of frozen shoulder?

Answer 33

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)

Question 34

Acute onset severe shoulder pain

Answer 34

acute calcific tendonitis

Question 35

What causes acute calcific tendonitis

Answer 35

calcium deposition in the supraspinatus tendon

Question 36

How to confirm acute calcific tendonitis?

Answer 36

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

Question 37

Acute calcific tendonitis is sself‐limitin

Answer 37

T | calcification resorbs = pain eases

Question 38

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

Answer 38

painful abnormal translational movement or subluxation and/or recurrent dislocation traumatic/atraumatic

Question 39

Traumatic shoulder dislocations always settle with conservative management

Answer 39

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

Question 40

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

Answer 40

T

Question 41

How do you treat recurrent dislocations in traumatic instability?

Answer 41

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

Question 42

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

Answer 42

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

Question 43

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

Answer 43

F | Treatment is difficult as soft tissue procedures may not work.

Question 44

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

Answer 44

T

Question 45

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

Answer 45

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