Shoulder Pathology

Question 1

Define shoulder dislocation

Answer 1

Complete separation of the glenohumeral joint, may be anterior or posterior

Question 2

What factors cause shoulder instability?

Answer 2

• Shallow glenoid
• Loose capsule
• Ligamentous laxity

Question 3

What neurovascular structures can be commonly involved in shoulder dislocations?

Answer 3

Neurological

• Axillary nerve
• Musculocutaneous nerve
• Median nerve

Vascular
-Axillary artery

Question 4

What complications occur with shoulder dislocations?

Answer 4

• Rotator cuff tears
• Hill-Sachs and Bankhart lesions
• Neurovascular injury (axillary nn, aa, median nn, musculocutaneous nn)
• Recurrent dislocations

Question 5

There is a 98% probability of a rotator cuff tear being present if the following 3 are present

Answer 5

1) Supraspinatus weakness
2) External rotation weakness
3) Positive impingement sign

Question 6

What are the 3 types of rotator cuff syndromes?

Answer 6

Subacute tendinitis (painful arc syndrome)
Chronic tendinitis (impingement syndrome)
Rotator cuff tears

Question 7

What are the 3 basic pathological processes of rotator cuff syndrome?

Answer 7

Degeneration
Trauma and impingement
Vascular reaction

Question 8

Which is the most common site of degeneration and fibrocartilaginous metaplasia?

Answer 8

Supraspinatus

Question 9

What is the “painful arc”?

Answer 9

Shoulder abduction between 60 and 120 degrees

Question 10

What is the management of rotator cuff syndrome?

Answer 10

Conservative:

• NSAIDs
• Physiotherapy
• 1/2 corticosteroid injections into the joint

Surgical:

• Removal of the coracoacromial ligament, anterior part of acromion and the osteophytes
• Can be either via open surgery or arthroplasty

Question 11

When is surgery indicated for rotator cuff syndrome?

Answer 11

• more than 3 months of ineffective conservative therapy

- persistent recurrence of the syndrome

Question 12

What are the advantages of arthroscopy vs open surgery?

Answer 12

• Earlier rehabilitation
• Less soft tissue damage
• Better cosmetic appearance

Question 13

What is the mechanism of developing calcific tendinitis?

Answer 13

Deposition of calcium hydroxyapatite crystals on the supraspinatus tendon, most probably due to fibrocartilaginous metaplasia from local ischemia. This leads to a vascular reaction in an attempt to resorb the calcium causing pain

Question 14

What is the management of calcific tendinitis?

Answer 14

Pain not so severe:
- slingand NSAIDs

Severe pain:

• Corticosteroid injections
• Extracorporeal shockwave treatment
• Drainage with ultrasound guidance (barbotage)
• Surgery (last resort)

Question 15

What is the purpose of performing an x-ray in adhesive capsulitis and what will it reveal?

Answer 15

Rule out other pathology

X-Ray is normal in adhesive capsulitis

Question 16

When is operative management indicated in anterior shoulder instability?

Answer 16

1) frequent dislocations with severe pain

2) interference with everyday activities, including sport

Question 17

What are the 6 complications of supracondylar fractures?

Answer 17

Immediate
Ulnar/median nerve injury
Compartment syndrome
Brachial artery injury

Late
Stiffness
Varus deformity