Shoulder disorders Flashcards
- Adhesive capsulitis - Subacromial impingement syndrome - Humeral shaft # - Bideps tendinopathy
What is the definition of Adhesive Capsulitis
A condition in which the glenohumeral joint capsule is contracted and adherent to humeral head
What are the RF for AC
- Women
- 40-70 y/o
- Acco c DM
- Commonly affects contralateral shoulder
What are the types of AC
Primary
- Idiopathic
Secondary
- Rotator cuff tendinopathy
- Subacromial impingement syndrome
- Biceps tendinopathy
- Previous surgery or trauma
*Assoc c aut
What are the 3 stages of AC?
- Painful stage (initial)
- Freezing stage
- Thawing stage (final)
What are the bursas found in the shoulder?
- subacromial bursa
- subcoracoid bursa
- subscapular bursa
What are the Sx & Ex of AC?
- Generalised deep and constant pain +/- radiate to biceps
- Pain disturbs sleep
- Joint stiffness
- Both active and passive movement affected
- Reduced ROM (external rot most effected)
- Atrophy of deltoid muscle
- Generalised tenderness
What are the differential dx for AC?
- acromioclavicular arthritis
- glenohumeral arthritis
- subacromial impingement syndrome (rotator cuff tendinopathy, subacromial bursitis)
- rotator cuff tear, long head biceps tear
- RA, SLE
How do you diagnose AC?
*AC is clinically diagnosed
Bedside
- HbA1c - AC assoc c DM
Imaging
- radiograph - rule our acromioclavicular pathology
- MRI - thickening of glenohumeral joint capsule, rule out impingement syndrome
How do you manage AC conservatively
* AC is self limiting
Conservative
- education and reassuarance
- physiotherapy
- NSAIDs
- Subacromial bursa steroid +/- LA
Surgical
- joint manipulation c GA - remove capsular adhesions
- arthrogaphic distension (inject sterile water to loosen adhesions)
- surgical release of glenohumeral joint
How do you manage AC surgically?
- joint manipulation c GA - remove capsular adhesions
- arthrogaphic distension (inject sterile water to loosen adhesions)
- surgical release of glenohumeral joint
Define Subacromial Impingement Syndrome (SAIS)
Inflammation and irritation of rotator cuff tendons as they pass through subacromial space
RF of SAIS
- <25 years
- active in sports
- manual labour
List of diseases under SAIS
- rotator cuff tendinosis (degeneration of tendon’s collagen due to overuse)
- subacromial bursitis
- calcific tendinitis
Define the borders of the subacromial space
Superior
- coracoacromial arch
Inferior
- humeral head
- greater tuberosity of humerus
What are the contents of the subacromial space
- rotator cuff tendons (SITS)
- long head of bicep tendon
- subacromial bursa
The pathophysiology of SAIS can be divided into intrinsic and extrinsic mechanism. What are they?
Intrinsic : involve pathologies of rotator cuff tendon due to internal compression
- Muscular weakness
- Overuse of shoulder
- Degenerative tendinopathy
Extrinsic: involve pathologies of rotator cuff tendon due to external compression
- congenital anatomical variation
- dec. scapular musculature (serratus anterior and trapezius)
- glenohumeral instability
What are the Sx and Ex of SIAS
- painful arc: 60-120
- Weakness and dec ROM
- (+) hawkin’s test
What is a Hawkin’s test used in SIAS?
- (+) if pain elicited at anterolateral aspect of shoulder
What are the differentials for SIAS?
- Rotator cuff tear
- long head bicep tendon tear
- cervical radiculopathy
- brachial plexus injury
- adhesive capsulitis
- acromioclavicular arthritis
How would you diagnose SIAS?
* SIAS is clinically diagnosed
Imaging
- MRI
- subacromial osteophytes
- subacromial bursitis
- humeral cystic changes
- narrowing of subacromial space
What are the conservative Mx for SIAS?
- Analgesia
- NSAIDs
- physiotherapy
What are the surgical options for SAIS?
- Arthroscopic acromioplasty
- Bursectomy
- Surgical repair of muscular tears,
What are the Cx of SIAS?
- Adhesive capsulitis
- rotator cuff degeneration
*
What nerve is at most risk in a humeral shaft fracture and why?
- Radial nerve due to location within spiral groove
