Shoulder Flashcards by Nicole Sparks

What are the stabilizing structures of the shoulder?

Glenohumeral ligaments, labrum, biceps tendon

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What are the rotator cuff muscles>

Supraspinatus, subscapularis, teres minor, infraspinatus

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What creates the FORCE COUPLE?

deltoid (up) and rotator cuff (in)

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Spinoglenoid notch cyst

selective infraspinatus atrophy

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Shoulder ___ rotators are stronger than ___ rotators. Noteable for shoulder dislocation.

internal, external

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Winging of scapula

spinal accessory nerve (XI) to trapezius (lateral scapular translation due to unopposed pull of serratus anterior)

Medial wing= long thoracic nerve

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5 sites of shoulder pain

rotator cuff, C-spine, biceps, labrum, AC Joint

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Inspection

scapular motion, rotator cuff strength, hawkins, speeds, obriens, yergasons, ant/post glide, apprehension test

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Imaging

True AP in ER, axillary or lateral

Instability view (west point, apical obl)

Clavicalular view: Zanca, AP stress

Sternoclavicular- serendipity

MRI instead of diagnostic arthroscopy

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Age of patient and relative disease
20s
30s
40s
older

atraumatic instability

traumatic instability

Partial cuff tear, avascular necrosis, capsulorrhaphy arthropathy

RA, frozen shoulder, rotator cuff tear, arthritis

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Glenohumeral instability

disassociation of humeral head from glenoid (anterior 97%)

Abducted externally rotated

XRAYS

Reduction, immobilize, surgery?

Degree, direction, etiology, frequency

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Traumatic Ant Instability

abducted externally rotated

arm tackling

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Traumatic Post Instability

fall on outstretched arm

pass blocking

seizure or electrocution

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Dislocation treatment

Closed Reduction- traction/countertraction with sedation and complete muscle relaxation

immobilize for 4-6 weeks

Arthroscopic repair of bankart lesion

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EBM for Shoulder Dislocation

Natural history- 50-90% recurrence

1st time dislocation, surgery results in less recurrence

Quality of life better with surgery

Immobilization in external rotation may prevent dislocation

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SLAP tears

Superior labrum anterior to posterior

fall or jerking motion

Exam*, MRI**, arthroscopy Dx

degenerative tears: arthroscopic debridement or untreated
acute tears: arthoscopic fixation

Hill-Sachs Deformity

compression fracture of humeral head

associated with dislocation

Adhesive Capsulitis

insidious onset pain with restricted ROM

50th decade of life

may develop after injury etc but often idiopathic

generalized tenderness

marked decrease of both passive and active motion

Treatment of Adhesive capsulitis

18 month course, usually regain full ROM

prevention of trauma
XRAY
relief of pain (rest, moist heat, analgesia
corticosteroid injection
systemic steroids
PT
Manipulation under anesthesia

Arthritis

Types: primary, post-traumatic, rheumatoid arthritis, rotator cuff arthropathy, capsulorraphy arthropathy, avascular necrosis

Treatments

Arthritis

Non-operative

* Operative: resectional arthroplasty, arthrodesis, total shoulder arthroplasty, reverse total shoulder arthroplasty

Rotator Cuff Pathology

Impingement, Bursitis, Partial and Complete Tear

Intrinsic and Extrinsic factors lead to rotator cuff degeneration
• Age related weakening of tendon
• Subacromial impingement
• Other environmental conditions

Subacromial Impingement

Rest or activity modification
NSAID
Physical Therapy
Injection
Surgery

Injection for Painful Shoulder

favored over placebo, NSAIDs, PT

In young overhead athletes, rotator cuff problems and | impingement are usually the result of subtle _____ ____.

glenohumeral instability

Rotator Cuff Tear

Present in 54% of patients >60 years * 51% become symptomatic by 3 years * Partial tears: 20% heal, 80% progress * Full thickness tears: do not heal spontaneously * Can lead to irreparable tear No sig difference in MRI, US, MRA in partial vs full thickness tear

Rotator Cuff Arthropathy

Characteristics * Rotator cuff insufficiency * Glenohumeral cartilage destruction * Superior migration of humeral head • Subchondral osteoporosis, humeral head collapse Treatment: injection, PT, surg debridement, reverse total shoulder

AC Joint Injury

separation of AC, direct blow, tenderness DEFORMITY * Incomplete injuries (type I and II) * Brief period of immobilization, ice, NSAIDS * Return to activity in 2-3 weeks * Dislocations (types IV, V, VI) * Surgical treatment * Type III Injuries * Controversial

Type III AC Tx

higher complications in surgical tx (vs non-op) No diff in pain and ROM Surgery not recommended

Clavicular Fracture

``` ORIF Neurovasc injury Tenting of skin/open fracture Multiple trauma 20 mm shortening ```

Scapula Fracture

mostly non-op tx

Proximal Humerus

* Greater tuberosity: 3-5 mm displacement acceptable * Surgical neck: malunion well tolerated • 3 or 4 part • “part” = 1 cm displacement or 45° angulation • ORIF for younger patients • Hemiarthroplasty or reverse total shoulder arthroplasty for older patients

Cervical Spine Pathology

Dysfunction of nerve root at the cervical spine. • Most commonly affect C7 (60%) and C6 (25%). • Younger patients: disc herniation affecting the exiting nerve root • Older patients: foraminal narrowing Treatment: conservative * Rest, NSAIDS, Physical Therapy, Injection * Cervical traction * Surgery if fails to improve after 6-8 weeks.

Treatment in older patients is more ____ while in younger patients _____.

conservative, they choose surgery earlier