Shoulder Conditions

Question 1

What is the most common direction of shoulder dislocation?

What are 2 types? Which is most common and why

Answer 1

Anterior

Humerus head may lie;

• Anterior to glenoid fossa (More common due to pull of muscles)
• Antero-inferior to glenoid fossa

Question 2

How does the arm appear in an Anterior dislocation

What are 2 mechanisms of anterior dislocation

Answer 2

Externally rotated
Slightly abducted

• Unexpected force pushes an abducted, laterally rotated arm posteriorly (Pushes shoulder backwards)
• Direct blow to posterior shoulder

Question 3

What is a Bankart lesion/ Labral tear?

What can sometimes accompany this?

Answer 3

When part of glenoid labrum is torn off due to force of humeral head popping out of socket

Sometimes a small piece of bone can be torn off

Question 4

What is a Hill-Sachs Lesion

Answer 4

A dent (Indentation fracture) in humeral head, caused by the tone of Infraspinatus and Teres Minor jamming the posterior humeral head into the anterior lip of the Glenoid Fossa

Question 5

Posterior dislocations are less common than Anterior, but more than Inferior.

Identify 3 possible causes

Answer 5

• Violent muscle contractions (Seizure/ electrocution)
• Blow to anterior shoulder
• Arm is flexed across body and pushed posteriorly

Question 6

How do patients with a Posterior Shoulder Dislocation present in 3 ways

Answer 6

• Arms are internally rotated and Adducted
• Flattening/ squaring of shoulder with a prominent Coracoid process
• Can’t be externally rotated

Question 7

Why can a posterior shoulder dislocation be missed on an X-ray?

Name 2 ways one can be identified from an X-ray

Answer 7

Looks “In joint”

• Light bulb sign (Head looks more round, as arm is medially rotated)
• Increased glenohumeral space

Question 8

How does a normal arm look in a lateral x-ray of shoulder, in reference to the Y-view

Name 3 injuries commonly associated with a Post. Dislocation

Answer 8

Normally, humeral head should be directly in line with bifurcation of the Y (Glenoid Fossa)

• Fractures
• Rotator cuff tears
• Hill-Sachs lesions

Question 9

Describe the mechanism of Inferior Dislocation of the Shoulder

Answer 9

Forceful traction of arm when it is fully extended over the head

(Grasping an object overheard to break a fall- Hyperabduction)

Question 10

What is the most common complication of shoulder dislocation (In any direction)

Answer 10

Recurrent dislocation (due to damage to stabilising tissues around the shoulder)

Question 11

Damage to Axillary artery is uncommon in shoulder dislocations. Why are they more common in older people

Are nerve or arterial injuries more common? Which nerve is especially at risk?

Answer 11

Blood vessels are less elastic

Nerve injuries more common, especially Axillary nerve

Question 12

Where may sensation be lost due to an Axillary Nerve injury

How well do most ppl with axillary nerve damage recover? Why?

Answer 12

Regimental Badge Area( Skin overlying the insertion of deltoid)

Most recover fully, as symptoms resolve when shoulder is reduced

Question 13

When are significant fractures more likely to occur due to a shoulder dislocation?

Which 4 bones/ bone parts are most commonly affected

Answer 13

• Traumatic mechanim of injury
• First time dislocation
• Person is over 40
• Head of humerus
• Greater tubercle of humerus
• Clavicle
• Acromion

Question 14

What is the most common part of the clavicle to be fractured?

What are 2 common mechanism of fracture?
How are most clavicle fractures treated?

Answer 14

The middle third (80%)

• Falls onto affected shoulder/ outstretched hand
• Treated conservatively with a sling

Question 15

What are 6 occasions where a clavicle fracture should be treated surgically, rather than with a sling?

Answer 15

• Complete displacement (Bone ends cannot unite)
• Severe displacement (Tenting of skin, risk of puncture)
• Open fractures (Break in skin)
• Neurovascular compromise
• Interposed muscle
• Floating shoulder

Question 16

Explain 3 outcomes of position of arm and clavicular fragment in a displaced mid-clavicular fracture?

Answer 16

• Medial segment elevated by Sternocleiodomastoid muscle
• Shoulder drops, as trapezius is unable to hold the lateral segment up against weight of upper limb
• Arm pulled medially by Pec Major (Adduction)

Question 17

What is a rotator cuff tear

Which muscle tendon is most commonly torn, where?

Answer 17

Tear of 1/ more of the tendons of the 4 rotator cuff muscles

Supraspinatus tendon, at insertion into greater tubercle

Question 18

Are rotator cuff tears mainly acute or chronic?

Answer 18

Can be acute (Dislocation), but mostly chronic due to extended used + other factors (Poor biomechanics/ muscle imbalance)

Question 19

What’s the most common cause of a rotator cuff tear and why?

Answer 19

Age related degeneration, as blood supply to tendons decreases so reduced healing

Question 20

The main theory behind rotator cuff tears is the Degenerative-microtrauma model.

Explain this

Answer 20

Age related tendon degeneration+ chronic micro trauma= Partial tendon tears-> Full tendon tears

Inflammation + oxidative stress-> Tenocyte apoptosis-> Further degeneration

Question 21

What does a rotator cuff tear i 1 shoulder signal

Answer 21

Signals a tear in the other arm

Question 22

Rotator cuff tears are usually asymptomatic.

Name 5 symptoms
Which is most common

Answer 22

• Anterolateral shoulder pain, radiating down arm (MOST COMMON)
• Shoulder pain when leaning on elbow and pushing downwards
• Shoulder pain when reaching forwards
• Pain restricted movement above horizontal position
• Weakness of arm abduction

Question 23

What is Impingement syndrome?

When do you get symptoms?
Name 4

Answer 23

When Supraspintous tendon impinges on the Coraco-acromial arch, leading to inflammation/ irritation

When shoulder is abducted/ flexed;

• Dull (Rather than sharp) pain
• Weakness
• Reduced range of motion
• Grinding/ popping sensation of shoulder

Question 24

In Impingment syndrome, what is the Painful Arc?

How is this syndrome treated

Answer 24

Pain, during 60-120 degrees of abduction

Treat the underlying cause

Question 25

What is Calcific Supraspinatus Tendinopathy

How kind of pain?
What 3 things make it worse?

Answer 25

Hydroxyapatite crystals, most commonly in Supraspinatus tendons, but can occur in any rotator cuff tendon

Acute/ chronic pain, made worse by;

• Abduction
• Flexion above shoulder level
• Lying on shoulder

Question 26

Other than the pain, name 4 symptoms of Calcific Supraspinatus Tendinopathy

How do they appear during the Resting and Reabsorption phases

Answer 26

• Stiffness
• Snapping sensation
• Catching
• Reduced range of motion

Resting- Crystalline
Reabsorption- Cloudy, like toothpaste

Question 27

What is Adhesive capsulitis, What is it also called?

What are 4 ways it presents?

Answer 27

Frozen shoulder

Capsule of glenohumeral joint is inflamed and stiff, causing chronic pain

• restricted movement
• Constant pain
• Worse at night
• Made worse by movement and cold weather

Question 28

What are 7 risk factors for Frozen Shoulder

Answer 28

• Female gender
• Diabtes Mellitus
• Trauma to shoulder
• Connective Tissue disease
• Breast cancer
• Parkinson’s
• Long periods of inactivity

Question 29

Frozen shoulder normally resolves with time

Name 4 treatments

Answer 29

• Anti-inflammatory drugs
• Analgesia
• Physiotherapy
• Surgery

Question 30

Is the Acromioclavicular or Glenohumeral joint more commonly affected by Osteoarthritis

Answer 30

Acromioclavicular