Shoulder conditions Flashcards
What kind of joint is the shoulder?
Synovial
What forms the shoulder joint?
Glenoid fossa of the scapula
Humeral head
What 4 muscles make up the rotator cuff?
Supraspinatus
Infraspinatus
Subscapularis
Teres minor
How is supraspinatus tested?
Hands semi-prone and push down
How is infraspinatus tested?
Trying to push hands together
How is subscapularis tested?
Hand at small of back and push
How is teres minor tested?
Not tested clinically
What do the rotator cuff muscles do?
Pull the humeral head into the glenoid to provide a fulcrum for stability
What age is most likely to be affected by shoulder instability?
Young adults
What age does rotator cuff tears affect?
Middle aged
What is impingement syndrome?
Tendons of rotator cuff are compressed in the tight subacromial space
Between what degrees of abduction can the painful arc of impingement syndrome be seen?
60 and 120
What are possible causes of impingement syndrome?
Tendonitis
Subacromial bursitis
Acromioclavicular OA with inferior osteophytes
Rotator cuff tear
Where does the pain from impingement syndrome radiate to?
Deltoid and upper arm
What clinical test is for impingement?
Hawkins-Kennedy
What is the treatment for impingement syndrome?
NSAIDs, analgesics, subacromial injection of steroids ( up to 3)
What is a “classic history” of a rotator cuff tear?
Sudden jerk in a pt >40 with subsequent pain and weakness
Which muscle do rotator cuff tears usually affect?
Supraspinatous
Which imaging technique can confirm tears?
USS
MRI
What are the options for repair?
Physio to strengthen remaining muscles
Open or arthroscopic rotator cuff repair
What are the negatives to surgically treating rotator cuff repairs?
Many tendons are diseased and so repair can fail.
Very large tears may be irreparable
What is frozen shoulder also known as?
Adhesive capsulitis
What does frozen shoulder present as?
Pain which subsides after 2-9 months
Increasing stiffness for 12/12 which then thaws
What is the principal clinical sign of a frozen shoulder?
Loss of external rotation
Which condition pre-disposes to adhesive capsulitis?
Diabetes
What is the treatment for adhesive capsulitis?
Physiotherapy and analgesics.
Intra-articular injections.
What is calcific tendonitis?
Calcium deposits in the supraspinatous tendon, just proximal to greater tuberosity.
What is the onset of action of calcific tendonitis?
Acute!
What relief can be provided for calcific tendonitis?
Subacromial steroid and local anaesthetic injection
What are the two types of instability?
Traumatic
Atraumatic
What is the repair called to stabilise recurrent dislocations?
Bankart repairs
Which conditions can pre-dispose to atraumatic instability?
Marfans
Ehlers-Danlos
Pain in what other areas of the body can cause shoulder pain?
Neck
Angina
Diaphragmatic irritation
Where is the long head of the biceps?
At the labrum/glenoid
What does Bigliani grading show?
Increasing angles of acromion. Higher grade is more likely to have an impingement.
What are Bankart lesions?
??
What are Hill Sachs lesions?
??
What nerve is involved in carpal tunnel syndrome?
median
What nerve is involved in cubital tunnel syndrome?
Ulnar nerve
What are the more common shoulder issues?
Supraspinatous tendonitis
Sub-acromial bursitis
Arcomioclavicular disease
