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Ortho > Shoulder Pathologies > Flashcards

Shoulder Pathologies Flashcards

1
Q

Rotator cuff tear presentation

A

After trauma in younger, due to degeneration in older
Shoulder weakness and pain, may be painful at night
Typically >40 yrs

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2
Q

Rotator cuff tear imaging

A

US gives info on tear/no tear

MRI can quantify muscle wasting - prognostic indicator

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3
Q

Rotator cuff tear treatment

A

Incomplete: surgery if symptoms persist
Complete: assess for open/arthroscopic repair

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4
Q

Impingement syndrome definition

A

Pain on abducting (45-160°)

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5
Q

Causes of impingement syndrome

A

Supraspinatus tendinopathy
Calcifying tendinopathy of supraspinatus
AC joint OA

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6
Q

Supraspinatus tendinopathy presentation

A

Pain when adducting pressure put on partially abducted arm

Typically 35-60 yrs

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7
Q

Supraspinatus tendinopathy treatment

A

Physio and analgesia
Subacromial bursa corticosteroid injection may help
Refractory symptoms for 6 mths - consider arthroscopic subacromial decompression

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8
Q

Calcifying tendinopathy of supraspinatus presentation

A

Acute calcific arthropathy
Presents typically around 40 yrs
Acute inflammation of supraspinatus
Maximum pain during resorption phase

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9
Q

Calcifying tendinopathy of supraspinatus treatment

A

Physio, NSAIDs, steroid injection

Excision of calcium if severe

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10
Q

ACJ osteoarthritis presentation

A

Common amongst young weightlifters

Pain above ACJ, shoulder stiffness and limited ROM

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11
Q

ACJ osteoarthritis treatment

A

Rest, NSAIDs, steroid injections

Excision of ACJ if resistant to other therapies

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12
Q

Long head of biceps tendinopathy presentation

A

Pain in anterior shoulder increases on forced contraction of biceps

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13
Q

Long head of biceps tendinopathy treatment

A

Analgesia

Corticosteroid injection into tendon may help but risks rupture

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14
Q

Rupture of long head of biceps

A

Pop when lifting/pulling, ball appears upon flexion

Repair rarely indicated as function remains

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15
Q

Adhesive capsulitis presentation

A

3 phases

1: painful phase up to 1 yr, ROM reduced (abduction <90°, external rotation <30°)
2: Frozen phase, pain settles but stiffness remains 6-12 mths
3: Thawing phase, ROM returns over 1-3 yrs

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16
Q

Adhesive capsulitis associations

A

Diabetes
Cervical spondylosis
Thyroid disease

17
Q

Adhesive capsulitis treatment

A

Early physio + NSAIDs
Corticosteroids may help pain in early phases
Surgical release with manipulation/arthroscopic arthrolysis is current most effective treatment

18
Q

Clavicular fracture presentation

A

FOOSH or more commonly direct blow to clavicle

Middle 1/3 most commonly affected, proximal fragment pulled up by sternocleidomastoid

19
Q

Clavicular fracture treatment

A

Broad-arm sling with 6 wk follow up xray to ensure union

Open reduction and internal fixation of displaced #

20
Q

Clavicular fracture complications

A

Brachial plexus injury
Subclavian vessel injury
Pneumothorax

21
Q

Scapula and Acromion fracture management

A

Rarely need fixation, high energy so ensure no other injury

22
Q

ACJ dislocation presentation

A

Typically direct blow to top of shoulder

Tender prominence over ACJ, adduction of arm over body inc pain

23
Q

ACJ dislocation imaging

A

Check for congruity of underside of acromion with distal clavicle, may not show abnormality

24
Q

ACJ dislocation management

A

Minimal displacement rest in broad arm sling

Severe may require open reduction + ligament reconstruction

25
Q

Anterior shoulder dislocation presentation

A

Often follows contact sport in young, FOOSH in old
Arm forced into abduction, extension, external rotation
Flattening of deltoid
Anterior bulge from head of humerus, may be palpated in axilla

26
Q

Anterior shoulder dislocation treatment

A

Check pulses and nerves pre+post-reduction, and xray to exclude fracture post
Simple reduction or Kocher’s method
Surgery may be needed if recurrent dislocation

27
Q

Posterior dislocation of shoulder presentation

A

Rare, limited external rotation

Presents with seizures/electrical shocks

28
Q

Posterior dislocation of shoulder diagnosis

A

Shoulder XR AP shows light bulb humeral head, lateral essential for better view

29
Q

of humeral shaft presentation

A

Typically fall onto arm, rarely outstretched

Wrist-drop if radial n. damage, but this can also be complication of surgery

30
Q

of humeral shaft treatment

A

Splinting with humeral brace + gravity traction with immobilisation for 8-12 wks
Surgical options of locking/compression plating

31
Q

of proximal humerus typical history

A

Mostly osteoporotic FOOSH in elderly

32
Q

of proximal humerus management

A

Minimally displaced conservatively managed

Open/pathological/multiple part fractures; dislocations or NV injury needs operative management

33
Q

of proximal humerus complications

A

AVN, worse with more fragments

34
Q

Recurrent shoulder dislocation causes

A

Atraumatic can be general joint laxity/connective tissue disorder (AMBRI: atraumatic, multidirectional, bilateral, rehab, inferior capsular shift surgery (if rehab fails))
Traumatic can be through Bankart lesions (avulsion of glenoid labrum from glenoid) or Hill-Sachs (# of humeral head following anterior dislocations)

35
Q

Erb’s palsy

A

C5,C6 damage (high lesion) of brachial plexus
Affects suprascapular, musculocutaneous and axillary n.
Waiter’s tip sign (arm internally rotated, extended, adducted, pronated)
Occurs during trauma in downwards direction e.g. difficult delivery for neonates

36
Q

Klumpke’s paralysis

A

C8, T1 damage (low lesion)
Combo of median/ulnar n. damage
Claw hand with arm in adduction
Forced abduction (pulled arm superiorly) causes this e.g. breaking fall from height by grabbing a branch

Ortho (13 decks)

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