Session 8 Common Shoulder Conditions Flashcards

1
Q

Most common shoulder dislocation

A

Anterior

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2
Q

Why does head of humerus displace in an anterior direction

A

Due to pull of muscles and disruption of anterior capsule and ligaments

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3
Q

Locations of displacement of humerus

A

60% are sub coracoid

30% are subglenoid

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4
Q

Arm held in what position during dislocated shoulder anteriorly

A

External rotation and slight abduction

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5
Q

Mechanisms of anterior shoulder dislocation

A

Hand behind head (abduction and external rotation). Forces arm further posterior

Direct blow to posterior shoulder

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6
Q

Force of humeral head popping out of socket often causes

A

Part of glenoid labrum to be torn off - Bankart lesion or labral tear

Sometimes a small piece of bone is torn off with labrum

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7
Q

Why does posterior aspect of humeral head sometimes become jammed against anterior lip of glenoid fossa in shoulder dislocation anteriorly

A

Tone of infraspinatus and teres minor muscles

Hills-Sachs lesion (indentation fracture)

Increased risk of secondary osteoarthritis

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8
Q

Posterior dislocations of shoulder mechanism

A

Violent muscle contractions due to seizure, electrocution or lightening strike

Arm flexed across body and pushed posteriorly

Blow to anterior shoulder

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9
Q

Posterior shoulder dislocation presentation

A

Internally rotated and adducted

Flattening of shoulder with prominent coracoid process

Cannot be externally rotated into anatomical position

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10
Q

X ray sign of posterior dislocation of shoulder

A

Lightbulb sign

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11
Q

Injuries commonly associated with posterior shoulder dislocation

A

Fractures, rotator cuff tears, Hills-Sachs lesions

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12
Q

Inferior dislocation mechanism

A

Forceful traction on arm when its fully extended over head

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13
Q

Injuries associated with inferior dislocation

A

Damage to nerves, rotator cuff tears, injury to blood vessel

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14
Q

Most common complication of shoulder dislocation

A

Recurrent dislocation due to damage to stabilising tissues leading to increased risk of osteoarthritis

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15
Q

Other complications of shoulder dislocation

A

Damage to axillary artery- haematoma, absent pulses or cool limb, more common in old as blood vessels less elastic

Axillary nerve injuries- usually recover fully

Cords of brachial plexus or musculocutaneous nerve damaged- rare

Fractures - usually traumatic, first-time dislocation, or age 40+

Rotator cuff muscle tears - older

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16
Q

80% of clavicle fractures occur in

A

Middle third

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17
Q

Common cause of clavicle fracture and treatment

A

Fall onto shoulder or outstretched hand

Sling or surgery

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18
Q

Surgery needed in clavicle fracture if

A
  • Complete displacement, severe - - - -displacement causing tenting of skin with risk of puncture
  • Open fractures
  • Neurovascular compromise
  • Interposed muscle
  • Floating shoulder (clavicle fracture with ipsilateral fracture of glenoid neck)
19
Q

What happens to position of arm and clavicular fragments in a displaced mid-clavicular fracture

A

Sternocleidomastoid muscle elevates medial segment

Trapezius unable to hold lateral segment up against weight of upper limb so shoulder drops

Arm is pulled medially by pectoralis major (adduction)

20
Q

General complications associated with fracture healing

A

Non-union or malunion

21
Q

Local complications of clavicle fracture

A

Pneumothorax injury

Injury to neurovascular structures- subscapular nerve damaged by medial elebation

or supraclavicular nerves (C3 and 4) results in Parasthesia of upper chest anterioly

22
Q

Rotator cuff tear is

A

A tear of one or more tendons of the 4 rotator cuff muscles of shoulder

Most commonly Supraspinatus

23
Q

Rotator cuff tears reason

A

Acute
Chronic
Age related degeneration - degenerative micro-trauma model

24
Q

Principles of degenerative microtrauma model

A
Blood supply decreases 
Age-related degeneration 
Chronic microtrauma 
Partial tendon tears 
Full tears 
Inflammatory cells cause oxidative stress
Tenocyte apoptosis 
Further degeneration
25
What shoulder injury is often asymptomatic
Rotator cuff tear
26
Most common rotator cuff tear presentation
Anterolateral shoulder pain, often radiating down the arm Pain when leaning on elbow and pushing down Pain when reaching forward/flexing shoulder Pain-restricted movement above the horizontal position Weakness of shoulder abduction
27
Scans for rotator cuff tear
MRI and ultrasound
28
What is impingement syndrome
Supraspinatus tendon impinges on coraco-Acromial arch leading to irritation and inflammation
29
3 causes of impingement syndrome
Thickening of coracoacromial ligament Inflammation of Supraspinatus tendon Subacromial osteophytes
30
Impingement syndrome symptoms
Shoulder abducted or flexed narrows space Pain, weakness and reduced ROM Worsened by shoulder overhead movement or at night Dull lingering pain Grinding or popping during movement
31
Most common form of impingement syndrome
Impingement of Supraspinatus tendon under acromion during abduction Painful arc between 60 and 120 degrees
32
What is calcific Supraspinatus tendinopathy
Presence of deposits of hydroxyapatite in tendon of Supraspinatus Can occur in any tendon of rotator cuff
33
Presentation of calcific Supraspinatus tendinopathy
Acute or chronic pain Aggravated by abducting or flexing the arm above the level of the shoulder or by lying on the shoulder Mechanical symptoms- stiffness, snapping sensation, catching, or reduced range of movement of the shoulder
34
Theories of calcific tendinopathy
Regional hypoxia leads to tenocytes being transformed into chondrocytes and laying down cartilage Ectopic bone formation from metaplasia of mesenchymal stem cells normally present in tendons into osteogenic cells
35
Calcific deposits visibility
Visible on X ray Crystalline in resting phase Eventually re absorbed by phagocytes- this stage causes most pain. Look like toothpaste and appear cloudy on x ray
36
Calcific Supraspinatus tendinopathy
Treatment is initially conservative with rest and analgesia. Surgical treatment is sometimes required for persistent symptoms
37
What is adhesive capsulitis
Frozen shoulder Capsule of glenohumoral joint becomes inflamed and stiff, greatly restricting movement and causing chronic pain
38
Frozen shoulder presentation
Constant pain Worse at night Exacerbated by movement and cold weather
39
Cause of frozen shoulder
Possible autoimmune component, triggered by localised trauma
40
Risk factors for frozen shoulder
``` Female Epilepsy with tonic seizures Diabetes Mellitis Trauma to shoulder CVD Parkinson’s ```
41
Frozen shoulder treatment
Physiotherapy, analgesia and anti-inflammatory medication Manipulation under anaesthesia to break up adhesions and scar tissue to restore ROM Typically resolves with time- 90% regain motion More likely opposite shoulder will become affected
42
Features of osteoarthritis in shoulder
Usually 50+ Commonly affects acromioclavicular joint rather than glenohumoral
43
Treatment ladder for shoulder OA
Activity mods Analgesia NSAIDs Glucosamine and chondroitin sulphate nutritional supplements Steroid injections Hyaluronic acid injections for lubrication Arthroscopy (remove loose pieces of damaged cartilage) Hemiarthroplasty (replace humeral head) or total shoulder replacement (and glenoid)