Shoulder Pathologies

Question 1

Rotator cuff tear presentation

Answer 1

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

Question 2

Rotator cuff tear imaging

Answer 2

US gives info on tear/no tear

MRI can quantify muscle wasting - prognostic indicator

Question 3

Rotator cuff tear treatment

Answer 3

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

Question 4

Impingement syndrome definition

Answer 4

Pain on abducting (45-160°)

Question 5

Causes of impingement syndrome

Answer 5

Supraspinatus tendinopathy
Calcifying tendinopathy of supraspinatus
AC joint OA

Question 6

Supraspinatus tendinopathy presentation

Answer 6

Pain when adducting pressure put on partially abducted arm

Typically 35-60 yrs

Question 7

Supraspinatus tendinopathy treatment

Answer 7

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

Question 8

Calcifying tendinopathy of supraspinatus presentation

Answer 8

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

Question 9

Calcifying tendinopathy of supraspinatus treatment

Answer 9

Physio, NSAIDs, steroid injection

Excision of calcium if severe

Question 10

ACJ osteoarthritis presentation

Answer 10

Common amongst young weightlifters

Pain above ACJ, shoulder stiffness and limited ROM

Question 11

ACJ osteoarthritis treatment

Answer 11

Rest, NSAIDs, steroid injections

Excision of ACJ if resistant to other therapies

Question 12

Long head of biceps tendinopathy presentation

Answer 12

Pain in anterior shoulder increases on forced contraction of biceps

Question 13

Long head of biceps tendinopathy treatment

Answer 13

Analgesia

Corticosteroid injection into tendon may help but risks rupture

Question 14

Rupture of long head of biceps

Answer 14

Pop when lifting/pulling, ball appears upon flexion

Repair rarely indicated as function remains

Question 15

Adhesive capsulitis presentation

Answer 15

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

Question 16

Adhesive capsulitis associations

Answer 16

Diabetes
Cervical spondylosis
Thyroid disease

Question 17

Adhesive capsulitis treatment

Answer 17

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

Question 18

Clavicular fracture presentation

Answer 18

FOOSH or more commonly direct blow to clavicle

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

Question 19

Clavicular fracture treatment

Answer 19

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

Open reduction and internal fixation of displaced #

Question 20

Clavicular fracture complications

Answer 20

Brachial plexus injury
Subclavian vessel injury
Pneumothorax

Question 21

Scapula and Acromion fracture management

Answer 21

Rarely need fixation, high energy so ensure no other injury

Question 22

ACJ dislocation presentation

Answer 22

Typically direct blow to top of shoulder

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

Question 23

ACJ dislocation imaging

Answer 23

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

Question 24

ACJ dislocation management

Answer 24

Minimal displacement rest in broad arm sling

Severe may require open reduction + ligament reconstruction

Question 25

Anterior shoulder dislocation presentation

Answer 25

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

Question 26

Anterior shoulder dislocation treatment

Answer 26

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

Question 27

Posterior dislocation of shoulder presentation

Answer 27

Rare, limited external rotation | Presents with seizures/electrical shocks

Question 28

Posterior dislocation of shoulder diagnosis

Answer 28

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

Question 29

of humeral shaft presentation

Answer 29

Typically fall onto arm, rarely outstretched | Wrist-drop if radial n. damage, but this can also be complication of surgery

Question 30

of humeral shaft treatment

Answer 30

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

Question 31

of proximal humerus typical history

Answer 31

Mostly osteoporotic FOOSH in elderly

Question 32

of proximal humerus management

Answer 32

Minimally displaced conservatively managed | Open/pathological/multiple part fractures; dislocations or NV injury needs operative management

Question 33

of proximal humerus complications

Answer 33

AVN, worse with more fragments

Question 34

Recurrent shoulder dislocation causes

Answer 34

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)

Question 35

Erb's palsy

Answer 35

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

Question 36

Klumpke's paralysis

Answer 36

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