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MSK 2023 > Shoulder conditions > Flashcards

Shoulder conditions Flashcards

1
Q

Most common shoulder dislocation

A

Anterior (90%) (humerus head anterior to glenoid fossa)

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2
Q

Signs of shoulder dislocation (visible)

A

Deformed
Swelling
Bruising

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3
Q

Why do shoulder dislocations occur?

A

Glenoid fossa shallow

Weakest on inferior aspect (dislocates anterioinferiorly then displaces anterior)

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4
Q

Types of anterior dislocation

A

Subglenoid (30%)

Subcoracoid (60%)

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5
Q

Actions anterior dislocation

A

EXTERNAL ROTATION
ABDUCTION

(anterior rotator cuffs lax so rotator cuffs (infraspinatus, supraspinatus and teres minor pull externally)

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6
Q

How does anterior dislocation occur?

A

Arm in position of abduction and external rotation (throwing ball, hand behind head)
Force pushes on it posteriorly

OR
Direct posterior blow to shoulder

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7
Q

What can occur when humeral head is forced out of socket?

A

Bankart lesion/Labral tear
(glenoid labrum torn off and some bone can be torn off with it)

Hills-Sach lesion

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8
Q

What is hills sach lesion?

A

Humerus dislocates anteriorly
Posterior humeral head is pressed against anterior lip of glenoid fossa
Indentation in posterolateral humerus head

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9
Q

What do Hills-Sach lesions have a risk of?

A

Increase risk of secondary arthritis in joint

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10
Q

Posterior shoulder dislocations causes

A 
VERY uncommon 
Epileptic fits
Lightening strike
Electrocution 
Blow to anterior shoulder
Arm flexed, pushed posteriorly (fall on elbow)
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11
Q

Presentation posterior dislocation

A

Internally rotated and adducted
Squaring of shoulder
Coracoid process prominent

(posterior rotator cuffs lax so subscapularis pulls internally)

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12
Q

Sign of posterior dislocation on X ray

A

Lightbulb humeral head
Glenohumoral distance increased

(Rotated internally so head faces X ray - appears more rounded)

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13
Q

Inferior dislocation cause

A

RARE

When arm is fully extended above head forceful traction (HYPERABDUCTION)

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14
Q

Complications inferior dislocation

A

Damage to nerves
Rotator cuff tears
Injury to blood vessels

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15
Q

Complications of all shoulder dislocations

A 
RECURRENT dislocation (damage to stabilising 
factors)

(can lead to OA)

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16
Q

Damage to neurovascular system shoulder dislocation

A 
Axillary artery 
Axillary nerve (wraps around surgical neck of humerus, supplies deltoid and regimental badge area of skin)

Less common: damage to brachial cords/musculocutaneous nerve

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17
Q

Test for axillary damage

A

See if sensation is lost in regimental badge area

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18
Q

What other damage to structures can occur after shoulder dislocation?

A

Fractures (clavicle, acromion, head/greater tubercle of humerus)
Rotator cuff tears

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19
Q

Clavicle fractures: where do they most often occur?

A

middle third of clavicle (midclavicular)

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20
Q

Treatment clavicle fractures

A

Sling BUT surgery if:

Complete displacement
Severe displacement (tenting skin, risk of puncture)
Open fracture
Neurovascular compromise
Floating shoulder (fracture with glenoid neck fracture)

21
Q

What happens to sections of clavicle when fractured?

A

Medial end: Sternocleidomastoid elevates

Lateral end: Weight of upper limb exceeds trapezius strength so drops

Arm pulled medially by pectoralis major

22
Q

Complications of clavicular fracture

A

non-union/malunion of fracture
Pneumothorax
Suprascapular and supraclavicular nerve damage

23
Q

Supraclavicular damage means

A

Paraesthesia over anterior upper chest (c3/C4)

24
Q

Rotator cuff tears most common

A

Tendons torn more frequently than muscles

Supraspinatous most at risk

25
Q

Where does supraspinatus usually tear?

A

At site of insertion on greater tubercle on humerus (passes under corocacromial arch)

26
Q

What are most rotator cuff tears a result of?

A 
Chronic (poor biomechanics/muscular imbalance)
Extended use (lifting/overhead activity - swimming)
AGE RELATED degeneration
27
Q

What happens with age to rotator cuffs?

A

Blood supply decreases with age

Impairs body’s ability to repair minor injuries

28
Q

Theory behind rotator cuff tears

A

Degenerative-microtrauma model

Age related tendon degeneration + microtrauma = partial tendon tears with become full tears

29
Q

Body’s response after tear

A

Inflammatory cells
= Oxidative stress
= tenocyte (tendon cell) apoptosis
= further degeneration

30
Q

Common presentation rotator cuff tear

A

Asymptomatic usually BUT
Anterolateral shoulder pain radiating down arm

(especially when leaning on arm rest, reaching forward/flexing)

31
Q

Action weakness rotator cuff injury

A

Abduction weakness

32
Q

Management and investigation rotator cuff tears

A

SOFT TISSUE
MRI
Ultrasound
Conservative or surgical

33
Q

What is impingement syndrome?

A

When supraspinatous tendon rubs/catches on corocoacromial arch leading to irritation

34
Q

Cause of impingement syndrome

A

Anything that narrows space between humerus and corocoacromial arch eg:

Thickening of corocoacromial ligament
Inflammation of supraspinatus tendon
Subacromial osteophytes
Bursitis

35
Q

When does pain present in impingement syndrome?

A

When shoulder is abducted or flexed, space is narrowed further so can cause pain and reduced motion

36
Q

Most common impingement syndrome

A

Impingement of supraspinatus tendon

Painful arc between 60-120 degrees of abduction

37
Q

What is calcific supraspinatus tendonopathy?

A

Macroscopic deposits of hydroxyapatite (calcium phosphate) crystals on supraspinatus tendon

38
Q

Signs/symptoms calcific supraspinatus tendonopathy

A 
Chronic pain (aggrevated by abduction/flexion)
Physical appearance of deposit
Stiffness
Snapping sensation
Reduced range of movement
39
Q

Why does calcific tendonopathy occur?

A

Regional hypoxia = tenocytes –> chondrocytes and lay down cartilage
Endochondral ossification produces calcified tendon

OR
Ectopic bone formation from metaplasia of mesenchymal stem cells

40
Q

When is most pain caused by calcific tendonpathy?

A

Reabsoption by phagocytes

Look like toothpaste at this stage (cloudy and less defined on X ray)

41
Q

Treatment calcific tendonpathy?

A

Conservative (rest, analgesia)

Surgical if persistent symptoms

42
Q

Viewing calcific tendonpathy

A

X ray

43
Q

What is adhesive capsulitis?

A

Frozen shoulder
Capsule of glenohumoral joint becomes inflamed and stiff
Worse in cold, at night and movement

44
Q

Risk factors adhesive capsulitis

A 
Autoimmune initiated by trauma?
Female
Epilepsy with seizures
Diabetes mellitus (glucose binds to capsular collagen)
Connective tissue disease 
Inactivity large periods of time
45
Q

Treatment frozen shoulder

A

Physio
Analgesia
Anti-inflammatories
Manipulation under analgesia to break up scar tissue/adhesions

46
Q

What can happen after frozen shoulder?

A

Can occur in opposite arm

Autoimmune hypothesis

47
Q

Osteoarthiritis in shoulder usually affects

A

More common in acromioclavicular joint than glenohumoral

48
Q

treatment OA shoulder (conservative)

A

NSAID’s
Analgesia
Viscosupplementation (hyaluronic acid injections to joint)
Nutritional supplements (glucosamine/chrondroitin sulfate)

49
Q

Surgical treatment OA shoulder

A

Arthroscopy (keyhole) remove loose pieces of damaged cartilage
Hemiarthroplasty (humeral head replaced)
Or Total shoulder replacement (reverse)

MSK 2023 (55 decks)

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