Shoulder Conditions Flashcards
Describe the presentation of anterior shoulder dislocation
- Shoulder looks square
- Acromion sticking out
- Arm held in a position of external rotation and slight abduction
- Far more common than posterior dislocations and commonly due to trauma
Describe the presentation and causes of posterior shoulder dislocation
- Locked posterior dislocation
- Will have normal looking shoulder but hurt when moving
- Usually present with arm internally rotated and adducted
- Caused by muscle pulling shoulder out of joint such as electric shocks and seizures
Describe potential structures damaged from shoulder dislocations
- Dislocations rarely involve damage to axillary artery
- Around 10-40% of dislocations involve damage to axillary nerve causing loss of sensation to the regimental badge area as well as deltoid muscle wasting
- Rotator cuff tears can also occur with dislocations
Describe where clavicular fractures commonly occur
80% of fractures occur in the middle third of clavicle (mid-clavicular fracture) - middle 2/3 or lateral 1/3
Describe the presentation of clavicular fractures and the reason for it
- Patients present with dropped shoulder and adducted
- Dropped shoulder occurs as SCM pulls the medial clavicle upwards
- However in a fracture, this is disconnected and the trapezius cannot pull up the weight of the entire arm, thus leading to dropped shoulder
- Adduction occurs due to action of pectoralis major
Describe the potential causes of rotator cuff tears
- Tear in one or more tendons of the rotator cuff muscles
- Commonly occurs chronic due to age related degeneration whereby reduced blood flow to the rotator cuff muscles reduces its ability to repair minor injuries
- Recurrent lifting or repetitive activity is also a risk factor
Describe the presentation of rotator cuff muscle tears
- Compromises functions of abduction, medial rotation and lateral rotation of the shoulder
- Reduces stability of the gleno-humeral joint - Present as anterolateral shoulder pain often radiating down the arm
- Pain during movement
- Weakness of shoulder abduction
- Pain during movement
Describe impingement syndrome and the causes and presentation
- Occurs when the tendons of the rotator cuff muscles impinge on the coraco-acromial arch, leading to irritation and inflammation
- Impingement may be due to thickening of coracoacromial ligament, inflammation of supraspinatus tendon, osteoarthritis
- Presents as pain, weakness and reduced motion when abducting arm
Describe calcific supraspinatus syndrome
- Hydroxyapatite (crystalline form of calcium phosphate) deposits in the tendon of supraspinatus
- Calcific deposits visible on X-ray
- Crystalline structures eventually reabsorbed by phagocytes
Describe the presentation of calcific supraspinatus syndrome
- Presents with pain, often aggravated by abduction or flexion of arm or by lying on shoulder
- May also have stiffness and reduced movement of shoulder
Describe frozen shoulder and its presentation
- Painful disabling disorder in which the capsule of the glenohumeral joint becomes inflamed and stiff, greatly restricting movement and causing chronic pain
- Pain usually constant, worse at night and exacerbated by movement and cold weather
- Resolves after 2 or 3 years, however opposite shoulder may become affected as well
Describe osteoarthritis of the shoulder and its presentation
- More commonly affects the acromioclavicular joint rather then the glenohumeral joint
- Crepitus - grating sound or sensation produced by friction between bone and cartilage or the fractured parts of a bone
- Swelling, pain, induced by exercise
Describe common shoulder conditions
- Shoulder dislocation
- Clavicular fracture
- Rotator cuff tears
- Impingement syndrome
- Calcific supraspinatus syndrome
- Frozen shoulder
- Osteoarthritis of shoulder
