Shoulder

Question 1

what is shoulder instability?

Answer 1

abnormal and symptomatic movement of the humeral head across the glenoid fossa

Question 2

what is the stanmore triangle?

Answer 2

a way of grouping causes of shoulder instability, often patients are in between groups.
Polar type 1- traumatic structural
Polar type 2- atraumatic structural
Polar type 3- muscle patterning non structural

Question 3

what is polar type I on the stanmore triangle?

Answer 3

traumatic structural

Question 4

what is polar type II on the stanmore triangle?

Answer 4

Atraumatic structural

Question 5

what is polar type III on the stanmore triangle?

Answer 5

muscle patterning non structural

Question 6

what are the features of polar type I on the stanmore triangle?

Answer 6

due to trauma there is structural change causing instability

often have a hills sach lesion or bankarts defect

Question 7

what is a hills sach lesion?

Answer 7

often seen in polar type I on the stanmore triangle

a posterolateral humeral head compression fracture often secondary to recurrent anterior dislocation.

Question 8

what is a bankarts defect?

Answer 8

Anterior labral pathology, often in trauma the shoulder labrum becomes detached
often seen in stanmore type I traumatic structural shoulder instability

Question 9

what is the main treatment for stanmore type I shoulder instability?

Answer 9

Laberal repair

Question 10

why does trauma cause instability in stanmore type I?

Answer 10

trauma causes a structural abnormality that damages both dynamic and static stabilisers

Question 11

what is stanmore type II instability?

Answer 11

atraumatic structural

Question 12

what is atraumatic structural stanmore type 2 shoulder instability?

Answer 12

There is a naturally looser capsule ie due to ehlor danlos causing shoulder dysfunction

Question 13

what is the main treatment for stanmore polar II shoulder instability (atraumatic structural)?

Answer 13

capsular shift

Question 14

what is stanmore polar III shoulder instability?

Answer 14

muscle patterning non structural

Question 15

what causes stanmore polar III muscle patterning non structural?

Answer 15

The muscles no longer stabilise the shoulder for example pec major normally pulls the shoulder forward and lat dorsi back

‘capsular dysfunction due to abnormal muscle patterning’

Question 16

what is the main treatment for polar type III muscle patterning non structural shoulder instability?

Answer 16

physiotherapy

Question 17

what is the management of traumatic shoulder dislocation?

Answer 17

safe reduction of acute dislocation

analgesia, restore function and prevent future instability

Question 18

what are clinical tests for instability?

Answer 18

sulcus sign: the arm is straight down and traction is placed inferiorly. You get a depression below the acromion

Anterior and posterior draw test

anterior apprehension test

relocation test

Question 19

what is shoulder impingement?

Answer 19

A form of rotator cuff dysfunction where the greater tuberosity of the humerus engages with the underside of the acromion.

Question 20

what are causes of shoulder impingement?

Answer 20

weak rotator cuff (main cause)

overgrown acromion meaning there isn’t enough space for greater tuberosity

poor scapula muscles

Question 21

what is the main cause of shoulder impingement?

Answer 21

weak rotator cuff

Question 22

what is the typical presentation of shoulder impingement?

Answer 22

over 40
anterior-superior pain often described as in the muscle
weakness secondary to pain

Question 23

what are clinical tests for impingement?

Answer 23

neers sign (stabilise scapula whilst putting arm into maximal elevation, positive if pain is reproduced)

Jobes test: empty can test (90 degrees abduction, thumb pointing down and resist elevation

hawkins test: arm 90 degrees elevated, internally rotated and put in differents degrees of abduction/adduction

Question 24

what is the management of shoulder impingement?

Answer 24

reduce pain with analgesia or steroid injections
Physiotherapy
Surgery to create more space

Question 25

what muscle is most often a rotator cuff tear?

Answer 25

supraspinatus

Question 26

what is a small vs large rotator cuff tear?

Answer 26

small: 1cm
Large: 5cm

Question 27

what are two types of causes of rotator cuff tears?

Answer 27

degenerative

traumatic

Question 28

what is the presentation of rotator cuff tear?

Answer 28

aged above 40
anteriorsuperior pain in the shoulder
weakness secondary to pain

Question 29

what is the treatment for rotator cuff tear?

Answer 29

reduce pain with analgesia and steroid injections
physiotherapy
surgery to repair tendons

Question 30

what are special tests for the rotator cuff tears?

Answer 30

Hornblowers sign(infraspinatus and teres minor)
Liftoff test for subscapularis
External rotation lag sign