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
What causes a humeral shaft #?
- fall onto outstretched hand
- fall laterally onto adducted limb
What is a Holstein-Lewis #?
- # of distal third of humerus resulting in entrapment of radial nerve > loss of sensation at radial distribution & wrist drop
What are the Sx for radial shaft #
- dec sensation over 1st dorsal webspace
- weakness in wrist extension
*
What Ix will you order for radial shaft #
- Imaging
- AP & Lateral radiograph
What are the name of these #
- Proximal humeral shaft spiral #
- Midshaft humeral #
- Distal humeral shaft spiral # - Holstein Lweis #
What are the Tx options for humeral shaft #
Conservative
- Humeral brace
- U-slab if brace unavailable
Surgical
- ORIF
- Intramedullary nailing
What Cx may arise from humeral shaft #?
- malunion & nonunion
- varus angulation
- radial nerve injury - improve within 3 months
What type of humeral shaft # is most common?
middle third of humerus
What is tendinopathy?
Pathological changes that occur in tendons due to overuse
(painful, swollen, weaker tendon, risk of rupture)
(disorganised, hypervascular, degenerative tendon)
What causes biceps tendinopathy?
Younger
- active in sports
Older
- degenerative tendinopathy
What are the Sx and Ex for biceps tendinopathy?
- pain. worse on excertion
- weakness on flexion and supination
- stiffness
- Atrophy
- tenderness
- Yergason’s test (+)
What is a Yergason’s test?
- special test for distal biceps tendinopathy
What are the differentials for biceps tendinopathy?
* BT is rarely an isolated pathology. Need thorough examination
- radiculopathy
- OA
- rotator cuff disease (if proximal involved)
What Ix would you perform for BT?
Bedside
- FBC
Imaging
- Plain radiograph
What Mx can you offer for BT?
Conservative (mostly treated)
- NSAIDs
- Ice therapy
- Physio
- US guided steroid injection
Surgical
- arthroscopic tenodesis
- tenotomy
Cx of BT?
Bicep tendon rupture
What are the RF for Biceps tendon rupture (BTR)?
- BT
- steroid
- smoking
- CKD
- fluoroquinolone
What are the clinical features of BTR?
- Sudden onset pain and weakness
- Pop sensation
- swelling and bruising at antecubital fossa
- reverse popeye sign
- (+) hook test
*
What is a hook test?
- special test to identify distal BTR
- Elbow flexd and supinated - examiner hook finger underneath lateral edge of bicep tendon
Ix for BTR
* clinically diagnosed
- Imaging
- USS
- MRI
Mx for BTR
Con
- Analgesia
- Physio
Surg
- Ant. single incision/dual incision technique (forming bone tunnel in radius and inseritng BT
- Cx: injury to lat. antebrachial cutaneous nerve
