Shoulder disease Flashcards
Most likely shoulder pathology in the young
Instability
Most likely shoulder pathologies in the middle aged
Rotator cuff injury
Frozen shoulder
Most likely shoulder pathology in the elderly
Osteoarthritis
Define shoulder instability
Tendency for the shoulder to dislocate
Symptoms of shoulder instability
Pain (worse on movement), feels unstable
Signs of shoulder instability
Sulcus sign, Relocation sign, Positive jerk test, Positive apprehension test
Describe the apprehension test
Anterior stress on an abducted and externally rotated shoulder leads to apprehension (instability)
Describe sulcus sign
Inferior force on a neutral arm causes depression of the acromion (instability)
Describe the jerk test
Inferior force on an internally rotated and abducted shoulder, clunk of relocation as it is moved to an adducted and flexed position (posterior instability)
Investigations for shoulder instability
X-ray, CT
Management for shoulder instability
Conservative: Immobilisation, Physiotherapy
Surgical: Repair bony lesions, Arthroplasty
Symptoms of a rotator cuff injury
Shoulder pain (insidious, worse on over head movements)
Sign of Supraspinatus injury
Unable to abduct externally rotated and 30 degree flexed arm against resistance
Sign of Infraspinatus injury
External rotation lag sign - Can’t keep the arm externally rotated
Sign of Subscapularis injury
Lift off test - Can’t push arm off of their back
Sign of Teres minor injury
Hornblowers test - Internal rotation of an abducted and 30 degree flexed elbow causes pain
Investigations for rotator cuff injury
USS, MRI
Management of rotator cuff injury
Conservative: Physiotherapy
Medical: NSAIDs, Corticosteroid injections
Surgical: AC joint decompression, Cuff repair, Tendon transfer
Risk factors for frozen shoulder
Diabetes, Thyroid disease, Immobility
Symptoms of frozen shoulder
Pain, Stiffness
Signs of frozen shoudler
Decreased range of movement
Management of frozen shoulder
Conservative: Physiotherapy
Medical: NSAIDs, Corticosteroid injections
Surgical: Manipulation, Arthroscopic release
Symptoms of shoulder osteoarthritis
Pain (worse on movement)
Signs of shoulder osteoarthritis
Joint line tenderness, Decrease range of motion
Investigations for shoulder osteoarthritis
X-ray
Management for shoulder osteoarthritis
Conservative: Physiotherapy
Medical: NSAIDs, Corticosteroid injections
Surgical: Debridement, Arthroplasty
First movement of shoulder to be lost in disease
External rotation
