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Orthopaedics > Shoulder > Flashcards

Shoulder Flashcards

1
Q

what forms the shoulder joint

A

humeral head

glenoid fossa of the scapula

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2
Q

what type of joint is the shoulder joint

A

ball and socket synovial joint

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3
Q

what forms the shoulder girdle

A

scapula
clavicle
proximal humerus
supporting muscles of rotator cuff and deltoid

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4
Q

rotator cuff muscles

A
  1. SUPRASPINATUS
    posterior scapula, above spine of scapula
  2. INFRASPINATUS
    posterior scapula, below spine of scapula
  3. TERES MINOR
    posterior scapula, below infraspinatus
  4. SUBSCAPULARIS
    anterior scapula
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5
Q

where do the rotator cuff muscles attach to

A

supraspinatus
infraspinatus
teres minor
- all attach to greater tuberosity of humerus

subscapularis
- attaches to lesser tuberosity of humerus

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6
Q

What shoulder movement is supraspinatus responsible for

A

initiation of abduction

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7
Q

What shoulder movement is infraspinatus responsible for

A

external rotation

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8
Q

What shoulder movement is teres minor responsible for

A

external rotation

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9
Q

what shoulder movement is subscapularis responsible for

A

internal rotation

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10
Q

principle muscle responsible for shoulder abduction

A

deltoids

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11
Q

most common shoulder problem in the young

A

instability

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12
Q

most common shoulder problems in the middle aged

A

rotator cuff tears

frozen shoulder

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13
Q

most common shoulder problem in the elderly

A

glenohumeral OA

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14
Q

what is impingement syndrome also known as

A

painful arc

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15
Q

what is impingement syndrome

A

a syndrome where the tendons of the rotator cuff are compressed in the tight subacromial space during movement, producing pain.

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16
Q

The tendon of which rotator cuff muscle is predominately involved in impingement syndrome

A

supraspinatus

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17
Q

presentation of impingement syndrome

A

painful arc between 60-120 degrees of abduction

pain ceases when tendon has passed through subacromial space

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18
Q

causes of impingement syndrome

A

tendonitis subacromial bursitis
acromioclavicular OA with inferior osteophyte
a hooked acromion rotator cuff tear

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19
Q

characteristic radiation pattern of impingement syndrome pain

A

deltoid and upper arm radiation

20
Q

Tx of impingement syndrome

A
  1. Conservative Mx -
    NSAIDs, analgesia, physio, subacromial steroid injection
  2. subacromial decompression surgery
21
Q

velocity of injury of rotator cuff tear in middle aged person: high or low?

A

Low velocity - there is already degenerative change in the rotator cuff tendons and injury happens from a sudden jerk type injury

22
Q

Most common muscle involved in rotator cuff tears

A

supraspinatus

23
Q

symptoms of rotator cuff tear

A

weakness of initiation of abduction (supraspinatus)
weakness of external rotation (infraspinatus)
weakness of internal rotation (subscapularis)
difficulty sleeping on affected side

24
Q

Ix for suspected rotator cuff tear

A

USS or MRI

25
Q

Mx rotator cuff tear

A

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

26
Q

what is frozen shoulder also known as

A

adhesive capsulitis

27
Q

what is adhesive capsulitis

A

progressive pain and stiffness of the shoulder which resolves after 18-24 months

capsule and glenohumeral ligaments become inflamed, and thickened and contracted

28
Q

causes of adhesive capsulitis

A 
often unclear 
?triggering injury 
?after shoulder injury 
?diabetes
? hypercholesterolaemia 
?Dupuytren's
29
Q

presentation of adhesive capsulitis

A

initial pain lasting for 2-9months

then stiffness for 4-12 months, which gradually thaws out over time

30
Q

Tx of adhesive capsulitis

A

physio
analgesia
intra-articular glenohumeral injections in painful phase
stiffness phase - can be manipulated under GA

31
Q

What is acute calcific tendonitis

A

deposition of calcium in the supraspinatus tendon

32
Q

presentation of acute calcific tendonitis

A

acute onset severe shoulder pain

33
Q

Ix for acute calcific tendonitis

A

X-ray - shows calcium deposition in the supraspinatus tendon (just proximal to the greater tuberosity)

34
Q

Tx of acute calcific tendonitis

A

subacromial steroid and local anesthetic injection

self-limiting - symptoms resolve as calcium is reabsorbed

35
Q

What 3 concepts does instability of the shoulder involve

A
  1. Abnormal tranlational movement
  2. Abnormal subluxation movement
  3. +/- Recurrent dislocation
    i. e. you can have the abnormal movements but the shoulder doesn’t dislocate
36
Q

2 sub-types of shoulder instability

A
  1. traumatic instability

2. atraumatic instability

37
Q

What is traumatic shoulder instability

A

A shoulder that is unstable after a traumatic anterior shoulder dislocation, after all treatment.

38
Q

What predicts the likelihood of a patient developing traumatic shoulder instability

A

Age at the time of first dislocation

80% re-dislocation rate in under 20s
20% re-dislocation rate in under 30s

39
Q

What is atraumatic shoulder instability

A

A shoulder that is unstable from conditions that predispose to generalised ligament laxity e.g. Ehlers Danlos syndrome, Marfan’s syndrome

40
Q

proximal insertions of the biceps brachii

A

short head: coracoid process of scapula

long head: supraglenoid tubercle of scapula (i.e. superior part of glenoid labrum)

41
Q

Is the long or short head of biceps brachii more commonly affected by biceps tendinopathy?

A

Long head

42
Q

Presentation of biceps tendonitis

A

anterior shoulder pain, radiating to elbow

pain on resisted biceps contraction

43
Q

Tx of biceps tendonitis

A

Conservative - rest and physio

44
Q

“popeye sign”

A

Sign of ruptured biceps brachii tendon - biceps muscle becomes ‘bunched up’

45
Q

what is the glenoid labrum

A

fibrocartilaginous structure around the rim of the glenoid cavity

46
Q

what is a SLAP tear

A

Superior Labrum Anterior Posterior tear

i.e. a tear of the glenoid labrum and long head of biceps tendon

47
Q

Ix for a SLAP tear

A

contrast MRI arthrogram

Orthopaedics (16 decks)

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