Shoulder Injuries Flashcards
What are the 2 types of shoulder dislocation?
Anterior- accounts for 95%
Posterior- accounts for 5%
How does a shoulder dislocation present, and how are they investigated?
Severe pain, inability to move shoulder
Glenoid fossa dent may be visible, LIGHTBULB SIGN on X-ray
X-ray- AP, and oblique to show humeral displacement
MR arthrogram
How are anterior shoulder dislocations managed?
Analgesia, sedation, o2 due to extreme pain
Reduced via manipulation (closed or open)
Post reduction:
Analgesia, 2-3 stabilisation, rehab
What is an instability injury
When the humeral head is forced out of the glenoid
What causes instability injuries?
Rotator cuff tears, or
Bankart lesions:
Occur as a result of full dislocation
Hill Sachs- impact damages humeral head
Bony Bankart- impact damages glenoid
Increases laxity and likelihood of future dislocations
How do instability injuries of the shoulder present?
Atraumatic laxity/subluxations, painless
Shoulder contour abnormality
Muscle wasting
Tenderness
Spasms
Scapular winging
How are shoulder instability related injuries tested and treated?
Drawer tests, apprehension tests
Physio and strengthening exercises
Open stabilisations for Bankart lesions, with rehab
What is shoulder impingement syndrome?
Pain caused by tendon/bursa rubbing against shoulder plate
What causes shoulder impingement syndrome?
intrinsic causes- structural
-degeneration (age related)
-poor vascularity to supraspinatus tendon
-overuse
-rotator cuff tears
extrinsic causes- external pressures
-acromial morphology
-coracoacromial ligament thickening
What is the pathophysiology of a shoulder impingement syndrome?
Tendonitis/bursitis more common in younger patients
Cuff tears and arthropathy more likely with age
Neer classification used
How does shoulder impingement syndrome present?
Progressive anterior superior shoulder pain, radiates to deltoid and upper arm
Difficulty seeping, reaching overhead, and lifting
Exacerbated by abduction
How is impingement syndrome investigated and managed?
X-ray- AP and oblique to rule out bony causes
USS or MRI
Managed conservatively, analegesia, steroid injections resolves a lot of cases but only can be done twice
Surgery- subacromial decompression, but only if 6 months non op management has failed
What is a rotator cuff tear and who gets it?
Tear in muscles or tendons surrounding shoulder
Associated with acute trauma and gradual wear- common in older patients
What are the types of rotator cuff tear?
Vary in thickness and size
Usually involve supraspinatus
Large tears extend into subscapularis and infraspinatus
How do rotator cuff tears present?
Pain in front of shoulder radiating down arm, with weakness
May be muscle wasting and tenderness
How are rotator cuff tears diagnosed and managed?
X-ray
USS if ROM good and MRI if ROM reduced
Jobes test- thumbs down and pressure applied down, patient to resist force
Managed with rest, analgesia, sling, physio
Can do open repair but not very effective and rehab is long
Steroid injections
What is adhesive capsulitis?
Frozen shoulder
Inflammation and fibrosis in the joint capsule, leading to contracture of the shoulder joint
Who gets adhesive capsulitis?
More common in females
Age 40-50
Associated with diabetes, hypercholesterolaemia, Dupuytren’s disease, strokes
What are the 3 phases of adhesive capsulitis?
Freezing- minimal synovitis but pain, inhibiting motion
Frozen/transitional- pain decreases but synovitis increases
Thawing- inflammation decreases, movement slowly improves
How does adhesive capsulitis present and how is it diagnosed?
Gradual severe pain, at night and rest
Stiffness, ROM restricted
Investigated clinically but images used to rule out other causes
How is adhesive capsulitis managed?
Self limiting, manage conservatively and it goes away after 18-24 months
Steroid injections can help in painful phase
Can be surgically manipulated if extreme
