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msk soh > Shoulder pathologies > Flashcards

Shoulder pathologies Flashcards

1
Q

Impingement syndrome - definition

A

Tendons of the rotator cuff become inflammed as they are compressed in the tight subacromial space during movement

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2
Q

Impingement syndrome - which rotator cuff muscle is most commonly affected?

A

Supraspinatous

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3
Q

Impingement syndrome - epidemiology

age

A

Middle aged

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4
Q

Impingement syndrome - causes

A

Rotator cuff tear
Tendonitis
Osteophytes from AC joint
Subacromial bursitis

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5
Q

Impingement syndrome - clinical features

A

Pain originating in the subacromial space which radiates to the deltoid and upper arm
Deep pain
Pain felt when arm is abducted

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6
Q

Impingement syndrome - examination

A

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

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7
Q

Impingement syndrome - painful arc angle

A

60-120 degrees of abduction

as inflammed area of supraspinatus tendon passes through the subacromial space

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8
Q

Impingement syndrome - investigations

A

X-ray
- fluffy dots floating outside (calcium)
US
MRI

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9
Q

Impingement syndrome - management

A

NSAIDs
Analgesia
Physio
Subacromial injection (can administer up to 3)
Severe:
subacromial decompression surgery (wait at least 6 months first)

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10
Q

Adhesive capsulitis - definition

A

Frozen shoulder. Inflammation of the capsule and glenohumeral ligament of the shoulder resulting in tightness due to contraction

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11
Q

Adhesive capsulitis - epidemiology

A

Middle age

Commoner in females

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12
Q

Adhesive capsulitis - cause

A

Can occur after shoulder surgery
Diabetes
High cholesterol

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13
Q

Adhesive capsulitis - clinical features

A

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

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14
Q

Adhesive capsulitis - examination

A

Restriction of range of movement (unable to externally rotate arm)

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15
Q

Adhesive capsulitis - investigations

A

X-ray

- should be normal

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16
Q

Adhesive capsulitis - management

A 
Non operative
- physio, analgesia
- intra-articular glenohumeral injections
Operative
- arthroscopic capsular release
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17
Q

Rotator cuff tear - definition

A

Tears can be partial or full thickness

Lack of muscular stability

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18
Q

Rotator cuff tear - causes

A

Tendon degeneration

Sudden jerk

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19
Q

Rotator cuff tear - epidemiology

A

Over 40 year olds

grey hair, cuff tear

20
Q

Rotator cuff tear - clinical features

A

Pain

weakness of initiation of abduction (supraspinatous)

21
Q

Rotator cuff tear - examination

A 
LOOK:
- contour, muscle wasting
FEEL:
- tenderness, subdeltoid region 
MOVE: 
- active movement is much less than passive movement
22
Q

Rotator cuff tear - investigations

A

X-rays

  • subacromial space is reduced
  • Greater tuberosity of humerus is looked and instead the humerus looks spherical
  • Confirm tears on US or MRI
23
Q

Rotator cuff tear - management

A 
Non-operative:
- physio
- subacromial injection 
Operative:
- rotator cuff repair (open or arthroscopic) [failure of surgery is common due to diseased tendon]
24
Q

Acute calcific tendonitis - definition

A

Calcium in the supraspinatus tendon

25
Q

Acute calcific tendonitis - clinical features

A

Acute onset of severe shoulder pain

26
Q

Acute calcific tendonitis - investigations

A

X-ray

- can see calcium deposition just proximal to the greater tuberosity of the humerus

27
Q

Acute calcific tendonitis - management

A

Subacromial steroid injection

28
Q

Instability - definition

A

Subluxation/dislocation

Humeral head is no longer sitting in the gleaned fossa

29
Q

Instability - epidemiology

age

A

Younger people

30
Q

Instability - causes

A

Mainly traumatic (e.g. sport injury)

31
Q

Instability - clinical features

A

Pain

32
Q

Instability - examination

A 
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
33
Q

Instability - investigations

A

X-ray

MRI

34
Q

Instability - management

A

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

35
Q

Instability - prognosis

A

The younger the patient, the higher the risk of recurrent dislocation

36
Q

The dislocation is usually anteriorly/posteriorly?

A

Anteriorly

37
Q

Causes of anterior dislocation

A

Trauma

38
Q

Causes of posterior dislocation

A

Electrocution

Epileptic fit

39
Q

Glenohumeral OA - epidemiology

A

Elderly

40
Q

GLenohumeral OA - Causes

A

Cuff tear
Instability (recurrent dislocation)
Previous surgery

41
Q

Glenohumeral OA - clinical features

A

Gradual onset
Pain at rest and at night
Pain at the front of shoulder
Stiffness

42
Q

Glenohumeral OA - examination

A 
Asymmetry
Wasting 
Limitation external rotation 
Global restriction in movement 
Crepitus
43
Q

Glenohumeral OA - investigations

A

X-ray

- LOSS

44
Q

Glenohumeral OA - management

A 
Non-operative:
- analgesia
- physio
Operative:
- total shoulder replacement 
- resurfacing
45
Q

Associated nerve involvement with anterior dislocation

A

Axillary nerve

msk soh (24 decks)

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