Shoulder Pathologies Flashcards
Rotator cuff muscles
(4) + action and site of insertion
Supraspinatus
- Initiation of abduction
- insert into greater tuberosity of humerus
Infraspinatus
- External rotation of shoulder joint
- Insert into greater tuberosity off humerus
Teres Minor
- External rotation of shoulder joint
- Insert into greater tuberosity of humerus
Subscapularis
- Internally rotates shoulder
- Inserts into lesser tuberosity of humerus
All function together to pull humeral head into glenoid fossa and provide stability
Rotator cuff tear aetiology
Sudden jerk in patients >40 which produces subsequent pain and weakness
Rotator Cuff Tear Site
Usually Supraspinatus
Can include infraspinatus and subscapularis
Rotator Cuff tear examination signs
Weakness of initiation of abduction (Supraspinatus)
Internal rotation weakness (subscapularis)
External rotation weakness (infraspinatus)
Wasting of Supraspinatus
Rotator Cuff tear investigations
MR
Ultrasound scan
Rotator Cuff Tear Treatment
Physiotherapy
Subacromial Injections
Surgery is controversial
Impingement Syndrome
Pain due to the tendons of the rotator cuff muscles caused by compression in the subacromial space during movement
Impingement syndrome aetiology
Tendonitis Subacromial Bursitis OA with inferior osteophyte Hooked acromion ROtator Cuff tear
Painful arc
Pain between 60 to 120 degrees on abduction
Painful arc radiation
Radiates to
- Deltoid
- Upper arm
painful arm investigations
Hawkings-kennedy test
Painful arc treatment
NSAIDs Analgesia Physio Subacromial Injections Subacromial decompression surgery
Adhesive Capsulitis
Progressive pain and stiffness of the shoulder in patients 40-60 years old
Adhesive capsulitis symptoms
Adhesive Capsulitis pain (subsides after 2-9 months)
Increasing stiffness (for 4- 12 months. Gradually thaws over time)
Loss of external rotation
Adhesive Capsulitis Risk Factors
Diabetes
hypercholesterolaemia
Dupuytren’s Contracture
Adhesive Capsulitis Treatment
Takes 18-24 months to fully resolve Physio Analgesia Intra-articular injections After pain settles: manipulation under analgesia. Surgical capsular release
Acute Calcific Tendonitis
Acute onset of sever shoulder pain characterised by deposition of calcium in the Supraspinatus tendon
Acute Calcific Tendonitis Site
Calcium deposits proximal to the greater tuberosity of the humerus
Acute calcific tendonitis treatment
Self-limiting
Subacromial steroids and local anaesthesia can control pain
Shoulder Instability Types
Traumatic
- usually anterior dislocation
Atraumatic
Traumatic Shoulder Instability Treatment
Rest
Physio
Strengthening
Recurrent dislocation requires bankcard repair which involves stabilising the shoulder by reattaching the labrum and capsule to the anterior glenoid.
Epidemiology of multidirectional subluxations/ dislocations
Occurs in patients with generalised ligamentous laxity
- Idiopathic
- Marfans
- Ehlers-Danlos
Bicep tendonitis symptoms
Anterior shoulder pain
- on resisted biceps contraction
Popeye deformity
- Spontaneous tendon rupture
Bicep tendonitis treatment
Surgical division of the tendon
Glenoid Labrum tear investigations
MRI arthrogram
Labral resection or repair
Other causes of shoulder pain
Neck Problems
Angina
Diaphragmatic Irritation