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Clinic - Common Conditions Overview > Shoulder > Flashcards

Shoulder Flashcards

1
Q

Which nerves supply cutaneous innervation to the shoulder?

A

Supraclavicular nerve (from cervical plexus, C3-4)

Axillary nerve (superior lateral brachial cutaneous branch, C5-6)

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2
Q

Which cervical facets can refer pain to the shoulder?

A

C5-6

C6-7

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3
Q

Which viscera can refer pain to the shoulder?

A

Heart
Lung and diaphragm
Liver and gallbladder (right)

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4
Q

Which spinal nerve supplies dermatomal innervation to the shoulder?

A

C4

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5
Q

What are the red flags in shoulder pain that indicate a serious cardiovascular condition?

A 
SOB / dyspnoea
Palpitations
Pallor
Sweating
Mental state changes
Nausea / vomiting
- SSX agg. by exertion

DVT SSX:

  • unilateral UL oedema, heaviness, fatigue, discolouration
  • visible veins
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6
Q

What are the red flags in a shoulder presentation that indicate a serious respiratory condition?

A

SOB / Dyspnoea
Pallor / cyanosis
Tacycardia

  • SSX ag. by activity and deep breathing
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7
Q

What are the signs and symptoms of a Pancoast tumour?

A

Horner’s syndrome

Brachial plexus compression (UL weakness, paraesthesia)

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8
Q

What are the 5 serious conditions that need to be considered in a shoulder presentation?

A 
Myocardial ischaemia
DVT
Pneumonia
Osteomyeltis
Neoplasia
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9
Q

What are the 4 neurological conditions that need to be considered in a presentation of shoulder pain?

A

Thoracic outlet syndrome
Cervical radiculopathy
Cervical myelopathy
Burners / stingers

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10
Q

What are PROMs that can be used to assess shoulder pain and dysfunction?

A

DASH (Disabilities of Arm, Shoulder and Hand) or Quick DASH

SPADI (Shoulder Pain and Disability Index)

UEFI (Upper Extremity Functional Index)

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11
Q

Describe the presentation of an AC sprain including mechanism, presentation, findings and prognosis

A

Mechanism: FOOSH, traumatic impact

Pain:

  • over top of shoulder and lateral clavicle
  • aching, sharp on movement

Agg by:
- shoulder movements (especially horizontal flexion / OH)

Findings:

  • pain on AC palpation
  • positive O’Briens and Scarf tests

Prognosis:
Grade 1: 2-4 weeks
Grade 2: 4-6 weeks

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12
Q

Describe the condition of shoulder instability including pathology, risk factors, presentation and findings

A

Pathology: instability of GH joint anteriorly, can be caused by lax joint capsule and ligaments and/or pathology of glenoid labrum

Risk factors: previous GH dislocation, repetitive OH movements (UL in abduction and ER, repetitive OH activities)

Presentation:

  • global shoulder pain
  • agg. by reaching backwards or OH

Findings:

  • GH hypermobility
  • positive apprehension / relocation test
  • diminished rotator cuff strength (esp. external rotators)
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13
Q

Which underlying pathologies can cause subacromial impingement?

A 
Supraspinatus tendinopathy
Bicipital tendinopathy
Glenoid labrum tear
Subacromial bursitis
Osteoperosis and osteophytic bone growth
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14
Q

Which 4 clinical tests can be used to test for subacromial impingement?

A

Empty Can
Hawkin’s Kennedy
Neer’s Impingement
Painful Arc

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15
Q

What are risk factors for the development of subacromial impingement?

A 
Osteoarthritis
Postural (Tx kyphosis, GH IR, decreased external rotator strength)
Supraspinatus or bicipital tendinopathy
Glenoid labrum tear
Repetitive OH movements
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16
Q

Describe the presentation of subacromial impingement

A

Pain:

  • anterior / anterolateral shoulder over acromial region, may radiate to upper arm
  • early stage: sharp, intermittent and assoc with movement
  • late stage: dull, aching and constant

Agg by:

  • shoulder abduction (under 15 and over 90)
  • shoulder extension and R
  • OH movements
  • lying on shoulder

Prognosis:

  • lengthy recovery (3-12 months) and need to address underlying cause of impingement
  • expect gradual return to activity within 1-3 month
17
Q

Describe the presentation of a glenoid labrum tear including mechanism and pathology, risk factors, presentation, findings and prognosis

A

Pathology: tear of glenoid labrum (most common type a SLAP tear involving attachment of long head of biceps)

Mechanism: traumatic traction of GH caused by FOOSH, GH dislocation, excessive strain on bicipital tendon, repetitive OH activities with GH abduction and ER

Risk factors:
- GH instability, history of GH dislocation, repetitive OH activities with GH abduction and ER (throwing sports), age related degeneration

Presentation:

  • pain deep in GH joint and across anterior GH
  • deep and aching pain agg. by OH movements, lifting and carrying
  • often comorbid with bicipital tendinopathy, bursitis, SAI, rotator cuff pathology

Findings:

  • GH instability
  • pain GH movements, esp. OH
  • clicking, popping or locking with GH ROM
  • decreased strength elbow flexion w pain (bicipital tendon affected)

Tests:
- positive O’Brien’s, positive Anterior Drawer, positive apprehension / relocation

Prognosis:
- surgical intervention needed for full recovery (if SSX aggravating)

18
Q

Describe the condition of adhesive capsulitis including pathology, presentation, risk factors, and the 3 phases of the condition

A

Pathology:
inflammation of synovial membrane in GH joint followed by severe capsular fibrosis and contraction

Risk factors: female, diabetes, metabolic or autoimmune disease, previous history adhesive capsulitis (high recurrence)

Presentation:
- acute phase (3-9/12): insidious onset pain and stiffness, sharp pain with extremes of ROM

  • adhesive phase (4-12/12): decreasing pain and increasing stiffness, pain present only at extremes of ROM
  • thawing phase (1-3 yrs): spontaneous resolution, gradually increasing ROM
19
Q

What is the typical healing timeframe for adhesive capuslitis?

A

Resolution (self-limiting) within 1-3 years, high risk of recurrence including on contralateral shoulder

20
Q

What are the risk factors and typical mechanisms for glenoid labrum tears?

A

Typical mechanisms:

  • overuse of bicipital tendon (heavy carrying, lifting, traumatic overstretch)
  • repetitive OH movements with ER and abduction (ie: throwing sports)
  • traumatic traction of GH caused by FOOSH or GH dislocation

Risk factors:

  • previous Hx GH dislocation or instability
  • GH trauma
  • OH activities (with ER and abduction, ie throwing sports)
21
Q

Describe the condition of rotator cuff tendinopathy including risk factors, presentation, findings, and prognosis

A

Risk factors:
- repetitive OH movements, heavy load bearing, postural or muscular imbalance, decreased mobility, age related degeneration, SAI, bursitis

Presentation:

  • pain over area of rotator cuff tendons and into shoulder joint
  • dull and aching pain, agg by GH movements (esp abduction and OH), sleeping on affected arm, reaching behind back (ie: seatbelt, jacket arm)
  • insidious onset gradually worsening and can become present at rest

Findings:
- decreased GH strength and GH ROM

Tests:
- painful arc, empty can, hawkin’s kennedy, neer’s impingement, lift off (subscapularis)

Prognosis:

  • recovery 2-9 months
  • SSX reduction 4-6 weeks
22
Q

What is the typical healing timeframe for a rotator cuff tendinopathy?

A

Between 2-9 months

typically SSX reduction within 4-6 weeks

23
Q

Which tests are used in a case of suspected rotator cuff tendinopathy?

A 
Painful Arc
Empty Can
Hawkin's Kennedy
Neer's Impingement
Lift off (subscapularis)
Resisted abduction (supraspinatus)
24
Q

What is the typical healing time frame for bicipital tendinopathy?

A

Recovery 2-9 months

SSX reduction 4-6 weeks

25
Q

Which 4 clinical tests are used in a case of suspected bicipital tendinopathy?

A

Yergason’s
Neer’s Impingement
Hawkin’s Kennedy
Speed’s

26
Q

What are risk factors for bicipital tendinopathy?

A
  • age related degeneration
  • repetitive OH activities involving abduction and ER (throwing sports, swimming, gymnastics)
  • repetitive carrying, lifting, heavy load bearing
  • SAI, rotator cuff pathology
  • incorrect biomechanics of GH and scapular
  • GH instability
27
Q

Describe the presentation of bicipital tendinopathy including mechanism, presentation, findings and prognosis

A

Mechanism:

  • acute: single load failure caused by heavy lifting, traction, OH action (esp. abduction with ER)
  • insidious: repetitive overuse or degeneration caused by overuse, impingement, SLAP lesion, GH instability (biceps overworking to stabilize GH)

Presentation:

  • pain over front of shoulder well localized to bicipital groove
  • deep, throbbing pain agg. by lifting, carrying, elbow flexion

Findings:
- decreased strength biceps tendon / elbow flexion

Tests:

  • yergasons
  • hawkins kennedy
  • neer’s
  • speed’s

Prognosis:

  • recovery 2-9 months
  • SSX reduction 4-6 weeks
28
Q

What are the 4 typical X rays of the shoulder, the key features evaluated, and which is best for evaluating a dislocation?

A

AP
AP IR
AP ER
lateral - best for evaluating dislocation (in anterior dislocation numeral bear will be inferior to coracoid)

Key features on AP:

  • AC joint space: should be 2.9 mm (f) to 3.3 mm (m)
  • acromio humeral joint space: should be 9mm, under 7 = degenerative tendon or rotator cuff pathology, over 9 = dislocation
29
Q

Which two spaces are evaluated on an AP shoulder x ray?

A

AC joint space - should be 2.9-3.3mm

Acromio-humeral joint space - should be 9 mm; under 7 = degenerative tendon or rotator cuff pathology; over 11 = dislocation

Clinic - Common Conditions Overview (26 decks)

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