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*Surgery > Shoulder > Flashcards

Shoulder Flashcards

1
Q

What are the stabilizing structures of the shoulder?

A

Glenohumeral ligaments, labrum, biceps tendon

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2
Q

What are the rotator cuff muscles>

A

Supraspinatus, subscapularis, teres minor, infraspinatus

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3
Q

What creates the FORCE COUPLE?

A

deltoid (up) and rotator cuff (in)

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4
Q

Spinoglenoid notch cyst

A

selective infraspinatus atrophy

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5
Q

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

A

internal, external

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6
Q

Winging of scapula

A

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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7
Q

5 sites of shoulder pain

A

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

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8
Q

Inspection

A

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

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9
Q

Imaging

A

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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10
Q 
Age of patient and relative disease
20s
30s
40s
older
A

atraumatic instability

traumatic instability

Partial cuff tear, avascular necrosis, capsulorrhaphy arthropathy

RA, frozen shoulder, rotator cuff tear, arthritis

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11
Q

Glenohumeral instability

A

disassociation of humeral head from glenoid (anterior 97%)

Abducted externally rotated

XRAYS

Reduction, immobilize, surgery?

Degree, direction, etiology, frequency

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12
Q

Traumatic Ant Instability

A

abducted externally rotated

arm tackling

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13
Q

Traumatic Post Instability

A

fall on outstretched arm

pass blocking

seizure or electrocution

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14
Q

Dislocation treatment

A

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

immobilize for 4-6 weeks

PT

Arthroscopic repair of bankart lesion

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15
Q

EBM for Shoulder Dislocation

A

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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16
Q

SLAP tears

A

Superior labrum anterior to posterior

fall or jerking motion

Exam*, MRI**, arthroscopy Dx

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

17
Q

Hill-Sachs Deformity

A

compression fracture of humeral head

associated with dislocation

18
Q

Adhesive Capsulitis

A

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

19
Q

Treatment of Adhesive capsulitis

A

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
20
Q

Arthritis

A

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

21
Q

Treatments

Arthritis

A
  • Non-operative

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

22
Q

Rotator Cuff Pathology

A

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

23
Q

Subacromial Impingement

A
  • Rest or activity modification
  • NSAID
  • Physical Therapy
  • Injection
  • Surgery
24
Q

Injection for Painful Shoulder

A

favored over placebo, NSAIDs, PT

25
Q

In young overhead athletes, rotator cuff problems and

impingement are usually the result of subtle _____ ____.

A

glenohumeral instability

26
Q

Rotator Cuff Tear

A

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

27
Q

Rotator Cuff Arthropathy

A

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

28
Q

AC Joint Injury

A

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
29
Q

Type III AC Tx

A

higher complications in surgical tx (vs non-op)

No diff in pain and ROM

Surgery not recommended

30
Q

Clavicular Fracture

A 
ORIF
Neurovasc injury
Tenting of skin/open fracture
Multiple trauma
20 mm shortening
31
Q

Scapula Fracture

A

mostly non-op tx

32
Q

Proximal Humerus

A
  • 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

33
Q

Cervical Spine Pathology

A

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.
34
Q

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

A

conservative, they choose surgery earlier

*Surgery (9 decks)

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