S H O U L D E R Flashcards
what are the rotator cuff muscles of the shoulder
SITS
- supraspinatous
- infraspinatous
- teres minor
- subscapularis
what is adhesive capsulitis
as ‘frozen shoulder’, adhesive capsulitis refers to contraction of the glenohumeral joint capsule to the humeral head, resulting in decreased range of movement and pain.
presentation of adhesive capsulitis in 3 stages
Freezing and painful
Frozen and stiff
Thawing (improving ROM)
lx and management of adhesive capsulitis
XR, MRI (gold standard). However, diagnosis is usually a clinical one
Management:
Conservative – NSAIDS, PT
Medical – steroid injections
Surgical – operative MUA, arthroscopy
what is subacrominal impingement syndrome syndrome
Constellation of a range of conditions, such as calcific tendonitis, subacromial bursitis and rotator cuff tendonitis
Most common shoulder pathology
presentation SAIS
progressive pain, worsened by overhead activities.
Lx in sais
MRI- gold , xr Again however, diagnosis may be clinical alone. Hawkins and Neer tests can be done to assess
testing clinically of rotator cuff muscles
Empty can test (SSp)
Gerber’s lift off (SSc)
External rotation against resistance (IS, TM)
rotator cuff investigation and management
Investigations: XR to exclude fracture and then USS, MRI
Management:
Conservative
Arthroscopy if moderate tear
Open surgery if severe tear (but need to consider patient age, activity, MOI
sequelae of rotator cuff tear
adhesive capsulitis
enlargement of tear
shoulder dislocation is also known as, why prone to happening
glenohumeral dislocation
shoulder joint is highly mobile and therefore inherently less stable
MOI of anterior shoulder dislocation
MOI is anterior force applied to the arm when shoulder is abducted and externally rotated
presentation of shoulder dislocation
post-traumatic, asymmetry between joints, pain, reduced movement
lx required in GH dislocation
Clinically assess the NV status of the limb
XR – ‘trauma series’ of AP, Y-scapula and axial views
USS can be utilised dynamically during reduction
MRI if other injuries suspected, e.g. labral tear
describe glenohumeral dislocation anteriorly
Anterior dislocation.
The humeral head is dislocated in an anterior and inferior direction.
posterior GH dislocation shows the
Posterior dislocation >
‘Lightbulb’ sign
GH Dislocation management
A to E assessment in line with acute/trauma principles
Prompt reduction under conscious sedation with analgesia
MUA (manipulation under anasthesia) if failure of reduction in ED setting
Assess NV status post-reduction
The joint needs to be immobilised for 3 weeks in a sling
PT
Surgical management if complications or recurrence
Reduction > immobilisation > rehabilitation
complications of GH dislocation
Bankhart lesion (leads to recurrence)
Hills-Sach defect (resulting in locking of joint)
Rotator cuff tear (older persons)
Greater/lesser tuberosity fracture (older persons)
Humeral neck fracture (high energy trauma)
Adhesive capsulitis
Nerve damage
proximal humeral fracture rx factures
– high energy trauma in a young male, low energy fall in an elderly female
proximal humeral fracture associated with
Associated with accompanying axillary nerve injury and dislocation
Anatomical fracture is rare but can be complicated by AVN
lx and management of proximal humeral fracture
Investigations
XR
CT
Management
Polysling and progressive mobilisation if minimally displaced
Surgical – ORIF, IMN, hemiarthroplasty or total shoulder arthroplasty
