Shoulder Pathology Flashcards
What causes rotator cuff tears?
Traumatic/acute
Degenerative/chronic
How do rotator cuff tears present?
Full passive range of motion
Pain and weakness during active abduction
What xray signs are seen in rotator suff tears?
Humeral head is pulled upwards as deltoid is dragging it up, rotator cuff is damaged so can’t pull it into normal place
If degenerative damage, sclerosis/white hard thickening
What test assesses the supraspinatus muscle?
Jobes test
When is surgical management of rotator cuff tears used?
Early surgery for acute rotator cuff tears
If symptomatic in chronic degenerative tears
What is superior capsular reconstruction?
Option for massive, irreparable rotator cuff tears, involving a cadaveric skin graft to reconstruct capsule, not the tendon
What is adhesive capsulitis?
Glenoid/shoulder capsule becomes inflamed, tight and constructive for unknown reason
What age group is adhesive capsulitis common in?
40/50s
What causes adhesive capsulitis?
Idiopathic/primary, accounts for 90%
Secondary
- Trauma
- Cardiac surgery
Associated conditions
- DM
- Stroke
- Connective tissue disease
How long does the pain stage of adhesive capsulitis last?
0-9 months, peaking at 4.5
How long does the stiffness stage of adhesive capsulitis last?
4.5-14 months, peaking at 14
How long does the thawing stage of adhesive capsulitis last?
14-24 months
How does adhesive capsulitis present?
Pain in all directions, external rotation is particuatly impaired
Progressive pain followed by progressive stiffness
What investigations are used in adhesive capsulitis diagnosis?
Radiograph is normal but allows us to exclude mimicking conditions
Diagnosis is based purely on presentation
How is adhesive capsulitis managed?
Physiotherapy
Injected corticosteroid in joint capsule, to reduce inflammation during early painful stage
Surgery, to loosen joint capsule during late stiff stage
What is subacromial impingement?
Compression/trapping of tendons and bursa of shoulder joint due to any pathology that decreases the volume of the subacromial space (space above shoulder joint) or increases the size of the contents, ie bursa becomes swollen
What causes subacromial impingement?
Inflammation of supraspinatus tendon
Bony outgrowth under the acromion
Subacromial bursitis
How does subacromial impingement present?
Painful arc of abduction
Unable to lie on affected side
No pain on palpation
How is subacromial impingement managed?
Subacromial steroid injection, to reduce inflammation
Physiotherapy followinh steroid injection
Arthroscopic subacromial decompression
- Surgical management in which doctor shaves away bone to make space wider
Why are shoulder dislocations so common?
Shoulder joint is the most mobile joint in the body, so therefore most commonly dislocated
Stability sacrificed for mobility
What are the types of shoulder dislocation?
Anterior
- 90%
- Fall on outstretched, adducted arm
Posterior
- 9%
- Consider epilepsy and electrocution
Inferior
- 1%
How do shoulder dislocations present?
Palpable dent at glenoid fossa
Posterior
- Shoulder locked in internally rotated position
What X-ray sign is seen in posterior shoulder dislocations?
Light bulb sign as the humeral head also internally rotates
How are shoulder dislocations managed?
Manipulation/reduction
- Movement of shoulder joint back into place under anaesthesia
Immobilisation/sling
Surgically move back into place
Adjuvant Physiotherapy
Morphine/analgesia
Give complications of shoulder dislocations
Rotator cuff injury
Axillary nerve damage
Bankart Tear
What is a Bankart tear?
Tearing of glenoid labrum between glenoid and humeral head due to anterior shoulder dislocation
What causes upper limb fractures?
Young high energy injuries
Elderly osteoporotic (low impact) injuries
Give complications of upper limb fractures
Trauma of shoulder means higher risk of arthritis
What are the two types of tendinopathies?
Golfers/medial epicondylitis
- Pain
Tennis/lateral epicondylitis
- Pain worse on wrist and elbow extention/cozen test positive
What is the management of tendinopathies?
Platelet rich plasma injection into most tender spot
Physiotherapy
