Shoulder conditions Flashcards
type of shoulder condition in <30 year old
instability (sports injury)
type of shoulder condition in middle aged people (2)
frozen shoulder
rotator cuff injury
type of shoulder condition in elderly people (2)
glenohumeral OA
cuff tear
general management of shoulder conditions (3)
short term NSAID
steroid injections
physio
another name for impingement syndrome
painful arc
what are compressed in impingement syndrome that cause the pain
rotator cuff tendons
which degree of movement is there pain in impingement syndrome
60-120 abduction
compression of rotator cuff tendons in the subacromial space between 60-120 degrees of abduction
painful arc (impingement syndrome)
which age group gets painful arc (impingement syndrome)
30-40s
aetiology of painful arc (3)
sports injury
manual worker
tendon degeneration
which rotator cuff muscle is typically affected in painful arc (impingement syndrome)
supraspinatus
presentation of impingement syndrome (3)
painful arc (60-120 degrees abduction) shoulder weakness pain radiating to deltoid
treatment from GP for impingement syndrome (3)
analgesia/NSAID
physio for 3 months
3 steroid injections
what are the steroid injections used in the shoulder
depo medrone with lignocaine
impingement syndrome
after 6 months if the 3 injections are ineffective what do you do
surgery for decompression
investigations for impingement syndrome (to rule out other causes)
xray - calcification, eyebrow sign ultrasound
which age group get rotator cuff tears
> 40 year olds
grey hairs = cuff tears
most common rotator cuff muscle for rotator cuff tears
supraspinatus
pathophysiology of rotator cuff tear
degenerative and a jerk
presentation of rotator cuff tear
sudden jerk of arm resulting in immediate pain and weakness
treatment of rotator cuff tear (3)
NSAID
physio
injections
when might you do a surgery for rotator cuff tear
if young
recurrence rate of rotator cuff tears
40% reoccur after 1 year
complication of rotator cuff tear
osteoarthritis
inflammation of glenohumeral ligaments causing them to thicken and contract
frozen shoulder
which age/gender get frozen shoulders
40-60s
females
(think mum)
which chronic condition predisposes you to getting a frozen shoulder
diabetes
what are the 3 phases of a frozen shoulder (how it presents)
severe pain for 6 months (FREEZING)
pain settles but limited movement (FROZEN)
movement returns within 2 years (THAWING)
which movement is lost in frozen shoulder
external rotation
investigation (necessary for diagnosis) of frozen shoulder
xray - must be normal for diagnosis (to exclude OA and locked posterior dislocation)
treatment of frozen shoulder
physio - first line!
NSAID/analgesia
injections if painful >6 months
how long should it take for full resolution of a frozen shoulder (self limiting conditions)
18-24 months
calcium deposits in the supraspinatus tendon seen on xray
acute calcific tendonitis
most common tendon for shoulder pathology
supraspinatus
presentation of acute calcific tendonitis
severe acute onset pain
treatment of acute calcific tendonitis
steroid injection for pain
local anaesthetic for pain
how is acute calcific tendonitis diagnosed
xray
how is acute calcific tendonitis cured
self limiting
calcification gets reabsorbed
most common type of shoulder dislocation
anterior
what is shoulder subluxation
partial dislocation
aetiology of posterior shoulder dislocation
seizure
ligamentous laxity conditions (ehlers-danlos syndrome, marfans)
aetiology of anterior shoulder dislocation
sports injury
cause of badge patch numbness in a shoulder dislocation
axillary nerve damage
shoulder dislocation presentation caused by trauma (3)
pain
loss of symmetry
sometimes badge patch numbness
investigations for shoulder dislocation caused by trauma (2)
xray
neurovascular assessment - pulses and nerves before and after surgery (to make sure you dont cause damage!)
treatment of shoulder dislocation caused by trauma (4)
calm patient - analgesia, sedation, O2
relocation/manipulation by closed reduction
sling for 2-4 weeks
physio for strengthening
treatment of recurrent shoulder dislocations from trauma
surgery for stabilisation
if <20 and have a shoulder dislocation are they more or less likely to have a re-dislocation than someone >30
more
80% re-dislocation for <20s
20% re-dislocation for >20s
aetiology of atraumatic shoulder dislocations
ligamentous laxity conditions eg ehlers-danlos, marfans
presentation of atraumatic shoulder dislocation
not painful
what would you see on xray in atraumatic shoulder dislocation
‘light bulb sign’ on xray
bc humerus is twisted so looks symmetrical front on
treatment of atraumatic shoulder dislocation
surgery
physio strengthening
what is a bankart lesion
when does it occur
when labrum (fibrocartilage) becomes injured and detaches from glenoid fossa
after shoulder dislocation
what is a hill sachs injury
when does it occur
fracture of posterior humeral head
after shoulder dislocation
shoulder dislocation but pain doesnt settle
rotator cuff tear
treatment of acromioclavicular joint dislocation (collar bone to shoulder)
sling and physio
surgery - if >100% dislocation, young athletes, chronic pain
which age group get glenohumeral osteoarthritis
> 60s
presentation of shoulder OA (4)
gradual onset
pain at night
limited movement
crepitus on examination
what would you see on xray for someone with shoulder OA
LOSS; loss of joint space osteophytes subchondral cysts sclerosis
treatment of shoulder OA (4)
analgesia
physio
steroid injections
surgery - shoulder replacement, a few different options
biceps tendonitis definition
where
inflammation of long head of biceps
in the bicipital groove of humerus
presentation of biceps tendonitis (3)
popeye sign - bunched up triceps
anterior shoulder pain worse on shoulder/elbow flexion
bruising
treatment of biceps tendonitis (2)
rest and physio
surgery (neurovascular risk)
complication of biceps tendonitis
tendon rupture
who gets biceps tendonitis (4)
athletes that through things
swimmers
gymnasts
heaving lifting occupations
how does biceps tendonitis come about
friction between biceps tendon and bicipital groove on humerus = inflammation of tendon
