Shoulder Injuries Flashcards
What is the medical term for frozen shoulder?
Adhesive capsulitis
How common are the different types of shoulder dislocation?
of all the shoulder dislocations what are the percentage of each type
Anterior 90%
Posterior 9%
Inferior 1%
What percentage of all dislocations are shoulder joint?
45% of all dislocations
What is a bankart tear?
A Bankart lesion is an injury of the anterior (inferior) glenoid labrum of the shoulder due to anterior shoulder dislocation. When this happens, a pocket at the front of the glenoid forms that allows the humeral head to dislocate into it. It is an indication for surgery and often accompanied by a Hill-Sachs lesion, damage to the posterior humeral head
What is a Hill-Sach’s lesion/ tear?
A Hill–Sachs lesion, or Hill–Sachs fracture, is a cortical depression in the posterolateral head of the humerus. It results from forceful impaction of the humeral head against the anteroinferior glenoid rim when the shoulder is dislocated anteriorly.
Give 3 causes of posterior dislocation
3 occasions where a posterior shoulder dislication could occur
- Seizure
- Electrocution
- Direct blow to front of shoulder (Boxing)
What will a person not be able to do in posterior dislocation?
Externally rotate arm
-Check passive external rotation for this
What sign on x-ray does a posterior dislocation of the shoulder give?
Light bulb sign
-When the humerus dislocates it also internally rotates such that the head contour projects like a lightbulb when viewed from the front.
What is the treatment for a shoulder dislocation?
ANALGESIA
Manipulation
Immobilisation
Physiotheraoy
Surgery -> if young to prevent recurrence
1 in 20 fractures involve which bone?
Clavicle
What are the commonest place(s) on the clavicle to fracture?
give percentages
Middle 1/3
-most common (80%)
Lateral 1/3
(12-15%)
Medial 1/3
(5-6%)
How do you manage clavicle fracture?
Vast majority unite
Sling
Figure of 8 bandage?
Surgery possibly
When do you consider surgery in clavicle fracture?
Open fractures
Threatening the skin
Neurovascular complication
Polytrauma
What kind of fall will cause damage to acromioclavicular joint?
Fall onto the point of shoulder
How do you diagnose AC joint problems?
Clincal
Radiographs
Stress Radiographs
How are the grades of AC joint injury used to determine treatment?
Grade I-II
-Conservative
Grade III ?
Grade IV-VI Operative
What are the two causes of rotator cuff tear?
Traumatic
Degenerative
What is the treatment of acute rotator cuff tears?
Early surgery
What is the treatment of chronic degenerative tears?
Surgery if symptomatic
What is the definition of subacromial impingement
Subacromial (SA) impingement is defined as the mechanical compression of subacromial structures between the coraco-acromial arch and the humerus during active elevation of the arm above shoulder height.
Decreasing volume of subacromial space or increasing size of its contents
What is the managemnet of subacromial impingement?
Subacromial steroid injection (reduce inflammation)
Physiotherapy
Arthroscopic subacromial decompression (if the first 2 fail)
What are the causes of frozen shoulder?
Primary (90% idiopathic)
Secondary (previous trauma, diabetes)
Describe the clinical features of frozen shoulder?
how does it progress over time? what is effected in a patients life?
Loss of movement and pain in a very characteristic pattern
Pain -> up to 6 months then subsides quite quickly
Stiffness starts and increases then decreases (thawing)
Active and passive effected
Sleep is horrendous and patient cannot do anything without thinking about shoulder. Miserable
What will the radiograph be like in adhesive capsulitis?
Normal radiograph
How do you treatment of the adhesive capsulitis?
Early presentation -> Inject steroid (I/A)
Later -> surgery (really stiff phase)
Name 3 types of shoulder arthritis
Osteoarthritis (bread and butter)
Inflammatory arthritis
Post-traumatic arthritis (injury in younger years (young dislocators more likely to get arthritis because of recurrence)
What are the common conditions of the elbow effecting the young, middle age and elderly?
Fractures and dislocations in young
Tendinopathies in middle age
Degenerative diseases in elderly
What is a new treatment that is showing promise in tennis and golfers elbow?
Centrifuge blood and inject platelets to help repair