Shoulder Conditions Flashcards
who usually presents with shoulder instability
young, sporty, teenage-30
aetiology of traumatic shoulder instability
instability following an anterior dislocation
what cause atraumatic shoulder instability
generalised laxity (ehlers-danlos, marfans) can have pain from recurrent multidirectional subluxation/dislocation
clinical signs of shoulder instability
abnormal shoulder contour
muscle wasting, spasm
good ROM
scapular winging
give some special tests you can do in examination of shoulder instability
sulcus sign, draw tests, apprehension and relocation tests
investigations for shoulder instability
radiographs: AP and garth
MRI arthrogram
management of traumatic shoulder instability
Bankart repair
name some injuries associated with shoulder instability
fracture of humeral head
fracture of glenoid
rotator cuff tear in older patients
what is glenohumeral OA
OA of the shoulder
who usually presents with OA of the shoulder
> 60 yrs
symptoms of OA of the shoulder
gradual onset, intermittent exacerbations
pain at rest and at night
stiffness, functional difficulties
clinical signs of OA of the shoulder
asymmetry, wasting
limitation of external rotation
global movement restriction
pain through ROM
investigation for OA of the shoulder
radiographs show: joint space narrowing, subchondral sclerosis, subchondral cysts, osteophyte formation
conservative management of OA of the shoulder
analgesia, physio, steroid injection
surgical management of OA of the shoulder
arthroplasty
what is another name of adhesive capsulitis
frozen shoulder
what is adhesive capsulitis
inflammation and fibrosis of the joint capsule leading to contracture of the shoulder joint
who usually presents with adhesive capsulitis
females 40-50
what is adhesive capsulitis associated with
diabetes, hypercholesterolaemia, dupuytrens
pathophysiology of adhesive capsulitis
contracture and thickening of coraco-humeral ligament, rotator interval, axillary fold → decrease in joint volume
symptoms of adhesive capsulitis
gradual severe pain: rest, at night, anterior pain
stiffness
clinical sign of adhesive capsulitis
global restriction in ROM, especially in external rotation
investigation of adhesive capsulitis
clinical diagnosis
conservative management of adhesive capsulitis
physio + analgesia
intra-articular steroid injection
who usually presents with a rotator cuff tear
grey hair = cuff tear
50-60 yrs
what are the 2 main causes of a rotator cuff tear
degeneration
FOOSH, sudden jerk
what is most commonly involved in a rotator cuff tear
supraspinatus
symptoms of a rotator cuff tear
pain in the front of the shoulder that radiates down the arm
associated weakness
clinical signs of a rotator cuff tear
wasting of supraspinatus
tenderness in subdeltoid region
management of a rotator cuff tear
rest, physio
injections
what is the most common joint dislocation
shoulder dislocation
why is the shoulder the most common joint dislocation
the head of the humerus is substantially larger than the glenoid fossa
who usually presents with a shoulder dislocation
younger patients, sporty, mostly traumatic
what is the most common direction of shoulder dislocation
anterior
cause of an anterior shoulder dislocation
fall with shoulder in external rotation
what is at risk with an anterior shoulder dislocation
axillary artery
what are the 2 main causes of a posterior shoulder dislocation
- fall with shoulder in anterior location
- direct blow to anterior shoulder
clinical sign of an anterior shoulder dislocation
humeral head anterior to the glenoid
clinical sign of a posterior shoulder dislocation
humeral head posterior to the glenoid
what are posterior shoulder dislocations often associated with
seizures
how do patients present with an inferior shoulder dislocation
arm above their head
clinical presentation of a shoulder dislocation
- Severe shoulder pain
- Inability to move the shoulder
- Empty glenoid fossa (dent) may be visible
investigation of a shoulder dislocation
x-ray: AP and garth
complication of a shoulder dislocation
recurrent instability risk
who usually presents with shoulder impingement
patients <25
what is shoulder impingement
inflammation and irritation of the rotator cuff tendons as they pass through the subacromial space
what is rotator cuff tendonitis
Repeated impingement results in inflammation or damage of the rotator cuff tendons
what is subacromial bursitis
calcification of the tendon following rotator cuff tendonitis
clinical presentation of shoulder impingement
progressive pain in the anterior superior shoulder
radiates to the deltoid and upper arm
difficulty sleeping, reaching overhead and lifting
examination finding that could be a sign of shoulder impingement
painful arc
first line imaging of shoulder impingement
x-ray: AP and garth
conservative management of shoulder impingement
rest, NSAIDs, physio, steroid injections
when is surgery indicated for shoulder impingement and what does it involve
> 6 months of no change
subacromial decompression
