Shoulder Flashcards
what forms the shoulder joint
humeral head
glenoid fossa of the scapula
what type of joint is the shoulder joint
ball and socket synovial joint
what forms the shoulder girdle
scapula
clavicle
proximal humerus
supporting muscles of rotator cuff and deltoid
rotator cuff muscles
- SUPRASPINATUS
posterior scapula, above spine of scapula - INFRASPINATUS
posterior scapula, below spine of scapula - TERES MINOR
posterior scapula, below infraspinatus - SUBSCAPULARIS
anterior scapula
where do the rotator cuff muscles attach to
supraspinatus
infraspinatus
teres minor
- all attach to greater tuberosity of humerus
subscapularis
- attaches to lesser tuberosity of humerus
What shoulder movement is supraspinatus responsible for
initiation of abduction
What shoulder movement is infraspinatus responsible for
external rotation
What shoulder movement is teres minor responsible for
external rotation
what shoulder movement is subscapularis responsible for
internal rotation
principle muscle responsible for shoulder abduction
deltoids
most common shoulder problem in the young
instability
most common shoulder problems in the middle aged
rotator cuff tears
frozen shoulder
most common shoulder problem in the elderly
glenohumeral OA
what is impingement syndrome also known as
painful arc
what is impingement syndrome
a syndrome where the tendons of the rotator cuff are compressed in the tight subacromial space during movement, producing pain.
The tendon of which rotator cuff muscle is predominately involved in impingement syndrome
supraspinatus
presentation of impingement syndrome
painful arc between 60-120 degrees of abduction
pain ceases when tendon has passed through subacromial space
causes of impingement syndrome
tendonitis subacromial bursitis
acromioclavicular OA with inferior osteophyte
a hooked acromion rotator cuff tear
characteristic radiation pattern of impingement syndrome pain
deltoid and upper arm radiation
Tx of impingement syndrome
- Conservative Mx -
NSAIDs, analgesia, physio, subacromial steroid injection - subacromial decompression surgery
velocity of injury of rotator cuff tear in middle aged person: high or low?
Low velocity - there is already degenerative change in the rotator cuff tendons and injury happens from a sudden jerk type injury
Most common muscle involved in rotator cuff tears
supraspinatus
symptoms of rotator cuff tear
weakness of initiation of abduction (supraspinatus)
weakness of external rotation (infraspinatus)
weakness of internal rotation (subscapularis)
difficulty sleeping on affected side
Ix for suspected rotator cuff tear
USS or MRI
Mx rotator cuff tear
Controversial! Long term results of surgery not known
Non-operative:
physio (strengthens up remaining muscles to compensate)
+/- subacromial steroid injection
Surgical:
repair of tear and subacromial decompression
what is frozen shoulder also known as
adhesive capsulitis
what is adhesive capsulitis
progressive pain and stiffness of the shoulder which resolves after 18-24 months
capsule and glenohumeral ligaments become inflamed, and thickened and contracted
causes of adhesive capsulitis
often unclear ?triggering injury ?after shoulder injury ?diabetes ? hypercholesterolaemia ?Dupuytren's
presentation of adhesive capsulitis
initial pain lasting for 2-9months
then stiffness for 4-12 months, which gradually thaws out over time
Tx of adhesive capsulitis
physio
analgesia
intra-articular glenohumeral injections in painful phase
stiffness phase - can be manipulated under GA
What is acute calcific tendonitis
deposition of calcium in the supraspinatus tendon
presentation of acute calcific tendonitis
acute onset severe shoulder pain
Ix for acute calcific tendonitis
X-ray - shows calcium deposition in the supraspinatus tendon (just proximal to the greater tuberosity)
Tx of acute calcific tendonitis
subacromial steroid and local anesthetic injection
self-limiting - symptoms resolve as calcium is reabsorbed
What 3 concepts does instability of the shoulder involve
- Abnormal tranlational movement
- Abnormal subluxation movement
- +/- Recurrent dislocation
i. e. you can have the abnormal movements but the shoulder doesn’t dislocate
2 sub-types of shoulder instability
- traumatic instability
2. atraumatic instability
What is traumatic shoulder instability
A shoulder that is unstable after a traumatic anterior shoulder dislocation, after all treatment.
What predicts the likelihood of a patient developing traumatic shoulder instability
Age at the time of first dislocation
80% re-dislocation rate in under 20s
20% re-dislocation rate in under 30s
What is atraumatic shoulder instability
A shoulder that is unstable from conditions that predispose to generalised ligament laxity e.g. Ehlers Danlos syndrome, Marfan’s syndrome
proximal insertions of the biceps brachii
short head: coracoid process of scapula
long head: supraglenoid tubercle of scapula (i.e. superior part of glenoid labrum)
Is the long or short head of biceps brachii more commonly affected by biceps tendinopathy?
Long head
Presentation of biceps tendonitis
anterior shoulder pain, radiating to elbow
pain on resisted biceps contraction
Tx of biceps tendonitis
Conservative - rest and physio
“popeye sign”
Sign of ruptured biceps brachii tendon - biceps muscle becomes ‘bunched up’
what is the glenoid labrum
fibrocartilaginous structure around the rim of the glenoid cavity
what is a SLAP tear
Superior Labrum Anterior Posterior tear
i.e. a tear of the glenoid labrum and long head of biceps tendon
Ix for a SLAP tear
contrast MRI arthrogram
