Shoulder

Question 1

What does shoulder instability involve?

Answer 1

Painful abnormal translational movement or subluxation and/ or recurrent dislocation

Question 2

Describe the 2 subtypes of shoulder instability?

Answer 2

Traumatic= young (teens to 30s), sporty, first time really traumatic, second time less force needed as you've stretched all the ligaments
Atraumatic= idiopathic laxity, Ehlers Danlos, Marfans

Question 3

Most common type of shoulder dislocation?

Answer 3

Anterior

Question 4

What is a bankart lesion?

Answer 4

injury of the anterior (inferior) glenoid labrum of the shoulder due to anterior shoulder dislocation. When this happens, a pocket at the front of the glenoid forms that allows the humeral head to dislocate into it

Question 5

Treatment of shoulder instability?

Answer 5

Once reduced need a sling for several weeks then physio, recurrent dislocations may need Bankart repair surgery, treatment of chronic shoulder instability that is atraumatic is difficult

Question 6

What is impingement syndrome?

Answer 6

Syndrome where the tendons of the rotator cuff (predominantly supraspinatous) are compressed in the tight subacromial space during movement producing pain.

Question 7

Causes of impingement syndrome?

Answer 7

Tendonitis and subacromial bursitis
Acromioclavicular OA with an inferior osteophyte
A hooked acromion rotator cuff tear

Question 8

Presentation of Impingement syndrome?

Answer 8

Pain radiates to deltoid and upper arm
Patient has a painful arc around 60-120 of abduction
Hawkins Kennedy positive- IR of flexed shoulder causes pain

Question 9

What do you need to exclude with shoulder conditions?

Answer 9

A cervical radiculopathy

Question 10

Investigations for impingement syndrome?

Answer 10

X-ray- AP shoulder and garth view looking for calcium in rotator cuff and sclerosis
USS or MRi depending on mobility (MRI if can’t move)

Question 11

Treatment of impingement syndrome?

Answer 11

Conservative- majority settle with NSAIDs, analgesics, physio and subacromial steroids (up to 3 can’t give more as risk of tendon rupture)
If no benefit- subacromial decompression surgery

Question 12

3 things that cause loss of external rotation in the shoulder?

Answer 12

locked posterior dislocation, gleno-humeral arthritis, frozen shoulder

Question 13

Why do you need X-ray to diagnose frozen shoulder?

Answer 13

need to exclude locked posterior dislocation, gleno-humeral arthritis which present similarly with loss of ER- X-ray is only way to distinguish. Frozen shoulder looks normal on X-ray

Question 14

Who gets rotator cuff tears? Why?

Answer 14

Tends to be older people as the tendons can tear with minimal or no trauma as a consequence of degenerate changes in the tendons- usually supraspinatous is involved. Many people are actually asymptomatic

Question 15

Presentation and investigations of rotator cuff tear?

Answer 15

Weakness of initiation of abduction (supraspinatus) IR (subscapularis) or ER (infraspinatus) may be detected and wasting of supraspinatus may be seen.

Tears can be confirmed on USS or MRI.

Question 16

Describe treatment of a rotator cuff tear?

Answer 16

Good to catch early as if a tendon tear is left it will shorten, the muscle will waste and then get fat infiltration and fibrosis.
Non surgical- physio to compensate and subacromial injection
Surgery- rotator cuff repair, controversial, long term results not known

Question 17

Frozen shoulder is also known as…

Answer 17

Adhesive capsulitis

Question 18

What is frozen shoulder?

Answer 18

Inflammation, scarring and thickening of the capsule that surrounds the normal shoulder joint. It causes severe shoulder pain and gradually reducing ROM leading to a frozen phase where there is loss of all shoulder movements but little pain. There is a thawing phase which sees gradual improvement in function over weeks to months.

Question 19

Who tends to get frozen shoulder?

Answer 19

The aetiology is unclear
40-50 yrs F more than M
Association with diabetes, lipid and endocrine disorders and dupuytrens. May occur after shoulder surgery.

Question 20

Presentation of frozen shoulder?

Answer 20

Pain which subsides as stiffness increases
Principal clinical sign= loss of ER
Must get normal X-ray to exclude glenohumeral arthritis and locked posterior dislocation

Question 21

Treatment of frozen shoulder?

Answer 21

Relieve pain and prevent further stiffness whilst the condition resolves itself
Physio, analgesics, intra-articular injections can help if pain
Once pain has settled if the patient can’t tolerate functional loss due to stiffness, recovery can be hastened by MUA or surgical capsular release.

Question 22

Describe acute calcific tendonitis?

Answer 22

This condition results in the acute onset of severe shoulder pain and is characterised by Ca deposition in the supraspinatus tendon. Great relief of pain is achieved by subacromial steroid and local anaesthetic injection. It is self limiting with pain easing as the calcification resorbs.

Question 23

Describe sternoclavicular osteoarthritis?

Answer 23

• Rare OA
• Swelling/ pain at SCjt
• Management= physio, injection, excision is very rare

Question 24

Is acromioclavicular OA common? What does it often overlap with?

Answer 24

yes

impingement

Question 25

Patient complaint in AC OA?

Answer 25

Pain- very specific with location

Often small bump over the joint that is tender

Question 26

Glenohumeral joint OA is more or less common than hip and knee OA?

Answer 26

Less

Question 27

What may be the cause of glenohumeral OA?

Answer 27

Cuff tear, instability, previous surgery, idiopathic

Question 28

Patient complaint in GH OA?

Answer 28

Pain, crepitus (grinding bone on bone), loss of movement especially ER