Shoulder Conditions Flashcards
Dislocated shoulder symptoms, type, cause
Deformity, swelling, bruising, movement restricted
90-95% anterior (humerus head anterior to glenoid fossa) weak at inferior aspect sondislocates anteroinferiorly ->pull of muscles displaces anterior (subcorcoid loaction) OR head lies antero-inferior to gelnoid (subglenoid location). Arm external rotation, slight abduction.
Arm abducted/ LR injury forces arm posterior OR direct blow posterior shoulder. Force part glenoid labrum tear off ‘Bankart lesion/ labral tear’ sometimes small piece of bone too
Posterior numeral head jammed against anterior lip glenoid fossa -> invention fracture in posterolateral humeral head ‘Hill-Sachs lesion’
Posterior dislocated shoulder cause, symptoms
Violent muscle contractions (epileptic fit/ electrocution/ lightning), blow to anterior shoulder, arm flexed adducted pushed posteriorly
Arm MR/ adducted, flattening/ squaring shoulder, prominent caracoid process, arm can’t be L, fractures, rotator cuff tears, Hill-Sachs lesion
2-4%
Inferior shoulder dislocations cause and complications
O.5% forceful traction on extended arm over head (hyperabduction)
Damage to nerves 60%, rotator cuff tears 80%, injury blood vessels 3%
6 complications of any shoulder dislocation
Recurrent dislocation , Osteoarthritis, damage to axiallary artery 1-2% (haematoma/ absent pulse/ cool limb), injuries axillary nerve 10-40% supplies regimental badge ( deltoid muscle and skin overlying insertion) - most symptoms resolve fully when reduced. Damage cords brachial plexus/ musculocutaneous. Significant fractures 25% (humeral head, greater tubercle, clavicle, acromion), rotator cuff tears
Clavicle fracture symptoms, cause, treatment, complications
Children and young adults, 80% middle third (mid-clavicular) medial segment clavicle elevated (sternockeiodomastoid muscle), shoulder drops, arm adducted by pectoralis major
FOOSH, falls on shoulder
Non-union, malunion, pneumothorax, suprascapular nerve damaged elevation of medial clavicle, supraclavicle nerves damaged -> paraesthesia upper cheat anteriorly
✅Sling, surgical fixation - complete displacement (bones can’t unite) , severe displacement (tenting skin risk of puncture), open fractures, neurovascular compromise, interposed muscle, floating shoulder (ipsilateral fracture of glenoid neck)
Rotator cuff tears what, symptoms, cause, risk, treatment
Tear 1+ tendons of the four rotation cuff muscles (Supraspinatus most, infraspinatous, subscapularis, teres minor) stabilises glenohumeral joint, abducting, lR, MR humerus.
Many Asymptomatic, anterolateral shoulder pain radiating down arm (May with activity), pain in shoulder lean on elbow/ reaching forwards, weakness of shoulder abduction and lain restricted movement above horizontal position. mRI, ultrasound.
Most chronic - extended use & poor biomechanics or muscular imbalance. Age-related degeneration (degenerative-microtrauma model) -> inflammatory cells recruited -> oxidative stress -> tenocyte apoptosis -> further degeneration
Recurrent lifting/ repetitive overhead use e.g. swimming/ carpenters
✅Rest/ analgesia or operative
Impingement syndrome cause, symptoms
Supraspinatus tendon impinges on caraco-acromial arch -> irritation and inflammation. most common ‘painful arc’ 60-120degrees of abduction
Space between head of humerus and caracoacromial arch small, anything narrows further: thickening of coracoacromial ligament, inflammation of Supraspinatus tendon, subacromial osteophytes (OA).
Shoulder abducted/flexed narrowed further -> pain, weakness, reduced range motion. Worse overhead movement/ night. May be acute or insidious, dull, grinding/ popping during movement.
✅underlying cause
Calcific supraspinatus tendinopathy cause, symptoms, treatment, what
Macroscopic deposits of hydroxyapatite (crystalline calcium phosphate) in suoraspinatus tendon.
Acute/ chronic pain, aggravated abduction/ flexion arm above shoulder/ lying on shoulder. Stiffness/ snapping sensation/ catching/ reduced range motion
Regional hypoxia -> tenocytes -> chondrocytes-> lay down cartilage -> endochckndrial ossification like process -> calcium deposits (seen X-ray) Or ectopic bone formation metaplasia of mesenchymal stem cells into osteogenic cells.
Crystalline Calcific deposits eventually reabsorbed by phagocytes = most pain (cloudy and less defined on x-rays)
✅rest/ analgesia, surgical if persistent
Adhesive cellulitis ‘frozen shoulder’ what, treatment, symptoms, cause, risks
Capsule glenohumeral joint inflamed and stiff -> restricts movement/ chronic pain (worse at night/ movement/ cold weather)
Autoimmune triggered localised trauma, long periods inactivity, alongside other problems
Female, epilepsy with tonic seizures, diabetes , trauma to shoulder, CT disorder, thyroid disease, CV disease, chronic lung disease, breast cancer, polymyalgia rheumatic (inflammation muscle pain and weakness), Parkinson’s disease
✅physiotherapy, analgesia, anti-inflammatory meds, manipulation breaks up adhesions and scar tissue, typically resolves with time, most regains shoulder motion, opposite shoulder can become affected
Osteoarthritis shoulder who, where, treatment
> 50yrs, most acromioclavicular joint then glenohumeral
✅Activity modification/ analgesia/ anti-inflammatory (NSAIDS), nutritional supplements (glucosamine, chondroitin sulfate), steroid injections, hyaluronic acid injections, arthroscopy remove loose cartilage, hemiarthroplasty, TSR
