Shoulder Flashcards
What does shoulder instability involve?
Painful abnormal translational movement or subluxation and/ or recurrent dislocation
Describe the 2 subtypes of shoulder instability?
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
Most common type of shoulder dislocation?
Anterior
What is a bankart lesion?
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
Treatment of shoulder instability?
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
What is impingement syndrome?
Syndrome where the tendons of the rotator cuff (predominantly supraspinatous) are compressed in the tight subacromial space during movement producing pain.
Causes of impingement syndrome?
Tendonitis and subacromial bursitis
Acromioclavicular OA with an inferior osteophyte
A hooked acromion rotator cuff tear
Presentation of Impingement syndrome?
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
What do you need to exclude with shoulder conditions?
A cervical radiculopathy
Investigations for impingement syndrome?
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)
Treatment of impingement syndrome?
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
3 things that cause loss of external rotation in the shoulder?
locked posterior dislocation, gleno-humeral arthritis, frozen shoulder
Why do you need X-ray to diagnose frozen shoulder?
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
Who gets rotator cuff tears? Why?
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
Presentation and investigations of rotator cuff tear?
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.
Describe treatment of a rotator cuff tear?
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
Frozen shoulder is also known as…
Adhesive capsulitis
What is frozen shoulder?
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.
Who tends to get frozen shoulder?
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.
Presentation of frozen shoulder?
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
Treatment of frozen shoulder?
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.
Describe acute calcific tendonitis?
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.
Describe sternoclavicular osteoarthritis?
- Rare OA
- Swelling/ pain at SCjt
- Management= physio, injection, excision is very rare
Is acromioclavicular OA common? What does it often overlap with?
yes
impingement
Patient complaint in AC OA?
Pain- very specific with location
Often small bump over the joint that is tender
Glenohumeral joint OA is more or less common than hip and knee OA?
Less
What may be the cause of glenohumeral OA?
Cuff tear, instability, previous surgery, idiopathic
Patient complaint in GH OA?
Pain, crepitus (grinding bone on bone), loss of movement especially ER
