Shoulder pathologies Flashcards
Impingement syndrome - definition
Tendons of the rotator cuff become inflammed as they are compressed in the tight subacromial space during movement
Impingement syndrome - which rotator cuff muscle is most commonly affected?
Supraspinatous
Impingement syndrome - epidemiology
age
Middle aged
Impingement syndrome - causes
Rotator cuff tear
Tendonitis
Osteophytes from AC joint
Subacromial bursitis
Impingement syndrome - clinical features
Pain originating in the subacromial space which radiates to the deltoid and upper arm
Deep pain
Pain felt when arm is abducted
Impingement syndrome - examination
Look:
contour, muscle wasting, deformity, scapula position
Feel:
Tenderness
Move:
Pain on abduction
- this pain subsides once they abduct their arm pst a certain height
Impingement syndrome - painful arc angle
60-120 degrees of abduction
as inflammed area of supraspinatus tendon passes through the subacromial space
Impingement syndrome - investigations
X-ray
- fluffy dots floating outside (calcium)
US
MRI
Impingement syndrome - management
NSAIDs
Analgesia
Physio
Subacromial injection (can administer up to 3)
Severe:
subacromial decompression surgery (wait at least 6 months first)
Adhesive capsulitis - definition
Frozen shoulder. Inflammation of the capsule and glenohumeral ligament of the shoulder resulting in tightness due to contraction
Adhesive capsulitis - epidemiology
Middle age
Commoner in females
Adhesive capsulitis - cause
Can occur after shoulder surgery
Diabetes
High cholesterol
Adhesive capsulitis - clinical features
FREEZING
- progressive severe pain, constant pain, pain at night
FROZEN
- pain eventually subsides as stiffness increases
- limitation of movement
THAWING
- stiffness gradually disappears over time and shoulder recovers
- patient gets movement of their arm back
Adhesive capsulitis - examination
Restriction of range of movement (unable to externally rotate arm)
Adhesive capsulitis - investigations
X-ray
- should be normal
Adhesive capsulitis - management
Non operative - physio, analgesia - intra-articular glenohumeral injections Operative - arthroscopic capsular release
Rotator cuff tear - definition
Tears can be partial or full thickness
Lack of muscular stability
Rotator cuff tear - causes
Tendon degeneration
Sudden jerk
Rotator cuff tear - epidemiology
Over 40 year olds
grey hair, cuff tear
Rotator cuff tear - clinical features
Pain
weakness of initiation of abduction (supraspinatous)
Rotator cuff tear - examination
LOOK: - contour, muscle wasting FEEL: - tenderness, subdeltoid region MOVE: - active movement is much less than passive movement
Rotator cuff tear - investigations
X-rays
- subacromial space is reduced
- Greater tuberosity of humerus is looked and instead the humerus looks spherical
- Confirm tears on US or MRI
Rotator cuff tear - management
Non-operative: - physio - subacromial injection Operative: - rotator cuff repair (open or arthroscopic) [failure of surgery is common due to diseased tendon]
Acute calcific tendonitis - definition
Calcium in the supraspinatus tendon
Acute calcific tendonitis - clinical features
Acute onset of severe shoulder pain
Acute calcific tendonitis - investigations
X-ray
- can see calcium deposition just proximal to the greater tuberosity of the humerus
Acute calcific tendonitis - management
Subacromial steroid injection
Instability - definition
Subluxation/dislocation
Humeral head is no longer sitting in the gleaned fossa
Instability - epidemiology
age
Younger people
Instability - causes
Mainly traumatic (e.g. sport injury)
Instability - clinical features
Pain
Instability - examination
LOOK: - abnormal shoulder contour - muscle wasting FEEL: - tenderness - muscle spasm MOVE: - range of movement - winged scapula Special tests: - rotator cuff strength - apprehension - relocation - general laxity
Instability - investigations
X-ray
MRI
Instability - management
IV analgesia, O2, IV sedation
Reduce shoulder to original position
In recurrent dislocations - try a Bankart repair which aims to reattach the labrum and capsule to the anterior glenoid
Instability - prognosis
The younger the patient, the higher the risk of recurrent dislocation
The dislocation is usually anteriorly/posteriorly?
Anteriorly
Causes of anterior dislocation
Trauma
Causes of posterior dislocation
Electrocution
Epileptic fit
Glenohumeral OA - epidemiology
Elderly
GLenohumeral OA - Causes
Cuff tear
Instability (recurrent dislocation)
Previous surgery
Glenohumeral OA - clinical features
Gradual onset
Pain at rest and at night
Pain at the front of shoulder
Stiffness
Glenohumeral OA - examination
Asymmetry Wasting Limitation external rotation Global restriction in movement Crepitus
Glenohumeral OA - investigations
X-ray
- LOSS
Glenohumeral OA - management
Non-operative: - analgesia - physio Operative: - total shoulder replacement - resurfacing
Associated nerve involvement with anterior dislocation
Axillary nerve
