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E - MSK > Shoulder Conditions > Flashcards

Shoulder Conditions Flashcards

1
Q

Why is shoulder dislocation common

A

The glenohumeral joint is lax - depending more on surrounding rotator cuff muscles than bony structures for stability

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2
Q

History of patient with shoulder pain

A

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

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3
Q

If all movements worsen pain what are you thinking it is

A

Arthritis or capsulitis

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4
Q

What muscles are used for shoulder flexion

A

Pec major
Deltoid (ant 1/3)
Coracobrachialis

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5
Q

Which muscles are used for shoulder extension

A

Deltoid (post 1/3)
Latissimus dorsi
Pec major
Teres major (begins extension if shoulder starts flexed)

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6
Q

which muscles are used for shoulder abduction

A

Supraspinatus (first 15o)

Deltoid

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7
Q

which muscles are used for shoulder adduction

A 
Pec major 
Deltoid (mid 1/3)
Latissimus dorsi 
Teres Major 
Subscapularis
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8
Q

Which muscles are used for lateral rotation

A

Teres minor

Infraspinatus

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9
Q

What muscle prevents winging of the scapula as pressure is placed on outstretched hand

A

Serratus anterior

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10
Q

what causes elevation of scapula

A

Levator scapulae

Trapezius

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11
Q

what causes depression of scapula

A

serratus anterior

pec minor

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12
Q

what causes forward action (protraction) of scapula

A

serratus anterior

pec major

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13
Q

what causes retraction (bracing) of scapula

A

trapezius

rhomboid

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14
Q

how are the cause of upper limb fractures different in young and old

A

Young - high energy injuries

Old - osteoporotic injuries

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15
Q

What is the most common type of shoulder dislocation and what is its cause

A

Anterior - sports injury

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16
Q

What is a common cause of posterior shoulder dislocation

A

Epileptic seizure

17
Q

Signs of shoulder dislocation

A

Loss of shoulder contour (flattening of deltoid)

Anterior bulge from head of humerus (may be palpated in axilla)

18
Q

What investigation should you do before reducing shoulder dislocation

A

X-ray - to check if fracture too

19
Q

Treatment of shoulder dislocation

A 
Pain - intra-articular LA, entonox, opioid 
Manipulation 
Immobilisation 
Physio 
Surgery - if young or recurrent
20
Q

What is subacromial impingement

A

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

21
Q

Signs and symptoms of subacromial impingement

A

Progressive pain in anterior superior shoulder
Exacerbated by abduction (painful arc) - gets more painful as raised higher
Relieved by rest
Weakness
Stiffness

22
Q

Investigation for subacromial impingement

A

MRI

23
Q

Treatment of subacromial impingement

A

Analgesia - NSAID
Subacromial Steroid Injection
Phsyio
Arthroscopic Subacromial Decompression (no proof any better than above)

24
Q

What is frozen shoulder / adhesive capsulitis

A

glenohumeral joint capsule becomes contracted and adherent to the humeral head leading to shoulder pain and reduce range of movement in shoulder

25
Q

What are the stages of frozen shoulder

A
  1. Painful stage
  2. Freezing stage (stiff)
  3. Thawing stage (range of movement improves)

can take 2 years to run through cycle

26
Q

categories of causes of frozen shoulder

A

Primary - idiopathic

Secondary - usually trauma

27
Q

Clinical features of frozen shoulder

A 
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
28
Q

Investigations of frozen shoulder

A

X-ray to rule out others

MRI - thickening of glenohumeral joint capsule

29
Q

Management of frozen shoulder

A

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)

30
Q

Presentation of rotator cuff tear

A

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

31
Q

Types of rotator cuff tears

A

Traumatic / acute (<3m)

Degerative / chronic (>3m)

32
Q

Investigations for rotator cuff tears

A

X-ray - exclude fracture
USS - presence and size
MRI - size, characteristics, location

33
Q

Treatment of rotator cuff tears

A

Acute - early surgery

Chronic - conservative (analgesia, physio, steroid injections) or surgery if symptomatic

E - MSK (29 decks)

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