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MSK > shoulder pathologies and upper limb nerve entrapments > Flashcards

shoulder pathologies and upper limb nerve entrapments Flashcards

1
Q

who is normally affected by shoulder instability?

A

teenage to 30s

  • young
  • sporty
  • mostly traumatic !

also commonly seen in older people with rotator cuff tears

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2
Q

what type of shoulder instability are there?

A

posterior and anterior dislocation

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3
Q

what is more common; an anterior or posterior dislocation?

A

anterior dislocation (95%) is more common compared to posterior dislocation (5%)

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4
Q

when does anterior dislocation typically occur?

A

during sports and it is usually traumatic

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5
Q

when does a posterior dislocation typically occur?

A

-epileptic fit or electrocution

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6
Q

what is the treatment for acute shoulder instability?

A

reduction in emergency department:

  • Kocher method
  • Hippocratic method
  • Stimson method

2-3 weeks sling

  • Analgesia
  • Gradual early mobilisation
  • Physiotherapy
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7
Q

what does shoulder instability look like?

A

abnormal shoulder contour

in chronic there is often muscle wasting

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8
Q

what does shoulder instability feel like on examination?

A

tenderness

muscle spasm

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9
Q

what tests should be done for someone with shoulder instability?

A
  • rotator cuff strength
  • apprehension test
  • relocation
  • general laxity
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10
Q

what investigations are done for shoulder instability?

A
  • general exam
  • XRAY :AP shoulder and garth views
  • MRI arthrogram
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11
Q

what are some injuries associated with shoulder instability?

A

Labral lesion (Bankart)
Fracture humeral head (Hill Sachs)
Fracture of glenoid (Bony Bankart)
Rotator cuff tear (older patients >40)

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12
Q

what is the instability rehab plan?

A

6 week sling
8-10 weeks no driving
12 weeks no heavy lifting

can return to non contact sport in 12 weeks

can return to contact sport in 6 months

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13
Q

how long should patient not drive after shoulder instability?

A

8-10 weeks

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14
Q

how long should a patient wait before heavy lifting after shoulder instability?

A

12 weeks

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15
Q

when can a patient return to sport after shoulder instability?

A

non contact= 12 weeks

contact= 6 months

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16
Q

what patients with shoulder instability need surgical repair?

A

those with a labral tear (Bankart)

most patients

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17
Q

what is impingement syndrome?

A

pain originating from the sub-acromial space

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18
Q

what does impingement syndrome suggest <30?

A
  • rotator cuff tendonitis

- subacromial bursitis

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19
Q

what does impingement syndrome in 30-40s suggest?

A
  • Calcific tendonitis

- Early tendinosis

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20
Q

what does impingement syndrome in 40-50s suggest?

A
  • Tendinosis

- partial tears rotator cuff

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21
Q

what does impingement syndrome suggest in 50-60s?

A

cuff tear

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22
Q

what does impingement syndrome in 70s suggest?

A

-cuff arthropathy

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23
Q

what are specialty tests for impingements?

A
  • Hawkins

- Jobe’s

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24
Q

what investigations are done if there is impingement?

A

XRAY- AP shoulder and garth views or outlet view

USS

MRI- if patient has difficulty moving shoulder

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25
Q

what is the treatment for impingement?

A
  • rest (avoid doing exercises that hurt)
  • oral pain relief
  • physio
  • cortico steroid injections in subacromial space (x2 at most)

at least 6 months non operative treatment

-decompression surgery

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26
Q

what is the impingement rehab after decompression surgery?

A

sling 1-2 weeks
early PT and ROM exercises
RC strengthening

usually takes about 6 months to work

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27
Q

what is impingement linked with on examination?

A
  • painful arc

- positive impingement test

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28
Q

who is impingement usually seen in?

A

30-40

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29
Q

who are cuff tears usually seen in?

A

50-60

grey hair=cuff tear

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30
Q

how do cuff tears normally present?

A
  • pain

- weakness mainly in overhead activity

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31
Q

what specialty tests should be done for someone with suspected cuff tears?

A
  • supraspinatus
  • Gerber’s lift off
  • Horn blowers
32
Q

what investigations are done for someone with suspected cuff tear?

A

XRAY
USS- if range of movement allows it
MRI - if stiff

33
Q

what is the treatment for cuff tear?

A
  • rest
  • analgesia
  • sling

Acute:

  • urgent investigation
  • early physio
  • early reassessment
  • early intervention
  • arthroscopic or open repair of RC
34
Q

what is the cuff repair rehab?

A
  • sling 6 weeks
  • no driving 8-10 weeks
  • 12 weeks no heavy lifting
  • prolonged physiotherapy

recovery can take 6-9 months

35
Q

what % of repaired cuff rotators re tear in the next year?

A

20-40%

36
Q

what is frozen shoulder?

A
  • primary idiopathic problem

- shoulder is painful and stiff for months sometimes years

37
Q

what age group is usually affected by frozen shoulder?

A

40-50s

38
Q

what sex is usually affected by frozen shoulder?

A

more common in females

39
Q

what other diseases does frozen shoulder have an association with?

A

diabetes, lipid and endocrine disease and Dupuytren’s

40
Q

what is the pathophysiology of frozen shoulder?

A
  • contracture and thickening of coraco- humeral ligament which tightens the rotator (which sits in between the supraspanous and subscapularous) and the axillary fold
  • decreases joint volume and makes the shoulder tighter
41
Q

frozen shoulder is an adhesive process.

TRUE or FALSE

A

FALSE!! :00

42
Q

how does frozen shoulder usually present?

A
  • pain at rest
  • pain at night
  • anterior pain
  • stiffness
  • global restriction in ROM
  • external rotation <50% of normal
43
Q

what are the possible diagnoses if there is a lack of external rotation in the shoulder?

A
  • locked posterior dislocation
  • glenohumeral arthritis
  • frozen shoulder
44
Q

what does frozen shoulder look like on radiograph?

A

normal

45
Q

what is the treatment for frozen shoulder?

A

Non operative:

  • gentle movements
  • analgesia
  • physio
  • glenohumeral steroid injections
  • fluoroscopic distention

Operative:

  • manipulation under anaesthetic
  • arthroscopic capsular release
46
Q

what is the rehab for frozen shoulder after surgery?

A
  • sling for short period
  • pain control
  • AGGRESSIVE physioooooooo
47
Q

what age group is glenohumeral osteoarthritis usually found in?

A

> 60s

48
Q

how does glenohumeral arthritis usually present?

A
  • gradual onset
  • pain at night
  • stiffness
  • intermittent exacerbation
  • functional difficulties
  • asymmetry
  • muscle wasting
  • limited external rotation
  • global restriction in movement
  • pain throughout ROM
49
Q

what would an Xray of someone with glenohumeral osteoarthritis look like?

A
  • joint space narrowing
  • subchondral sclerosis
  • subchondral cysts
  • osteophyte formation
50
Q

what is the treatment for glenohumeral osteoarthritis?

A

non operative:

  • analgesia
  • physiooooo
  • GH steroid injection

operative:

  • shoulder replacement (arthroplasty)
  • resurfacing
  • total shoulder arthroplasty
  • reverse polarity shoulder arthroplasty
51
Q

what is the post arthroplasty rehab?

A 
-sling 6 weeks
8-10 weeks NO DRIVING!
-physiooooo
-no heavy lifting for 12 weeks
-pain relief
52
Q

what is the median nerve neuropathy?

A

carpal tunnel syndrome

52
Q

what is the median nerve neuropathy?

A

carpal tunnel syndrome

53
Q

what is the ulnar nerve neuropathy?

A

cubital tunnel syndrome

54
Q

who is usually affected by carpal tunnel syndrome?

A 
>30s
female
pregnant
hypothyroidism
diabetes
obesity
RA
55
Q

why do patients feel pins and needles if they have carpal tunnel syndrome?

A

due to the relative reduction in blood supply to the median nerve

56
Q

what would an intrinsic cause of reduction in blood supply to median nerve be? (carpal tunnel)

A

diabetes

57
Q

what would an extrinsic cause of reduction in blood supply to median nerve (carpal tunnel syndrome) be?

A

pressure put on the nerve due to swelling e.g. synovitis

58
Q

what hand muscles does the median nerve innervate?

A

LOAF!!

Lateral two lumbricals
Opponens Pollicis
Abductor Pollicis brevis
Flexor pollicis brevis

59
Q

what are some carpal tunnel signs?

A
  • thenar atrophy
  • altered sensation thumb, index, half of middle
  • weakness of abductor pollicis brevis
60
Q

what special tests would be conducted on someone with suspected carpal tunnel?

A

Durkan’s test- compression
Tinnel’s test- tapping
Phalen’s test- volar flexion

61
Q

treatment for mild/moderate carpal tunnel syndrome?

A
  • splintage
  • physio
  • steroid injection
62
Q

treatment for severe carpal tunnel syndrome?

A

-carpal tunnel decompression

63
Q

what is the rehab for carpal tunnel decompression surgery?

A
  • 2 days to reduce dressing
  • 5 days to keep dry
  • 10 days for sutures
  • 6 weeks return pincher grip
  • 12 week grip strength
64
Q

who is more commonly affected by cubital tunnel syndrome?

A

> 30s

males

65
Q

what can cause cubital tunnel syndrome?

A
  • post traumatic causes
  • direct causes (cysts, tumours)
  • arthritis
66
Q

what muscles does the ulnar nerve innervate in the hand?

A

All other muscles in hand (all muscle but LOAF):

  • ulnar two lumbricals
  • all hypothenar muscles
  • deep head FPB
  • adductor pollicis
67
Q

how does cubital tunnel syndrome present?

A

Early:

  • pins and needles
  • pain
  • clumsiness

Late:

  • numbness
  • weakness
68
Q

what are the signs for cubital tunnel?

A
  • hypothenar and interosseous atrophy
  • clawing of ring and small finger
  • altered sensation
  • weakness And dig minimi
  • weakness of grasp and pinch
  • Wartenbergs sign (abducted small finger)
68
Q

what are the signs for cubital tunnel?

A
  • hypothenar and interosseous atrophy
  • clawing of ring and small finger
  • altered sensation
  • weakness And dig minimi
  • weakness of grasp and pinch
  • Wartenbergs sign (abducted small finger)
69
Q

what special tests are done for cubital tunnel tests?

A
  • Tinnels test (tapping)
  • Modified Phalen’s test (elbow flexion test)
  • Froments test (thumb flexion during key grip)
70
Q

what are investigations for cubital tunnel?-

A
  • clinical examination

- nerve conduction studies (NCS) and electromyogram (EMG)

71
Q

what is treatment for cubital tunnel?

A

mild/moderate:

  • elbow splintage
  • physiotherapy
  • NSAID

Severe:
-ulnar nerve decompression

72
Q

what is the rehab plan after cubital tunnel decompression surgery ?

A
  • 2 days reduce dressing
  • 5 days keep dry
  • 10 days for sutures
73
Q

what are the three stages of frozen shoulder?

A

FREEZING STAGE- any movement of shoulder causes pain, and shoulder’s range of movement starts to become limited.

FROZEN STAGE- pain may get slightly better at this stage. However, shoulder becomes more stiff and increasingly difficult to use.

THAWING STAGE- range of motion in shoulder begins to improve

MSK (64 decks)

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