Shoulder Flashcards
What is the role of the fibrocartilaginous labrum in shoulder stability?
increases articulating surface area
enhances stability
What are the four muscles of the rotator cuff?
supraspinatus
infraspinatus
teres minor
subscapularis
What motions does supraspinatus aid in
depresses and centers the humeral head in the glenoid as the deltoid abducts the arm
What motions do infraspinatus and teres minor aid in
external rotation
What motion does subscapularis aid in?
internal rotation
Describe subacromial impingement
Previous injury to the AC joint, degenerative changes secondary to overuse and/or aging can result in spurring at the undersurface of the AC joint and/or calcification of the coracroamial ligament, decreasing the space beneath the coracoacromial arch, leading to subacromial impingement.
What tendon is most commonly involved in rotator cuff injuries?
supraspinatus
What group are at greatest risk of acute rotator cuff injury?
over 40 years, activity induced
Describe chronic rotator cuff injuries
subacromial impingement
tendinosis
tears
more common with aging, degeneration, overuse, external or internal comrpession
Describe the pain associated with rotator cuff pathology
- anterolateral shoulder pain, particularly with reaching overhead or behind the back.
- radiates to the deltoid region, may also radiate to the neck or down the arm to the elbow
- pain worse at night in tears
Describe the pain associated with rotator cuff pathology
- anterolateral shoulder pain, particularly with reaching overhead or behind the back.
- radiates to the deltoid region, may also radiate to the neck or down the arm to the elbow
- pain worse at night in tears
Patients older than 50 years are likely to have true bony impingement from _______ and thus have pain even at rest, as well as shoulder weakness
subacromial spurring
_____ is the gold standard for imaging rotator cuff pathology
MRI
Subacromial impingement is an _____ condition wherein there is decreased space between the undersurface of the acromion and supraspinatus leading to pain and dysfunction
extrinsic
Rotator cuff _____ is a degenerative process of the tendon including varying degrees of inflammation and degeneration.
tendinosis
Rotator cuff tendinosis is commonly associated with ______ __________
subacromial impingement
Describe treatment for rotator cuff tears
- smaller tears with minimal functional defects (ex older patients) treated with injections and PT
- surgery for large acute tears, tears of any size in young active patients
Surgical intervention for rotator cuff tears must address all associated pathology including:
removal of spurs from acromian/ AC joint
treatment of biceps tendon pathology
treatment of labral or chondral damage
Most anterior shoulder dislocations produce a _____ lesion
Bankart- tearing of anterior inferior labrum and capsule
Anterior shoulder dislocations can also impact on the posterior superior humeral head and produce a _______ lesion
Hill Sachs- indentation of the humeral head
Anterior shoulder dislocations can also impact on the posterior superior humeral head and produce a _______ lesion
Hill Sachs- indentation of the humeral head
Shoulder dislocations often involve neuropraxia from traction on the _______ nerve
axillary
What sorts of trauma are associated with posterior shoulder dislocations?
electrocution, gran mal seizure
Describe the presentation of a patient with an acute anterior shoulder dislocation
arm held in externally rotated, abducted position
shoulder has anterior fullness and loss of normal deltoid contour
