Shoulder & Arm Flashcards
What is a Bankart lesion?
Injury of antero(inferior) glenoid labrum due to anterior shoulder dislocation —> pocket in ant. glenoid forms that the humeral head dislocates into
What is a Hills-Sachs lesion?
Cortical depression in posterolateral head of humerus due to anterior shoulder dislocaton —> humeral head impacts against anteroinferior glenoid rim
What is the origin, insertion, and function of supraspinatus?
Origin = medial 2/3 of supraspinous fossa Insertion = superior facet of greater tubercle
Function = abduction (0-15 degrees)
Suprascapular nerve (C5, C6)
What is the origin, insertion, and function of infraspinatus?
Origin = medial 2/3 of infraspinous fossa Insertion = middle facet of pos. surface of greater tubercle
Function = external rotation
Suprascapular nerve (C5, C6)
What is the origin, insertion, and function of subscapularis?
Origin = medial 2/3 of subscapular fossa Insertion = lesser tubercle
Function = internal rotation
Upper and lower subscapular nerves (C5, C6)
What is the origin, insertion, and function of teres minor?
Origin = upper 2/3 of pos. scapula, immediately adjacent to lateral border Insertion = inferior facet of pos. surface of greater tubercle
Function = external rotation
Axillary nerve (C5, C6)
What is the look component of the shoulder exam?
FRONT:
- alignment and posture
- symmetry
- wasting: deltoid, pectorals
- lumps, scars, bruising, sinuses, swellings
- scapula
BACK:
- scapula
- wasting: supraspinatus, infraspinatus
- movements of scapulothoracic joint
Axilla: lymphadenopathy, large joint effusions
Arm position: rotation
Bony prominences: ACJ and SCJ
What is the feel component of the shoulder exam?
Skin: palpate general area for temp. and effusions
Muscle: supraspinatus, infraspinatus, deltoid
Tendons: flex biceps and feel tendon, push arm back and feel just ant. for supraspinatus tendon
Bony landmarks: run hand from SCJ along clavicle to ACJ —> greater and lesser tuberosities and around glenohumeral joint —> spine of scapula and around inf. scapula back to ACJ
What is the move component of the shoulder exam?
Flexion (180 degrees)
Extension (65 degrees)
Abduction (180 degrees):
- active: high arc pain (ACJ e.g. arthritis), middle arc pain (rotator cuff e.g. tendinitis, cuff tear)
- passive: pain (mechanical) or no pain (muscular)
Adduction (50 degrees)
External rotation (70 degrees) - loss of external rotation = frozen shoulder
Internal rotation
- try to touch inf. scapula with fingers behind back (normal is base of scapula)
What are the special tests of the shoulder?
Serratus anterior = patient pushes up against wall —> winging of scapula
Deltoid = abduct against resistance at 90 degrees
Supraspinatus = resisted empty can test
Teres minor/infraspinatus = resisted external rotation
Subscapularis = lift-off test
Neers impingement test = stabilise scapula with one hand, internally rotate straight arm and passively flex other arm —> pain indicates impingement
Hawkin’s test = flex arm to 90 degrees, pronate hand, and flex elbow to 90 degrees, then passively internally rotate shoulder —> pain indicates impingement
Crank shoulder apprehension test = high five position, pull back elbow and push proximal humerus forward —> patient shows fear of instability in shoulder dislocation/subluxation disorders
Scarf ACJ test = patient places hand on opposite shoulder —> pain in ACJ pathology
Give some examples of intrinsic causes of shoulder pain.
Rotator cuff disorders:
- rotator cuff tears = traumatic or atraumatic, drop arm test, painful arc, Hx of repetitive/heavy movements
- subacromial pain
- calcific tendinitis: self-limiting, 30yrs-60yrs
Glenohumeral disorders:
- adhesive capsulitis (frozen shoulder): diabetes, prolonged immobilisation
- arthritis
Acromioclavicular disorders:
- trauma
- osteoarthritis
- restriction of passive horizontal movement of arm across the body when elbow extended
Biceps tendinitis
Infection
Shoulder instability +/- associated hypermobility disorders
Give some examples of extrinsic causes of shoulder pain.
Referred pain e.g. neck, MI, diaphragm
Polymyalgia rheumatica
Malignancy e.g. apical lung tumours, metastases
What are some red flags signs in a shoulder exam?
- Hx of malignancy, S&S consistent with neoplasia
- overlying skin erythema (tumour/infection)
- systemic S&S (polymyalgia rheumatica, giant cell arteritis)
- fever (tumour/infection)
- Hx of trauma/recent convulsions/electric shock (?unreduced dislocation)
- change in shoulder contour with loss of rotation (dislocation)
- sensory motor deficit (neurological lesion)
