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Orthopaedics > Shoulder > Flashcards

Shoulder Flashcards

1
Q

3 main places shoulder problems can arise

A

ACJ
Subacromial space
Glenn numeral joint

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2
Q

At conditions are associated with the 3 places that problems can arise

A

ACJ - OA or RA
Subacromial space - impingement - subacromial inflamed bursa, rotator cuff problems weakness and tears
Gleno-numeral joint
Capsule - frozen shoulders, labral injuries -instability, OA

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3
Q

What are the joints in the shoulder

A

Glenn-numeral joint - ball and socket joint which is very mobile
ACJ
Sternoclavicular joint - saddle manubrium and the clavicle
Scapulocostal - physiological joint formed by an articulation of the anterior scapula and post thoracic rib cage

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4
Q

What are the shoulder stabilisers

A 
Passive 
Glenoid and the labrum
-ve intrarticular pressure 
Capsule and glenohumeral 
Active
Rotator cuff muscles
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5
Q

How to asses the rotator cuff

Supraspinatus

A

Supraspinatus tested by patient internally rotates arm whilst in 45 degree abduction and 30 degree forward flexion with an extended elbow
Attempt to further adult against resistance on their elbow produces pain if weak or injured

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6
Q

How to assess the rotator cuff

Subscaplaris

A

Belly press - hands on belly and push elbows forwards against resistance results in pain or weak if injury or weak
Put hand with palm on the back and push out - pain or weakness injury

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7
Q

How to assess the rotator cuff

Infraspinatus and teres minor

A

Flex elbow to 90 degree elbows to side and internally rotate against resistance

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8
Q

What is the drop arm sign

A

Patient lowers arm lowly from 160 abduction

If the patient cant control he Armand it drop quickly to the side = rotator cuff tear

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9
Q

What is the test of ACJ disease

A

Scarf test

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10
Q

Tests for impingement

A

Painful arc between 60 and 120 abduction exacerbated when thumb pointing down (empty can) and better when thumb pointing up (full can)
Neer - passive flexion of the shoulder with a pronated arm whilst the scapula is stabilised
Hawkins - passive test arm positioned 90 degrees in scapular plane elbow bent at 90 arm passively rotates across the body

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11
Q

Hx for impingement

A 
>50
Pain in deltoid region 
Pain on overhead activity 
Pain at night 
Pain radiated down the lateral aspect of the arm
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12
Q

What should you also examine when you examine the shoulder

A

First start by screening the neck - pain down the cervical spine any pain or reproduction of symptoms on movement
Move head forward backwards, left right, to the left ear to the right ear

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13
Q

Mx of impingement

A

Once clinical suspicion is made on x and exam
Then organise for a dynamic USS or MRI
Con - NSAIDS, rest physio
Steroid injections max 3
Surgery - arthroscopic subacromial decompression
Repair arthroscopically

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14
Q

What holds the clavicle in place

A

Sup AC ligament
Coraco clavicular ligament

In a dislocation the ligament can rupture an ma nee reconstruction in surgery via a hamstring graft synthetics

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15
Q

What are the 3 phases of a frozen shoulder

A

Pain
Stiffness
Resolutions

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16
Q

How long can it take for a frozen shoulder to resolve

A

3 years

17
Q

What are risk factors for a frozen shoulder

A

Diabetes

CV disease

18
Q

What is a frozen shoulder also called

A

Adhesive capsulitis

19
Q

What causes frozen shoulder

A

Fibroelastic proliferation of the inferior shoulder capsule
Anterior capsule is in between the biceps tendon and the subscapsularis
This thickens os reduces rotation
Reduction in all movements

20
Q

How is a frozen shoulder different from impingement

A

Loss of passive external rotation diff from impingement as this is maintained

21
Q

Tx frozen shoulder

A

Con - active surveillance, physio, steroid injection
Arthroscopic subacromial decompression
Cuff relain arthroscpically is damaged due to the subscapualris being on the floor of the anterior capsule

22
Q

What is the borders of the subacromial space

A

Roof - acromion, cocracoaromial ligament

Floor - rotator cuff muscles

23
Q

What is inside the subacromial space

A

The subacromial bursa

24
Q

What becomes inflamed in shoulder impingement

A

The subacromial bursa

As you elevate the arm this become squeezed and you get pain

25
Q

What other structures can become damaged in impingement

A

Underlying rotator cuff

The bursa inflamed the rotator cuff can be inflamed too and this can lead to rotator cuff tears

26
Q

Shoulder instability how to test for is

A

Sulcus sign
Anterior translation
Apprehension test

27
Q

What means a shoulder is unstable

A

Recurrent shoulder dislocations

28
Q

What are the 2 types of shoulder instability

A

Torn loose and born loose
TUBS and AMBRI
Traumatic and atraumatic

29
Q

Atraumatic instability what is it

A

Often a teenager with no hx of trauma, but having general joint laxity
A=atraumatic
M= multidirectional- anterior and posterior
B=bilateral
R=rehabilitation is tx due to usually urgent not helping
I = inf capsular shift surgery only if rehab fails
Beware of habitual dislocations , a patient who purposely dislocated due to performing their dislocations they are less likely to respond to tx

30
Q

What is traumatic instability

A

Dislocation is anterior, rarely inferior, really rarely posterior
Secondary to trauma - may be mild
Abduction + lateral rotation of the arm (putting on a coat) may cause dislocationor may be more traumatic such as a rugby tackle
Traumatic
Unidirectional
Bankart lesion
Surgery

31
Q

What is a bankart lesion

A

Arise from avulsion of the glenoid labrum

32
Q

What is a Hill-Sachs lesion

A

An impaction fracture of the humeral head following anterior dislocation
Tx - bone graft or metal implant

33
Q

What age most likely affected by recurrent dislocation

A

<25 compared to >40 the latter group requires imaging of the rotator cuff as high risk of traumatic rupture rather than labral injury

Orthopaedics (7 decks)

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