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shoulder pathology Flashcards

1
Q

Biceps Tendinitis and Tenosynovitis s/s? (2)

A
  • pain over anterolateral shoulder that radiates down
  • inflammation of the long head of the biceps tendon (tendinitis) within the bicipital groove and tendon sheath (tenodynovitis)
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2
Q

what is Acute Tendinitis?

A

rotator cuff tendons become inflamed or irritated

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3
Q

acute tensinitis AKA?

A

common with athletes AKA:

  • swimmers shoulder
  • pitchers shoulder
  • tennis shoulder
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4
Q

acute tendinitis symptoms?

A
  • pain triggered by arm movement
  • swelling in front of shoulder
  • stiffness
  • clicking sound with arm movement
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5
Q
A

tendonitis

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6
Q

what is chronic tendinitis?

A
  • long term inflammation and degeneration of tissue in one or more of the tendons in the shoulder
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7
Q

chronic tendinitis is more likely to occure due to?

A
  • repetitive motions over time which puts stress on the tendons
  • calcifications may form and restrict movement within the shoulder
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8
Q

chronic tendinitis symptoms?

A
  • pain and discomfort
  • pain worsened during use, at night, or in the morning
  • stiffness
  • loss of strength
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9
Q

injury rate of shoulder related injuries depends on? (3)

A
  • shallowness of glenoid fossa
  • laxity of ligaments
  • strength of muscles
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10
Q

Common Shoulder Problems (8)?

A 
Instability
Impingement
Rotator cuff tears
AC joint sprains and degeneration
Adhesive capsulitis
Labral tears
Biceps tendinopathy
Clavicle fractures
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11
Q

3 categories of shoulder instability?

A
  • shoulder subluxation
  • shoulder dislocation
  • shoulder separation
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12
Q

what is shoulder subluxation?

A
  • incomplete or partial dislocaiton
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13
Q

what is shoulder dislocation?

A
  • complete dislocation of the GH joint

- most common anteriorly and inferiorly

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14
Q

what is shoulder separation?

A
  • complete dislocation of the AC joint
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15
Q

most common glenohumeral instability?

A

anteriorinferior instability

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16
Q

glenohumeral instability is caused by?

A
  • overstretching of the middle and inferior glenohumeral ligaments
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17
Q

6 categories of glenohumeral instability?

A 
Traumatic
Atraumatic
Unidirectional
Multi-directional
Unilateral
Bilateral
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18
Q

what is subacromial impingement syndrome?

A
  • entrapment or impingement of the structures in the subacromial space
  • between the CA arch and greater tuberosity
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19
Q

Subacromial space contains?

A
  • rotator cuff tendons
  • long head of biceps tendon
  • subacromial bursa
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20
Q

3 stages of impingement syndrome?

A 
1. <25 years old, overuse injury
    edema
2. 25-40 years old,
    fibrosis, bursal thickening
3. >50 years old
    partial or ft tear or rupture
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21
Q

what is Rotator Cuff Interval?

A
  • hypoechoic area surrounding the cross-sectioned long head of the biceps tendon
  • varies in size and may not be apparent in some individuals
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22
Q

Rotator Cuff Interval could be mistaken for?

A

rotator cuff tear

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23
Q

Musculotendinous Junction on U/S?

A

shows varying echogenicity of the interdigitating hyperechoic tendinous fibers and hypoechoic muscle fibers, an appearance that mimics tendinosis or a rotator cuff tear.

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24
Q

Supraspinatus-Infraspinatus Interface?

A
  • thinning of the rotator cuff at the supraspinatus-infraspinatus interface is a normal finding and should not be mistaken for a partial-thickness tear
  • seen in patients with rheumatoid arthritis
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25
Q
A

Supraspinatus-Infraspinatus Interface

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26
Q

Most commonly torn rotator cuff muscle is the?

A

supraspinatus

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27
Q

ROTATOR CUFF TEARS/FAILURE?

A
  • usually torn from chronic subacromial impingement

- may be traumatic tear

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28
Q

a complete tear is a result of?

A

repeated movements or sudden injury

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29
Q

what is a complete tear?

A
  • tears all the way through to the tendon or it can rip the tendon off of the bone
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30
Q

complete tear symptoms?

A
  • clicking or popping when you move your arm
  • pain when you move your arm or lie on it
  • weakness sin arm
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31
Q

complete tear diagnosis and treatment?

A

diagnosis: MRI, X-ray, U/S
treatment: physical therapy or surgery

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32
Q
A

complete tear

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33
Q

Full Thickness Rotator Cuff Tears - Criteria? complete non visualization of the cuff

A
  1. complete non visulaization of the cuff

- bare shoulder or massive tear

34
Q

Full Thickness Rotator Cuff Tears - Criteria? localized or focal nonvisualization of cuff?

A

Localized or focal nonvisualization of cuff
Occur in anterolateral critical zone
Deltoid Herniation sign -defined pieces of cuff seperated by herniation of deltoid muscle into tear

35
Q

what is the deltoid herniation sign?

A

defined pieces of cuff seperated by herniation of deltoid muscle into tear

36
Q

Critical Zoneof the rotator cuff?

A

area of relative avascularity on the supraspinatus muscle tendon near its insertion (tenoperiosteal junction) on the greater tubercle of the humerus.

37
Q

Full Thickness Rotator Cuff Tears - Criteria? discontinuity of the cuff?

A

Smaller tear associated with fluid collection from SA-SD bursa
Double cortex sign-bright reflective line at the surface of cartilage overlying the humeral head in the presence of focal overlying fluid

38
Q

Full Thickness Rotator Cuff Tears - Criteria? abnormal cuff echogenicity

A

Focal area of increased or decreased echogenicity

Least reliable

39
Q

full thickness rotaor cuff tears allow communication of the?

A

glenohumeral and the SA-SD bursa, partial thickness tears do not

40
Q

Partial- and full-thickness rotator cuff tears are visualized as?

A

hypoechoic lesions or mixed hyper-and hypoechoic lesions most frequently located in the critical zone of the supraspinatus tendon and should be verified in two orthogonal directions.

41
Q

what is a partial tear?

A
  • one of the muscles that forms the rotator cuff is damaged

- happens over time while repeating same arm motion

42
Q

most common sports for partial tears (2)?

A

tennis and baseball

43
Q

partial tear symptoms?

A
  • difficulty lifting arm
  • weakness in shoulder
  • trouble doing things you normally do
44
Q

patrial tear treatment?

A

physical therapy

45
Q

Partial Thickness Rotator Cuff Tears - Types (3)?

A
  1. intrasubstance (m/c)
  2. articular surface
  3. bursal surface
46
Q

Partial Thickness Rotator Cuff Tears - articular surface?

A
  • rim rent= early supraspinatus tear within the critical zone
  • associated with focal cortical irregularity of the humerus
47
Q
A

partial thickness tear- intrasubstance tear

48
Q
A

partial thickness articualr tear

49
Q
A

partial thickness bursal tear

50
Q

Minor Criteria for Tears (3)?

A
  1. intra or extra articular fluid collections
  2. abdormal contour of subdeltoid bursa
  3. elevation of humeral head
51
Q

intra or extra articular fluid collections found where?

A

subacromial-subdeltoid bursa

52
Q

abnormal contour of subdeltoid bursa?

A
  • concavity- medium or large tear

- thickness normal SA-SD bursa measures 2mm or less

53
Q

thickness normal SA-SD bursa measures?

A

2mm or less

54
Q

elevation of humeral head?

A
  • massive tear

- compare with normal side

55
Q

what is associated with “popeye sign”?

A

biceps tendon rupture

56
Q

what is Popeye Deformity ? who does it affect

A
  • Bicep tendon (usually the long head) tears causing the muscle to bunch up and form a ball of muscle in the upper arm
  • The tear usually occurs suddenly
  • Mostly affects people over 50 yrs
57
Q
A

popeye sign

58
Q

Calcific Tendinitis?

A

Calcium crystal deposit within the substance of the supraspinatus(critical zone) or biceps tendons

59
Q
A

calcific tendinitis

60
Q

Subluxation/ Dislocation of Biceps Tendon occurs where?

A

over medial wall of bicipital groove

61
Q
A

Subluxation/ Dislocation of Biceps Tendon

62
Q

Effusion?

A

Abnormal accumulation of fluid in or around a joint

63
Q

effusion symptoms? (4)

A

Swelling - mild to severe
Pain - suttle throb to sharp pain
Stiffness - limit range of motion or entirely immobilize the joint
Redness/warmth - associated with inflammation

64
Q

effusion causes? (2)

A

septic

aseptic

65
Q

septic causes or effusion?

A
  • caused by infection
  • Most commonly caused by bacteria
  • Symptoms are rapid and painful
  • Infection may be caused by systemic infection through bloodstream or through a wound or medical procedure
66
Q

septic causes or effusion risk factors?

A
  • older age
  • diabetes
  • HIV
  • intravenous drug use
  • joint replacement
67
Q

aseptic causes or effusion?

A
  • not caused by infection
  • sports injury
  • car accident
  • serious fall
68
Q

aseptic effusion is commonly associated with?

A
  • bursitis

- tendosynocitis

69
Q
70
Q

Teardrop Sign?

A

– effusion – teardrop shaped thickening of the bursa distal to lateral edge of greater tuberosity

71
Q

burisitis?

A
  • inflammation

- hypervascularity with colour doppler

72
Q
A

Transverse ultrasound image of the rotator cuff depicting acute subacromial-subdeltoid bursitis

73
Q

Frozen Shoulder?

A
  • adhesive capsulitis
  • shoulder capsule thickens and becomes tight
  • Stiff bands of tissue — called adhesions — develop less synovial fluid in the joint
74
Q
A

frozen shoulder

75
Q

Labral Tear causes?

A

pain and a catching sensation with movement of the shoulder

76
Q

labral tear causes?

A

probably the result of an injury to the shoulder, such as falling on an outstretched hand

77
Q

what might damage the labrum over time?

A
  • excess motion of the humerus moving around on the glenoid

- An unstable shoulder may also cause injury to the labrum, if it repeatedly dislocates out of the glenoid.

78
Q

Labral Cyst?

A
  • pockets of joint fluid that develop outside of the joint under tears of the labrum
  • also known as ganglia (or a ganglion)
79
Q
A

labral cyst AKA glanglia

80
Q

Avulsion Fracture?

A

greater and lesser tuberosity at insertion of rc tendons

81
Q

Hill-Sachs Deformity?

A

depression fracture of posterior humeral head secondary to recurrent anterior dislocation

82
Q

Geyser sign?

A

(effusion at the acromioclavicular joint) in a patient with total rotator cuff rupture

MSK (8 decks)

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