Shoulder Conditions

Question 1

who usually presents with shoulder instability

Answer 1

young, sporty, teenage-30

Question 2

aetiology of traumatic shoulder instability

Answer 2

instability following an anterior dislocation

Question 3

what cause atraumatic shoulder instability

Answer 3

generalised laxity (ehlers-danlos, marfans) can have pain from recurrent multidirectional subluxation/dislocation

Question 4

clinical signs of shoulder instability

Answer 4

abnormal shoulder contour
muscle wasting, spasm
good ROM
scapular winging

Question 5

give some special tests you can do in examination of shoulder instability

Answer 5

sulcus sign, draw tests, apprehension and relocation tests

Question 6

investigations for shoulder instability

Answer 6

radiographs: AP and garth
MRI arthrogram

Question 7

management of traumatic shoulder instability

Answer 7

Bankart repair

Question 8

name some injuries associated with shoulder instability

Answer 8

fracture of humeral head
fracture of glenoid
rotator cuff tear in older patients

Question 9

what is glenohumeral OA

Answer 9

OA of the shoulder

Question 10

who usually presents with OA of the shoulder

Answer 10

> 60 yrs

Question 11

symptoms of OA of the shoulder

Answer 11

gradual onset, intermittent exacerbations
pain at rest and at night
stiffness, functional difficulties

Question 12

clinical signs of OA of the shoulder

Answer 12

asymmetry, wasting
limitation of external rotation
global movement restriction
pain through ROM

Question 13

investigation for OA of the shoulder

Answer 13

radiographs show: joint space narrowing, subchondral sclerosis, subchondral cysts, osteophyte formation

Question 14

conservative management of OA of the shoulder

Answer 14

analgesia, physio, steroid injection

Question 15

surgical management of OA of the shoulder

Answer 15

arthroplasty

Question 16

what is another name of adhesive capsulitis

Answer 16

frozen shoulder

Question 17

what is adhesive capsulitis

Answer 17

inflammation and fibrosis of the joint capsule leading to contracture of the shoulder joint

Question 18

who usually presents with adhesive capsulitis

Answer 18

females 40-50

Question 19

what is adhesive capsulitis associated with

Answer 19

diabetes, hypercholesterolaemia, dupuytrens

Question 20

pathophysiology of adhesive capsulitis

Answer 20

contracture and thickening of coraco-humeral ligament, rotator interval, axillary fold → decrease in joint volume

Question 21

symptoms of adhesive capsulitis

Answer 21

gradual severe pain: rest, at night, anterior pain
stiffness

Question 22

clinical sign of adhesive capsulitis

Answer 22

global restriction in ROM, especially in external rotation

Question 23

investigation of adhesive capsulitis

Answer 23

clinical diagnosis

Question 24

conservative management of adhesive capsulitis

Answer 24

physio + analgesia
intra-articular steroid injection

Question 25

who usually presents with a rotator cuff tear

Answer 25

grey hair = cuff tear 50-60 yrs

Question 26

what are the 2 main causes of a rotator cuff tear

Answer 26

degeneration FOOSH, sudden jerk

Question 27

what is most commonly involved in a rotator cuff tear

Answer 27

supraspinatus

Question 28

symptoms of a rotator cuff tear

Answer 28

pain in the front of the shoulder that radiates down the arm associated weakness

Question 29

clinical signs of a rotator cuff tear

Answer 29

wasting of supraspinatus tenderness in subdeltoid region

Question 30

management of a rotator cuff tear

Answer 30

rest, physio injections

Question 31

what is the most common joint dislocation

Answer 31

shoulder dislocation

Question 32

why is the shoulder the most common joint dislocation

Answer 32

the head of the humerus is substantially larger than the glenoid fossa

Question 33

who usually presents with a shoulder dislocation

Answer 33

younger patients, sporty, mostly traumatic

Question 34

what is the most common direction of shoulder dislocation

Answer 34

anterior

Question 35

cause of an anterior shoulder dislocation

Answer 35

fall with shoulder in external rotation

Question 36

what is at risk with an anterior shoulder dislocation

Answer 36

axillary artery

Question 37

what are the 2 main causes of a posterior shoulder dislocation

Answer 37

- fall with shoulder in anterior location - direct blow to anterior shoulder

Question 38

clinical sign of an anterior shoulder dislocation

Answer 38

humeral head anterior to the glenoid

Question 39

clinical sign of a posterior shoulder dislocation

Answer 39

humeral head posterior to the glenoid

Question 40

what are posterior shoulder dislocations often associated with

Answer 40

seizures

Question 41

how do patients present with an inferior shoulder dislocation

Answer 41

arm above their head

Question 42

clinical presentation of a shoulder dislocation

Answer 42

- Severe shoulder pain - Inability to move the shoulder - Empty glenoid fossa (dent) may be visible

Question 43

investigation of a shoulder dislocation

Answer 43

x-ray: AP and garth

Question 44

complication of a shoulder dislocation

Answer 44

recurrent instability risk

Question 45

who usually presents with shoulder impingement

Answer 45

patients <25

Question 46

what is shoulder impingement

Answer 46

inflammation and irritation of the rotator cuff tendons as they pass through the subacromial space

Question 47

what is rotator cuff tendonitis

Answer 47

Repeated impingement results in inflammation or damage of the rotator cuff tendons

Question 48

what is subacromial bursitis

Answer 48

calcification of the tendon following rotator cuff tendonitis

Question 49

clinical presentation of shoulder impingement

Answer 49

progressive pain in the anterior superior shoulder radiates to the deltoid and upper arm difficulty sleeping, reaching overhead and lifting

Question 50

examination finding that could be a sign of shoulder impingement

Answer 50

painful arc

Question 51

first line imaging of shoulder impingement

Answer 51

x-ray: AP and garth

Question 52

conservative management of shoulder impingement

Answer 52

rest, NSAIDs, physio, steroid injections

Question 53

when is surgery indicated for shoulder impingement and what does it involve

Answer 53

>6 months of no change subacromial decompression