Shoulder Conditions Flashcards
Why is shoulder dislocation common
The glenohumeral joint is lax - depending more on surrounding rotator cuff muscles than bony structures for stability
History of patient with shoulder pain
Occupation
Any previous trauma
Where is the pain - shoulder or neck? does shoulder movement make it worse?
Is general health okay - could be fibromyalgia or polymyalgia
If all movements worsen pain what are you thinking it is
Arthritis or capsulitis
What muscles are used for shoulder flexion
Pec major
Deltoid (ant 1/3)
Coracobrachialis
Which muscles are used for shoulder extension
Deltoid (post 1/3)
Latissimus dorsi
Pec major
Teres major (begins extension if shoulder starts flexed)
which muscles are used for shoulder abduction
Supraspinatus (first 15o)
Deltoid
which muscles are used for shoulder adduction
Pec major Deltoid (mid 1/3) Latissimus dorsi Teres Major Subscapularis
Which muscles are used for lateral rotation
Teres minor
Infraspinatus
What muscle prevents winging of the scapula as pressure is placed on outstretched hand
Serratus anterior
what causes elevation of scapula
Levator scapulae
Trapezius
what causes depression of scapula
serratus anterior
pec minor
what causes forward action (protraction) of scapula
serratus anterior
pec major
what causes retraction (bracing) of scapula
trapezius
rhomboid
how are the cause of upper limb fractures different in young and old
Young - high energy injuries
Old - osteoporotic injuries
What is the most common type of shoulder dislocation and what is its cause
Anterior - sports injury
What is a common cause of posterior shoulder dislocation
Epileptic seizure
Signs of shoulder dislocation
Loss of shoulder contour (flattening of deltoid)
Anterior bulge from head of humerus (may be palpated in axilla)
What investigation should you do before reducing shoulder dislocation
X-ray - to check if fracture too
Treatment of shoulder dislocation
Pain - intra-articular LA, entonox, opioid Manipulation Immobilisation Physio Surgery - if young or recurrent
What is subacromial impingement
A range of conditions which decrease the volume of the subacromial space or increase size of the contents leading to inflammation and irritation of rotator cuff muscles as they pass through it
Signs and symptoms of subacromial impingement
Progressive pain in anterior superior shoulder
Exacerbated by abduction (painful arc) - gets more painful as raised higher
Relieved by rest
Weakness
Stiffness
Investigation for subacromial impingement
MRI
Treatment of subacromial impingement
Analgesia - NSAID
Subacromial Steroid Injection
Phsyio
Arthroscopic Subacromial Decompression (no proof any better than above)
What is frozen shoulder / adhesive capsulitis
glenohumeral joint capsule becomes contracted and adherent to the humeral head leading to shoulder pain and reduce range of movement in shoulder
What are the stages of frozen shoulder
- Painful stage
- Freezing stage (stiff)
- Thawing stage (range of movement improves)
can take 2 years to run through cycle
categories of causes of frozen shoulder
Primary - idiopathic
Secondary - usually trauma
Clinical features of frozen shoulder
Generalised deep and constant pain of shoulder Pain radiate to biceps Pain disturbing sleep Stiffness (later) Reduction in function Loss of arm swing (external rotation and flexion) Atrophy of deltoid Tenderness of palpation
Investigations of frozen shoulder
X-ray to rule out others
MRI - thickening of glenohumeral joint capsule
Management of frozen shoulder
Self-limiting over months to years
Physio
Paracetamol and NSAIDs for pain
Glenohumeral joint injections and oral steroids for no improvement
Surgical - joint manipulation to remove adhesions (if no improvement after 3 months)
Presentation of rotator cuff tear
Pain over lateral shoulder
Inability to abduct arm over 90o
Dominant arm
Tenderness over greater tuberosity and subacromial bursa
Supraspinatus and infraspinatus atrophy if massive tear
Types of rotator cuff tears
Traumatic / acute (<3m)
Degerative / chronic (>3m)
Investigations for rotator cuff tears
X-ray - exclude fracture
USS - presence and size
MRI - size, characteristics, location
Treatment of rotator cuff tears
Acute - early surgery
Chronic - conservative (analgesia, physio, steroid injections) or surgery if symptomatic
