Shoulder Flashcards
What kind of joint is the shoulder?
Ball and socket synovial joint.
What forms the glenohumeral joint?
Head of the humerus and scapular glenoid.
What is the function of the rotator cuff?
As the joint has very little inherent anatomy its reliant on active support.
What muscles make up the rotator cuff?
Supraaspinatus
Infraspinatous
Subscapularis
Teres minor
What muscles of the rotator cuff attach to the greater tuberosity?
Supraspinatus
Infraspinatus
Teres minor
What is the function of the Supraspinatus?
Initiates abduction
What is the function of the Teres minor and infraspinatous?
External rotators
Where does the Subscapularis attach too?
Lesser tuberosity
What is the function of the supscapularis?
Internal rotation
In young what is usual issue in the shoulder?
Instability
In middle age what is the usual shoulder issue?
Rotator cuff tears
Frozen shoulder
In old age what is the usual shoulder issue?
Glenohumeral Osteoarthritis
What happens in impingement syndrome?
Tendons of the rotator cuff are compressed in the supacromial space during movement.
In what phase of movement is there pain?
60 to 120 degrees of abduction
What tendon is usually involved in impingement syndrome?
Supraspinatus
List some causes of impingement syndrome
Tendonitis/Subacromial bursitis
Acromioclavicular OA with inferior osteophytes
Hooked acromium rotator cuff tear
Where does pain radiate to in impingement syndrome?
deltoids and upper arm
Tenderness below lateral edge of the acromium
What X ray signs should be looked for in impingement syndrome?
Sclerosis under acromium
Calcificaton above greater trochanter
Spurring/uneven surface on the underside of the acromium
Non surgical management of impingement sydrome
Analgesics
NSAIDs
Physiotherapy
Subacromial steroid injections up to 3x
Surgical intervention
Subacromial decompression surgery
Open or athroscopically
How long is rehab following subacromial decompression?
Several weeks sling and physiotherapy
Acute rotator cuff tear
Usually traumatic, younger patients.
>40 still
Chronic rotator cuff tear
Degenerative are usually asymptomatic and in older patients.
What is the most common muscle to be torn ?
Supraspinatous
What is key in acute tears?
Early diagnosis and treatment.
What happens if there is a delay in diagnosing an acute cuff tear?
Wasting fibrosis and fat infiltration of the muscle all of which make treatment more difficult.
If a large tear is present which muscles can be affected aswell?
Subscapularis and infraspinatus
What are the clinical signs of a rotator cuff tear?
Pain and weakness
If weakness was found in abduction what muscle was likely torn?
Supraspinatus
If weakness was found in internal rotation what muscle was likely damaged?
Subscapularis
If weakness was found in external rotation what muscle was likely damaged?
Infraspinatus
What imaging is used to diagnose a cuff tear but what is the issue with these methods?
MRI or Ultrasound
Dependant on mobilising the shoulder
What are the issues surrounding treatment of a rotator cuff tear.
Surgery has a high re-tear rate 1/3 within a year.
Often muscle is so diseased or retracted too far.
What are the benefits of a successful surgical tear repair?
It will aid and maintain strength.
Help prevent subsequent OA of the joint.
Non surgical treatment of a rotator cuff tear.
Physiotherapy to strengthen up remaining muscles to compensate.
Adhesive Capsulitis
Progressive pain and stiffness in the shoulder in patients between 40-60 resolving after 18 months
What is pathology of frozen shoulder?
Thickening and fibrosis off the coracohumeral ligament.
What is the initial presenting complaint?
Pain which subsides
2-9 months
In frozen shoulder what follows the pain?
Increasing stiffness 4-12 months
What follows the stiffness?
Gradual resolution of symptoms may be some refractive stiffness.
Clinical signs of frozen shoulder.
Lack of passive external rotation
What is the non surgical treatment involved in frozen shoulder?
Analgesics and physiotherapy
What the surgical options in frozen shoulder?
Manipulation under anaesthetics
Surgical capsular release
What are the indications for surgical treatment of frozen shoulder?
Loss of function due to stiffness
Which groups are at risk of frozen shoulder?
Diabetics
Hypercholesterolaemia
Dupuytrens disease
Acute Calcific tendonits
Acute onset severe shoulder pain.
What tendon is calcium deposited in?
Supraspinatus
What is diagnostic modality of choice for calcific tendonitis?
X-ray as the calcium shows up as a opacity within soft tissue.
What is treatment for acute calcific tendonitis?
Subacromial steroid and local anaesthetic injections.
Are there any surgical indication in acute calcific tendonitis?
No as the condition is self limiting
What group is usually affected by traumatic instability?
Young and sporty
Teenagers to 30’s
What are the two types of traumatic dislocation?
Anterior and posterior
How common is an anterior dislocation and what is it associated with?
95% of all
Trauma and sports
How common is a posterior dislocation and what is it associated with?
5%
Electrocution and epiliptics
What lesions is associated with a posterior dislocation?
Hillsacks lesion
Dent in the humeral head
The older you are when you first dislocate the more likely you are to redislocate?
No the likely hood of further dislocation decreases with age
Acute treatment for dislocation
Painful reduction, sling , physiotherapy avoidance.
What occurs in chronic dislocation?
Atraumatic laxity and subluxations
Not painful but no support for the joint
What is surgical treatment for recurrent dislocations?
Bankarts repair
Reattatching labrum and capsule to anterior glenoid.
In anterior dislocations what should you look out for?
Lesions which increase likelihood of recurrent dislocations
What is the labrum and its function?
Cartilaginous ring which increases stability of the joint by deepening the glenohumeral joint.
What other sources can cause pain in the shoulder
Reffered from angina pectoris
Diaphragmatc irritations
-biliary colic hepatic or subphrenic abscess
