Shoulder Ouchies Flashcards
What are the 3 bones that make up the shoulder joint?
Clavicle
Scapula
Humerus
What are the 4 shoulder joints?
Sternoclavicular
Acromioclavicular
Glenohumeral
Scapulothoracic
What is the significance of the glenoid fossa of the scapula?
Articulating surface with the humeral head
What is the significance of the coracoid process of the scapula?
Anchor point of tendinous and ligamentous attachments
What helps stabilise the highly mobile Glenohumeral joint?
Glenoid labrum
Rotator cuff muscles
Which direction is the most common way to dislocate the shoulder?
Anteriorly
How does an anterior shoulder dislocation appear?
Squaring of the shoulder
How does a posteriorly dislocated shoulder appear on an xray?
Humerus looks like a light bulb
It internally rotates so you see the back of it
Which way does the sternocleidomastoid muscle pull the clavicle?
Pulls up the medial side
Which way does the Pectoralis major muscle pull the clavicle?
Inwards
Which way does the Trapezius muscle pull the clavicle?
Upwards
Which way does the weight of the arm pull the clavicle?
Downwards with gravity
When the clavicle fractures the medial and lateral segments move differently, which way does the medial side move and what way does the lateral segment move?
Medial pulled superiorly
Lateral moved inferomedially
What causes the medial segment of fractured clavicle to move superiorly?
Sternocleidomastoid muscles pulls superiorly
What causes the lateral segment of fractured clavicle to move inferomedially?
Weight of arm drags it down
Pectoralis major pulls inwards
What is the function of infraspinatus?
External rotation
What is the function of subscapularis?
Internal rotation
How do you test for the function of subscapularis?
Put hand behind back and push against doctors
What is the function of Supraspinatus?
Initiates first bit of abduction
What are the muscles of the rotator cuff?
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
Where does Supraspinatus, Infraspinatus and Teres minor insert?
Greater tubercle of Humerus
Where does subscapularis originate and insert?
Origin = Subcapular fossa of scapula
Insert = Lesser tubercle of Humerus
What nerve supplies both Supraspinatus and Infraspinatus?
Suprascapular nerve
What are the nerve roots of the Suprascapular nerve?
C5 and C6
What is the innervation of Teres minor?
Axillary nerve
What is the innervation of subscapularis?
Subscapularis nerve
What is impingement syndrome?
Narrowing of the subacromial space
When the Supraspinatus tendon impinges/rubs on the coraco-acromial arch leading to irritation and inflammation
What can lead to narrowing of the subacromial space leading to impingement syndrome?
Tendinitis
Bursitis
Osteophytes
What is the normal cause of tendinitis that leads to impingement syndrome?
Over use and weakening of Supraspinatus tendon leads to it becoming inflamed narrowing the space of the joint
What bursa usually leads to the bursitis that is responsible for impingement syndrome?
Subacromial bursa
The thickening of what ligament can cause impingement syndrome?
Coracoacromial ligament
Where do osteophytes form to cause impingement syndrome?
Subacromial space
In impingement of the Supraspinatus tendon, what is the presentation?
Painful arc
Pain between 60º and 120º
What is Calcific Supraspinatus tendinopathy?
Deposits of hydroxyapatite (Calcium phosphate) in the tendon of Supraspinatus
What aggravates the pain in calcific supraspinatus tendinopathy?
ABducting or flexing arm above shoulder
Lying on shoulder
How is Calcific supraspinatus tendinopathy treated?
Rest
Analgesia
Surgery for persistent symptoms
What is Adhesive Capsulitis (Frozen shoulder)?
When Glenohumeral joint (Whole shoulder capsule thickens) becomes stiff thick and inflamed which restricts movement
You run out of synovial fluid
What are the 3 time periods for Adhesive Capsulitis?
Freezing (6-9 weeks)
Frozen (4-6 months)
Thawing (6 months - 2years)
What are some risk factors to developing Adhesive Capsulitis?
Diabetes
Female
Hyper and Hypothyroidism
Connective tissue disease
What is the treatment for Adhesive Capsulitis (Frozen Shoulder)?
Physiotherapy
Analgesia
Anti inflammatory drugs
Manipulation under anaesthesia to break adhesions
What are the 4 signs on an x-ray that indicate osteoarthritis?
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts
How is Osteoarthritis of the shoulder treated?
Analgesia
NSAIDs
Steroid injections for swelling
Surgery as last resort
What are some risk factors of osteoarthritis?
Age (Over 50yrs)
Female
Obesity
What is Hemiarthroplasty
Where half of the shoulder joint is replaced to treat Shoulder Osteoarthritis
What is a reverse total shoulder replacement?
Where the ball part of humeral head would be put in the normal place of the glenoid fossa, they are the other way around
Why may a reverse total shoulder replacement may be done?
In old age the rotator cuff muscles are lost so by moving the joint out the Deltoid takes over
If someone has pain on abduction between 60º to 120º of their shoulder, what are they likely suffering with?
Impingement syndrome This is the painful arc
What is a Bankart lesion?
The Glenoid labrum tears in the anterior joint capsule allowing humeral head to move aroun
What is a Hilsack legion?
Deformity of humeral head caused by recurrent dislocations (dent)
Where is the main point that the clavicle fractures?
Fractures in the middle third
Which way does the shoulder dislocate?
Anteriorly
What is general impingement syndrome?
Compression of rotator cuff in the subacromial space
What nerve can be damaged if the clavicle is fractured and the medial segment is pulled up?
Suprascapular nerve
What are the nerve roots of the subscapular nerve?
C3 and C4
What movement cannot happen to the arm if the subscapular nerve is damaged?
Cannot internally rotate
What blood vessels can be damaged from a clavicular fracture?
Subclavian artery
Subclavian vein
What is it called when a fractured clavicle punctures the lungs?
Pneumothorax
What nerve is most at risk of being damaged during dislocation of the humeral head?
Axillary nerve
What sensory region is lost when the Axillary nerve is damaged?
Regimental badge region
Why do humeral neck fractures likely lead to Axillary nerve damage?
Axillary wraps around the surgical neck of the humerus
If somebody has a posterior shoulder dislocation, what do you need to consider as potential causes?
If they’ve had seizures or an electric shock
(Lightbulb sign)
