Shoulder Conditions Flashcards
What are the types of shoulder dislocation?
Anterior
Posterior
Inferior
What is the most common type of shoulder dislocation?
Anterior
What are the subtypes of anterior dislocations?
Subcoracoid
Subglenoid
What is a subcoracoid dislocation?
Head of humerus lies anterior to glenoid fossa, inferior to coracoid
What is a subglenoid dislocation?
Head of humerus lies antero-inferior to glenoid
How does an anterior dislocation occur?
Humeral head dislocates antero-inferiorly
Disruption of gleno-humeral ligaments
Head pulled anteriorly by muscles
- subscapularis
- pec major
What is the mechanism of an anterior dislocation?
‘Hand behind head’
- abduction
- external rotation
Direct blow to posterior shoulder
What is the clinical presentation of an anterior dislocation?
Arm = slightly abducted
Flattened shoulder
Acromion prominent
What is a Bankart lesion?
Tear of glenoid labrum +/- glenoid fracture
What is a Hill-Sachs lesion?
Indention fracture of posterior humeral head against anterior lip of glenoid fossa
What is the mechanism of a posterior dislocation?
Violent muscle contraction
Blow to anterior shoulder
Arms flexed across body and pushed posteriorly
What is the clinical presentation of a posterior dislocation?
Squaring of shoulder
Arm = adducted + internally rotated
Prominent coracoid process anteriorly
What is the mechanism of an inferior dislocaton?
Hyperadduction injury
What are complications of shoulder disslocation?
Recurrent dislocation Axillary artery damage Nerve injuries Fractures Rotator cuff tears
Which part of the clavicle is most likely to fracture?
Middle 1/3
What is the common mechanism for a clavicle fracture?
FOOSH
What happens to the medial segment of the clavicle?
Elevated by SCM
What happens to the lateral segment of the clavicle ?
Depressed as trapezius unable to hold it up
What happens to the arm in a clavicle fracture?
Pulled medially by pec major
How is a clavicle fracture managed?
Most managed conservatively
What are indications for surgical fixation of a clavicle fracture?
Complete displacement Severe displacement - with skin tenting Open fracture Neurovascular compromise Floating shoulder
What is a floating shoulder?
Clavicle fracture + glenoid neck fracture
What are complications of a clavicle fracture?
Non-union
Malunion
Infection
Nerve damage
- suprascapular
- supraclavicular
Damage to apex of lung = pneumothorax
What is a rotator cuff tear?
Tear of one or more rotator cuff tendon
What is the most common site of rotator cuff tear?
Supraspinatus under coracoacromial arch
What are risk factors for a rotator cuff tear?
Increasing age Recurrent overhead activity Recurrent heavy lifting OA of shoulder Abnormally shaped acromion
What is the clinical presentation of a supraspinatus tear?
Anterolateral shoulder pain
Brought on by activity
Weakness of shoulder abduction
What is impingement syndrome?
Rotator cuff tendons rub on coracoacromial arch
What causes impingement syndorme?
Narrowing of subacromial space
- thickening of coracoacromial ligament
- inflammation of supraspinatus ligament
- subacromial osteophytes
What are the symptoms of impingement syndrome?
Pain
Weakness
Reduced range of movement
What is the painful arc?
60-120 degrees
What is calcific supraspinatus tendonitis?
Hydroxyapatite crystals in supraspinatus tendon
What is adhesive capsulitis also known as?
Frozen shoulder
What is adhesive capsulitis?
Glenohumeral joint is inflammed and stiff
What are risk factors for adhesive capsulitis?
Female Shoulder trauma Epilepsy with tonic seizures Diabetes mellitus Connective tissue disease
How is adhesive capsulitis managed?
Physio
Analgesia
Anti-inflammatory treatment
