Shoulder and upper limb nerve entrapment Flashcards
What is the relevant bony anatomy of the shoulder?
Acromioclavicular joint
Glenohumeral joint
What are the relevant muscles of the shoulder?
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
What is the rotator interval?
The anatomical space bound by the subscapularis, supraspinatus and corocoid containing the coracohumeral and superior glenohumoral ligament, the biceps tendon and anterior joint capsule
There is a ligament spanning from the acromion to the corocoid. T/F
True - acromiocoracoid ligament
Where does tendon impingement occur?
Against the acromion or acromiocoracoid ligament
What is the rotator cuff?
The combined tendons of the rotator cuff muscles
What is more important in shoulder stability - bony anatomy or soft tissue anatomy?
Soft tissue anatomy - bony anatomy does not provide much stability
How can pathology of the shoulder bursa be investigated?
Ultrasound
How common is shoulder impingement?
Very
What are the typical symptoms of shoulder impingement?
Pain on movement (often specific movements) Night pain (more common with tears)
What are the signs of shoulder impingement?
Painful arc
Positive hawkins kennedy test
Positive impingement tests (internal rotation)
How common is muscle wasting in shoulder impingement?
Uncommon - usually points to another pathology
What are the possible causes of loss of range of movement of the shoulder?
Frozen shoulder
Tear (rotator cuff)
Shoulder impingement (only due to pain)
What endocrine condition is frozen shoulder associated with?
Diabetes
What is often the main feature which separates shoulder impingement from a rotator cuff tear?
Weakness is present in tears
What diagnosis would painful and complete loss of movement at the shoulder point too?
Frozen shoulder
What is a painful arc?
Pain on abduction from 50-120 degrees
What is a crescendo arc? What does it point towards?
Increasing pain as the shoulder adducts. Acromioclavicular joint pathology
What is subacromial bursitis?
Inflammation of the shoulder bursa usually due to or related to impingement
What is the bigliani acromial classification? Why is it relevant?
Classification of shoulder morphology (type I - flat, type II - curved, type III - hooked)
Type II and III acromions are associated with higher risk of impingement
What is calcific tendonitis?
Build up of calcium within the rotator cuff of unknown cause
How does calcific tendonitis present?
Pain
Impingement
Reduced range of movement
Who gets calcific tendonitis?
30-60 y/o most commonly
How is calcific tendonitis treated?
Joint aspirate –> steroid injection
Self resolving but takes years
What is os acromiale?
Non fused epiphysis of the acromion
How common is os acromiale?
Very rare
How does os acromiale present?
Often asymptomatic
Pain
Impingement
How is a rotator cuff tear managed?
Physiotherapy
Surgery
How is shoulder arthritis managed?
Conservatively
Surgery high risk with poor results
What structure is needed for total shoulder arthroplasty?
Rotator cuff
When is a reverse arthroplasty indicated?
When conservative measures have failed and the rotator cuff is rubbish
Shoulder instability can be traumatic or atraumatic which is more common?
Traumatic causes
What does TUBS stand for?
TUBS relates to shoulder instability
T - traumatic aetiology
U - unidirectional instability
B - bankart lesion
S - surgery needed (bankart repair OR latarjet)
Which direction of shoulder dislocation is most common?
Anterior
What is at risk in an anterior shoulder dislocation?
Axillary nerve
What is a posterior dislocation associated with?
Epileptic seizure
Electric shock
Atraumatic
What are hill sachs lesions?
Posterolateral humeral head compression fractures
What are hill sachs lesions associated with?
Anterior shoulder dislocation (humeral head becomes wedged beneath glenoid)
What is a bankart lesion?
Tear in the anterior inferior glenoid labrum due to anterior shoulder dislocation
Do bakart lesions need repaired?
Yes
What does AMBRI stand for?
AMBRI is related to shoulder instability
A - atraumatic M - multidirectional B - bilateral R - rehabilitation I - inferior capsule shift (surgery if conservative fails)
What is often positive in atraumatic shoulder instability?
Sulcus sign
What conditions are associated with multidirectional shoulder instability?
Ehlers danlos
Marfans
What is ehlers danlos syndrome?
A heritable disorder of connective tissue causing joint hypermobility, stretchy and fragile skin
What scoring system can be used to diagnose hypermobility syndrome(s)?
Beighton score
Which radiographical sign is present with posterior shoulder dislocation?
Light bulb sign
Which views should be taken for a suspected posterior shoulder dislocation?
AP
Lateral
How is inferior capsule shift managed?
Conservatively
Surgically
What is carpal tunnel syndrome?
Compression of the median nerve at the carpal tunnel
How does carpal tunnel syndrome present?
Paraesthesia of index, middle and radial ring finger Thumb weakness Dull pain Loss of grip strength Reduced dexterity Night disturbance
How can carpal tunnel be managed?
Night splints
Surgery
Steroid injections
What conditions are associated with carpal tunnel?
Pregnancy Hypothyroidism Rheumatoid arthritis Diabetes Obesity
How is carpal tunnel investigated?
Nerve conduction studies
What is the carpal tunnel?
Tunnel by which flexor tendons of the wrist pass inferior to the flexor retinaculum/transverse carpal ligament
What is cubital tunnel syndrome?
Compression of the ulnar nerve at the cubital tunnel
How does cubital tunnel syndrome present?
Pain/paraesthesia of the elbow
Pain/paraesthesia of the ulnar ring and little finger
Weakness
What sign may be present in carpal tunnel syndrome?
Thenar wasting
What sign may be present in cubital tunnel syndrome?
Claw-like grip
Which three sites might cause compression of the ulnar nerve?
Cubital tunnel
Flexor carpi ulnaris tendon heads
Intermuscular fibrous bands above elbow
How is cubital tunnel syndrome treated?
Surgery
