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Year 2 > Shoulder and upper limb nerve entrapment > Flashcards

Shoulder and upper limb nerve entrapment Flashcards

1
Q

What is the relevant bony anatomy of the shoulder?

A

Acromioclavicular joint

Glenohumeral joint

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2
Q

What are the relevant muscles of the shoulder?

A

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

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3
Q

What is the rotator interval?

A

The anatomical space bound by the subscapularis, supraspinatus and corocoid containing the coracohumeral and superior glenohumoral ligament, the biceps tendon and anterior joint capsule

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4
Q

There is a ligament spanning from the acromion to the corocoid. T/F

A

True - acromiocoracoid ligament

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5
Q

Where does tendon impingement occur?

A

Against the acromion or acromiocoracoid ligament

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6
Q

What is the rotator cuff?

A

The combined tendons of the rotator cuff muscles

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7
Q

What is more important in shoulder stability - bony anatomy or soft tissue anatomy?

A

Soft tissue anatomy - bony anatomy does not provide much stability

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8
Q

How can pathology of the shoulder bursa be investigated?

A

Ultrasound

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9
Q

How common is shoulder impingement?

A

Very

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10
Q

What are the typical symptoms of shoulder impingement?

A 
Pain on movement (often specific movements) 
Night pain (more common with tears)
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11
Q

What are the signs of shoulder impingement?

A

Painful arc
Positive hawkins kennedy test
Positive impingement tests (internal rotation)

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12
Q

How common is muscle wasting in shoulder impingement?

A

Uncommon - usually points to another pathology

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13
Q

What are the possible causes of loss of range of movement of the shoulder?

A

Frozen shoulder
Tear (rotator cuff)
Shoulder impingement (only due to pain)

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14
Q

What endocrine condition is frozen shoulder associated with?

A

Diabetes

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15
Q

What is often the main feature which separates shoulder impingement from a rotator cuff tear?

A

Weakness is present in tears

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16
Q

What diagnosis would painful and complete loss of movement at the shoulder point too?

A

Frozen shoulder

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17
Q

What is a painful arc?

A

Pain on abduction from 50-120 degrees

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18
Q

What is a crescendo arc? What does it point towards?

A

Increasing pain as the shoulder adducts. Acromioclavicular joint pathology

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19
Q

What is subacromial bursitis?

A

Inflammation of the shoulder bursa usually due to or related to impingement

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20
Q

What is the bigliani acromial classification? Why is it relevant?

A

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

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21
Q

What is calcific tendonitis?

A

Build up of calcium within the rotator cuff of unknown cause

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22
Q

How does calcific tendonitis present?

A

Pain
Impingement
Reduced range of movement

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23
Q

Who gets calcific tendonitis?

A

30-60 y/o most commonly

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24
Q

How is calcific tendonitis treated?

A

Joint aspirate –> steroid injection

Self resolving but takes years

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25
Q

What is os acromiale?

A

Non fused epiphysis of the acromion

26
Q

How common is os acromiale?

A

Very rare

27
Q

How does os acromiale present?

A

Often asymptomatic
Pain
Impingement

28
Q

How is a rotator cuff tear managed?

A

Physiotherapy

Surgery

29
Q

How is shoulder arthritis managed?

A

Conservatively

Surgery high risk with poor results

30
Q

What structure is needed for total shoulder arthroplasty?

A

Rotator cuff

31
Q

When is a reverse arthroplasty indicated?

A

When conservative measures have failed and the rotator cuff is rubbish

32
Q

Shoulder instability can be traumatic or atraumatic which is more common?

A

Traumatic causes

33
Q

What does TUBS stand for?

A

TUBS relates to shoulder instability

T - traumatic aetiology
U - unidirectional instability
B - bankart lesion
S - surgery needed (bankart repair OR latarjet)

34
Q

Which direction of shoulder dislocation is most common?

A

Anterior

35
Q

What is at risk in an anterior shoulder dislocation?

A

Axillary nerve

36
Q

What is a posterior dislocation associated with?

A

Epileptic seizure
Electric shock
Atraumatic

37
Q

What are hill sachs lesions?

A

Posterolateral humeral head compression fractures

38
Q

What are hill sachs lesions associated with?

A

Anterior shoulder dislocation (humeral head becomes wedged beneath glenoid)

39
Q

What is a bankart lesion?

A

Tear in the anterior inferior glenoid labrum due to anterior shoulder dislocation

40
Q

Do bakart lesions need repaired?

A

Yes

41
Q

What does AMBRI stand for?

A

AMBRI is related to shoulder instability

A - atraumatic
M - multidirectional
B - bilateral
R - rehabilitation 
I - inferior capsule shift (surgery if conservative fails)
42
Q

What is often positive in atraumatic shoulder instability?

A

Sulcus sign

43
Q

What conditions are associated with multidirectional shoulder instability?

A

Ehlers danlos

Marfans

44
Q

What is ehlers danlos syndrome?

A

A heritable disorder of connective tissue causing joint hypermobility, stretchy and fragile skin

45
Q

What scoring system can be used to diagnose hypermobility syndrome(s)?

A

Beighton score

46
Q

Which radiographical sign is present with posterior shoulder dislocation?

A

Light bulb sign

47
Q

Which views should be taken for a suspected posterior shoulder dislocation?

A

AP

Lateral

48
Q

How is inferior capsule shift managed?

A

Conservatively

Surgically

49
Q

What is carpal tunnel syndrome?

A

Compression of the median nerve at the carpal tunnel

50
Q

How does carpal tunnel syndrome present?

A 
Paraesthesia of index, middle and radial ring finger
Thumb weakness 
Dull pain
Loss of grip strength
Reduced dexterity 
Night disturbance
51
Q

How can carpal tunnel be managed?

A

Night splints
Surgery
Steroid injections

52
Q

What conditions are associated with carpal tunnel?

A 
Pregnancy
Hypothyroidism
Rheumatoid arthritis 
Diabetes 
Obesity
53
Q

How is carpal tunnel investigated?

A

Nerve conduction studies

54
Q

What is the carpal tunnel?

A

Tunnel by which flexor tendons of the wrist pass inferior to the flexor retinaculum/transverse carpal ligament

55
Q

What is cubital tunnel syndrome?

A

Compression of the ulnar nerve at the cubital tunnel

56
Q

How does cubital tunnel syndrome present?

A

Pain/paraesthesia of the elbow
Pain/paraesthesia of the ulnar ring and little finger
Weakness

57
Q

What sign may be present in carpal tunnel syndrome?

A

Thenar wasting

58
Q

What sign may be present in cubital tunnel syndrome?

A

Claw-like grip

59
Q

Which three sites might cause compression of the ulnar nerve?

A

Cubital tunnel
Flexor carpi ulnaris tendon heads
Intermuscular fibrous bands above elbow

60
Q

How is cubital tunnel syndrome treated?

A

Surgery

Year 2 (72 decks)

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