SHOULDER Flashcards
What classification is used for the clavicle fracture?
Allman classification system – determined by the anatomical location of the fracture along the clavicle
How do clavicle fractures uually appear and present?
What are the risks assoiciated with a clavicle fracture?
- Risks: forming an open fracture as the bone is so close to the surface of the skin
- Check neurovascular status of the upper limb, given the propensity for brachial plexus injuries following a clavicle fracture
How are clavicle fractures managed?
- Most can be treated conservatively, even those with significant deformity, as evidence has shown no long-term benefit to surgical management
- Sling: to ensure that the elbow is well supported and improves the deformity. Keep it on until pt regains pain free movement
- Early movement of the shoulder joint is recommended, to prevent the development of frozen shoulder in these patients
- Open fractures: need surgical intervention
- Malunion: usually performed 2-3 months post-injury
- Healing time for most clavicular fractures in adults is 4-6 weeks
What are the rotator cuff muscles?
The rotator cuff is a group of 4 muscles that support and rotate the glenohumeral joint
The rotator cuff is composed of four muscles:
- Supraspinatus– abduction
- Infraspinatus – external rotation
- Teres minor – external rotation
- Subscapularis – internal rotation
SIT muscles attach to the greater tuberosity of the numeral head; Supraspinatous, Infraspinatous and Teres Minor
These muscles maintain stability of the shoulder joint
What are some of the RFs for rotator cuff tears?
- age
- trauma
- overuse
- repetitive overhead shoulder motions e.g. athletes, certain occupations
How do rotator cuff tears presentation or specific examination findings?
- Pain over the lateral aspect of shoulder and an inability to abduct the arm above 90 degrees
Examination:
- Tenderness over the greater tuberosity and subacromial bursa regions
- Specific tests:
- Jobe’s test/the ‘empty can test’ - tests supraspinatus
- Gerber’s lift-off test - tests subscapularis
- Posterior cuff test - tests infraspinatus and teres minor
How are rotator cuff tears Ixd and mxd?
Ix:
- X-ray - exclude a fracture
- USS: assess the size of the tear
Mx:
- Presentation < 2 weeks since injury: conservative - analgesia and physiotherapy
- Steroid injections into the subacromial space can be used if medication doesn’t help
- > 2 weeks: or remaining symptomatic despite conservative management should be referred for surgical intervention
What is the main complication of a rotator cuff tear?
Adhesive capsulitis
What is adhesive capsulitis?
the glenohumeral joint capsule becomes contracted and adherent to the humeral head
How does adhesive capsulitis present?
Sx and examination
- shoulder pain and a reduced range of movement in the shoulder
- generalised deep and constant pain of the shoulder, that often disturbs sleep
- Associated symptoms include joint stiffness and a reduction in function
On examination
- loss of arm swing and atrophy of the deltoid muscle
- Limited range of motion, mainly affecting external rotation and flexion of the shoulder
- reduced range on both passive and active movenents
How is adhesive capsulitis ixd and mxd?
Ix:
- Clinical one – X-ray to rule out fractures
- MRI imaging;
- HbA1c and blood glucose (as it often presents in diabetics)
Mx
- Self-limiting condition ( recurrence is common) - recovery occurs over months to years; some patients never recover full range of movement.
- Activity encouraged, physio
- Analgesia
- Steroid injection
- Surgery: manipulation under general anaesthetic to break the capsular adhesions to the humerus, or arthroscopic release of the glenohumeral joint capsule
Whast type of shouolder dislocations can you get and how do these arise?
- Anterior dislocation: caused by force being applied to an extended, abducted, and externally rotated humerus~
- Posterior dislocation: seizures or electrocution, but can occur through trauma (a direct blow to the anterior shoulder or force through a flexed adducted arm)
Mx
- Mx A-E if the injury was induced during trauma
- Reduction, immobilisation and rehabilitation
- Analgesia for the reduction process – give Entonox
- Assess the neurovascular status both pre- and post-reduction
- Broad-arm sling for 2 weeks post reduction
- Physio
How does a shoulder dislocation present?
Painful shoulder, acutely reduced mobility - patients will be reluctant to move the affected limb
Examination
- Asymmetry with the contralateral side
- Loss of shoulder contours (from a ‘flattened deltoid’)
- Anterior bulge from the head of the humerus
How is a shoilder dislocation Ixd and mxd?
Examination: test NVS - axillary nerve and regiments badge
X ray - light bulb sign - posterior dislocation
