shoulder and elbow pathologies Flashcards
2 that block external rotation
posterior dislocation
glenohumeral OA
which 2 block internal rotation and abduction
impingement
rotator cuff tear
summary of impingement
normal movement
painful abduction and IR
Hawkin test
adhesive capsulitis summary
can’t move shoulder at all global loss both passive and active
summary rotator cuff tear
Jobe’s test
painful abduction, but can be all
loss of above shoulder height
normal passive, weak active
test for supraspinatous
jobe test- internal rotation
test for infraspinatous and teres minor
hands push out- external rotation
subscapularis
gerber’s lift off
belly press test
pathologies seen in <30 and test
shoulder dislocation/ instability = apprehension test
pathologies seen middle age
impingement
frozen shoulder
traumatic cuff tear
pathologies seen in elderly
glenohumeral OA
acromio-clavicular OA
degnerative cuff tear
what is impingement
rotator cuff tendon caught between bursa acromion
ROfM for impingement pain
abduction and IR becomes painful
2 causes of impingement
calcific tendonitis
acromion clavicular joint OA
what is calcific tendonitis
depositis of hydroxyapatite crystals into tendon- usually supraspinatous
cause inflammation
presentation of calcific tendonitis
chronic pain intermittent flare ups pain radiates to deltoid insertion stiffness reduced abduction and internal rotation
test for impingement3
hawkin’s test- pain on internal rotation
painful arc
x-ray for osteophytes or calcium depositis
management of impingement conservative
conservative
- physio
- analgesia
- steroids
- subacromial injection
indication for operative manaement on impingement
conservative failure minimum 4-6 months
subacromial decompression with acromioplasty
3 phases of adhesive capsulitis and how long
freeze-3months-painful
frozen-6months- ROM
thawing-12 months
most common loss of ROFM 3 from adhesive capsulitis
rem global loss though
ER most then
flexion then
IR
presentation frozen
global loss
worse at night
preceding event possible
tender over anterior GHJ
causes of frozen shoulder 2
primary: idiopathic
seconddary: risk factors
- DM
- endocrine
- previous surgery
- trauma
diagnosis criteria for frozen shoulder
painful shoulder with restricted active and passive motion for at least 1 month duration
x-ray of frozen shoulder shows
normal
conservative management of frozen shoulder
physio
analgesia
intra- steroids
non-conservative frozen management and indication
- MUA-crack adhesions
2. arthroscopic surgical release- if 3-6 months failed
types of shoulder dislocation and cause
anterior: FOOSH
posterior: subglenoid- epilepsy/ electric
subclavicular
intrathoracic
cause of anterior dislocation
forced abduction, ER and extension
causes of shoulder instability traumatic4
- bakart lesion: avulsion of glenoid labrum from glenoid
- Glenohumeral ligament avulsion- tear from glenoid
- hill-sachs lesion impaction # posterior humeral head cause anterior dislocation
- slack capsule= repetitive stretching of joint capsule
causes of shoulder instability atrumatic 2
generalised ligament laxity eg ehlers danlos
hypoplastic glenoid
clinical presentation of anterior dislocation
- <25 male following trauma
- wilful dislocation/ habitual
- ;pain
- arm paraesthesia
- swelling-palpable humeral head
clinical presentation of posterior dislocation
fixed in internal roatation
complications of shoulder dislocation 3
- recurrence risk 80% in young
- rotator cuff tear/ greater tuberosity fracture older
- axillay nerve/brachial plexus palsy
diagnosis shoulder dislocation
x-ray
apprehension test
management dislocation conservative
MUA then physio
indications for operative managenment of dislocations
hill-sachs <35 play contact sport sig bone injury patient wish posterior dislocate
operative management for dislocations
- re-construct the glenoid labrum/ tighten ligaments
- for posterior have to take off muscles
2 main causes of rotator tear
degernative
trauma
rotator cuff tear RofM affected
normal passive, loss active
abduction
external rotation
internal rotation
most common tendon to have tear in
suprapsinatous
then teres minor and infrapsinatous
2 main dx tool for cuff tear
mri and usss
presentation cuff tear
muscle wasting >50 history trauma dull ache abduction, ER, IR tender painful/ loss of arc active loss, passive normal
conservative management for rotator cuff tear
nsaid
analgesia
steroid
physio
surgical indication for cuff tear
if conservative fails for elderly or young traumatic
surgical option for cuff tear
subacromial decompression
reatachment cuff
arthroplasty
which is the most common shoulder OA
ACJ
presentation of GHJ
pain deep shoulder and lateral aspect
stiffness
crepitus
global loss of ROFM
x-ray of GHJ shows
high riding humeral head dysfunction of rotator cuff tendon as not opposed to deltoid muscle
risk factor for GHJ trauma
previous rotator cuff tear- as centralising effect of cuff muscle is lost= cuff arthropathy
ACJ oa presentation
chronic history
tender to palpate superior shoulder
reduced abduction but normal power
risk of shoulder dislocation recurrence ages 19 and 30
> 90% at 18
<50% if over 30
axillary distibution of pain in shoulder dislocation name for it
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