shoulder pathology Flashcards
what attaches to the greater tubercle of the humerus
the SIT muscles
role of supraspinatus
abduct 0-15
role of infraspinatus and teres minor
externally rotate
role of subscapularis
internally rotate
what is subacromial impingement
compression of (normally supraspinatus) under the coracoacromial arch
what can cause subacromial impingement
osteophytes, bursitis (may be caused by overuse of the tendon by repetitive overhead action), calcific tendonitis
examination findings of subacromial impingement
painful arc and positive hawkins test
diagnosis of subacromial impingement
normally clinical but can do an MRI to confirm
3 tests which test for it:
1) empty can test
2) Hawkins test
3) painful arc test
MX of subacromial impingement
1) conservative - NSAID, ice, rest, physio 2) steroid injections 3) surgery
complications of subacromial impingement
adhesive capsulitis and rotator cuff tears
will strength be effected in subacromial impingement
no
a rotator cuff tear can be what
acute or chronic
RF for rotator cuff tear
age, trauma, repetitive overhead use
Ex findings of a rotator cuff tear
tenderness over the lateral aspect of the shoulder, muscle wasting, reduced ROM and power
IX for rotator cuff tear
Xray to rule out fracture, US to confirm tear and MRI for details of tear
Mx of rotator cuff tear
conservative or surgical
main complication of any shoulder pathology
adhesive capsulitis
RF for adhesive capsulitis
diabetes, thyroid, female, adhesive capsulitis in other shoulder
PC in adhesive capsulitis
generalised deep and constant pain, joint stiffness and reduced ROM
Ex findings in adhesive capsulitis
reduced ROM in active and passive, tenderness on palpation, movement worse in external rotation and flexion
Ix for adhesive capsulitis
clinical diagnosis but can do MRI to confirm and do HbA1c
surgical options for adhesive capsulitis
MUA and arthrographic distension (where water is put into the joint to break down the adhesions)
how long might adhesive capsulitis last
3 years
what kind of shoulder dislocation causes a lightbulb sign
posterior
why is shoulder dislocation most common
shallow glenoid fossa
MOA of anterior shoulder dislocation
FOOSH
MOA of posterior shoulder dislocation
electrocution
how does someone with an anterior inferior shoulder dislocation present
pain, unwillingness to move, loss of shoulder contours, anterior bulge and arm in ABDUCT and EXT ROTATION
nerves to assess in shoulder dislocation
axillary and supra scapular (if abnormal recheck in one week)
IX for shoulder dislocation
AP and scapula Y and axillary
complications of shoulder dislocation
Hill sach and bankart lesion
MX of a shoulder dislocation
reduction (kocher or double traction) and immobilisation for 6 weeks in a broad arm sling. Early physio is important.
what displacement occurs in a clavicular fracture
medial displaces superiorly due to the pull of SCM an the lateral displaces inferiorly due to the weight of the arm
how are most clavicle fractures treated (even those with significant deformity)
conservatively due to the prominence of the metal work
non union is a big problem for clavicle fractures - where is this most likely to happen
if the fracture occurs in the distal third and if non union occurs there has to be an ORIF
