Shoulder and Elbow Flashcards
what is Subacromial impingement
first stage of rotator cuff disease
continuum of disease from
- impingement and bursitis
- partial to full-thickness tear
- massive rotator cuff tears
- rotator cuff tear arthropathy
what is the Pathophysiology of Subacromial Impingement?
subacromial impingement is thought to be a combination of
extrinsic compression of rotator cuff between the humeral head and
- anterior acromion
- coracoacromial ligaments
- acromioclavicular joint
intrinsic degeneration of
supraspinatus
attrition of the supraspinatus leads to inability to balance the humeral head on the glenoid causing superior migration and narrowing of the subacromial space
inflammatory process
inflammation of the subacromial bursa due to abutement between the humerus and rotator cuff, and acromion and associated ligaments
what are the Associated conditions with subacromialimpingement?
- hook-shaped acromion
- os acromiale
- posterior capsular contracture
- scapular dyskinesia
- tuberosity fracture malunion
- instability
what are the common radiographic findings associated with impingement
findings
common radiographic findings associated with impingement
- proximal migration of the humerus as seen in rotator cuff tear arthropathy
- traction osteophytes
- calcification of the coracoacromial ligament
- cystic changes within the greater tuberosity
- Type III-hooked acromion associated with impingment
- os acromiale best seen on axillary lateral
Nonoperative treatment of subacromial impingement
- physical therapy
- NSAID
- subacromial injections
- platelet-rich plasma injections
what is the Operative treatment of subacromial impingement?
subacromial decompression / acromioplasty
what is the indications of the operative rx in Subacromial impingement? and whats the outcome?
subacromial impingement syndrome that has failed a minimum of 4-6 months of nonoperative treatment
outcomes
poor subjective outcomes have been observed after acromioplasty in patients with
- workers’ compensation claims
- anxiety and depression
Technique of Subacromial decompression and acromioplasty?
two-step procedure performed open or arthroscopically
- anterior acromionectomy
- anteroinferior acromioplasty
treatment of an os acromiale
two-stage procedure may be required with the presence of an os acromiale to avoid deltoid dysfunction caused by direct excision
- os acromiale is first fused with bone graft and allowed to heal
- acromioplasty is then performed as a separate second procedure
what are the complications of the OR rx of Subacromial decompression?
- Deltoid dysfunction
- Anterosuperior escape
What is subcoracoid impingement?
Subcoracoid impingement is defined as impingement of the subscapularis between the coracoid and lesser tuberosity
What is the position of maximal impingement In subcoracoid impingement?
- adduction,
- flexion
- internal rotation
What is the position of maximal pain In Subcoracoid impingement
120-130° of arm flexion and internal rotation
MRI In Subcoracoid Impingement
used to evaluate degree of rotator cuff pathology
findings
- increased signal in subscapularis
- increased signal in lesser tuberosity
What is the non-operative treatment for Subcoracoid Impingement
- rest, ice
- activity modification
- NSAIDS
- corticosteroid injections
techniques
- local corticosteroid injections can be diagnostic and therapeutic
- PT focuses on stretching
What is the operative treatment for Subcoracoid Impingement
- arthroscopic coracoplasty ± subscapularis repair
- open coracoplasty
What is Calcific Tendonitis
Calcification and tendon degeneration near the rotator cuff insertion
associated with subacromial impingement
What is the non-operative treatment Of Calcific Tendonitis
- NSAIDs
- physical therapy
- stretching & strengthening
- steroid injections
- extracorporeal shock-wave therapy
- ultrasound-guided needle lavage vs. needle barbotage
What is the operative treatment Of Calcific Tendonitis
surgical decompression of calcium deposit
What are the complications of Calcific Tendonitis
- Recurrence
- Persistent shoulder pain
- Shoulder stiffness
- Iatrogenic injury to rotator cuff with operative treatment
What is the epidemiology of rotator cuff tear
- age >60: 28% have full-thickness tear
- age >70: 65% have full-thickness tear
What are the risk factors for rotator cuff tear
- age
- smoking
- hypercholesterolemia
- family history
What are the mechanism of rotator cuff tear
- chronic degenerative tear ( intrinsic degeneration is the primary etiology)
- chronic impingement
- acute avulsion injuries
- iatrogenic injuries
What is the prognosis of rotator cuff tear
- 50% of asymptomatic tears become symptomatic in 2-3 years
- 50% of symptomatic full-thickness tears progress at 2 years and bigger tears progress faster
What are the different classification of rotator cuff tear
- Anatomic Classification
- Cuff Tear Size
- Ellman Classification of Partial-Thickness Rotator Cuff Tears
- Cuff Atrophy (Goutallier)
- Cuff Tear Shape
What images we can order as part of our diagnoses to rotator cuff tear
- Radiographs
- Arthrogram
- MRI
- MRA
- Ultrasound
What are The Lesions Associated with Posterior Instability
- Avulsion of posterior band of IGHL
- Posterior Bankart lesions
- Reverse Hill-Sachs lesions
- Posterior labral cyst
- Posterior glenoid rim fracture
- Lesser tuberosity fracture
- Large capsular pouch
What are the indications of shoulder fusion?
- stabilization of paralytic disorders
- brachial plexus palsy
- irreparable deltoid and rotator cuff deficiency with arthropathy
- salvage of a failed total shoulder arthroplasty
- reconstruction after tumor resection
- painful ankylosis after chronic infection
- recurrent shoulder instability which has failed previous repair attempts
- paralytic disorders in infancy
What are the contraindications of shoulder fusion?
- ipsilateral elbow arthrodesis
- contralateral shoulder arthrodesis
- lack of functional scapulothoracic motion
- trapezius, levator scapulae, or serratus anterior paralysis
- Charcot arthropathy during acute inflammatory stage (Eichenholtz 0-2)
- elderly patients
- progressive neurologic disease
what is the outcome of Non-operative treatment of Distal Biceps Rupture?
- will lose 50% sustained supination strength
- will lose 40% supination strength
- will lose 30% flexion strength
- will lose 15% grip strength
what is the operative treatment of the distal biceps Avulsion? type of incision?
surgical repair of tendon to tuberosity
- Anterior Single-Incision Technique
- Dual Incision Technique
what are the distal biceps fixation technique?
- comparison
- bone tunnel
- suture anchors
- intraosseous screw fixation
- suspensory cortical button
what is the nonopreative rx of Elbow Arthritis?
- NSAID
- cortisone injections
- resting and splints
- activity modification
what is the operative options rx for Elbow Arthritis?
- arthroscopic debridement and capsular release
- ulnohumeral distraction interposition arthroplasty
- olecranon fossa debridement (Outerbridge-Kashiwagi procedure)
- total elbow arthroplasty
What are the Forms of elbow arthroplasty
- total elbow arthroplasty
- hemi elbow arthroplasty
- radiocapitellar
- distal humeral (not FDA approved)
- ulnohumeral distraction & interpositional arthroplasty
- olecranon fossa debridement
- radial head arthroplasty
