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Musculoskeletal + Rheumatology > Shoulder Pathology > Flashcards

Shoulder Pathology Flashcards

1
Q

What causes rotator cuff tears?

A

Traumatic/acute

Degenerative/chronic

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2
Q

How do rotator cuff tears present?

A

Full passive range of motion

Pain and weakness during active abduction

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3
Q

What xray signs are seen in rotator suff tears?

A

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

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4
Q

What test assesses the supraspinatus muscle?

A

Jobes test

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5
Q

When is surgical management of rotator cuff tears used?

A

Early surgery for acute rotator cuff tears

If symptomatic in chronic degenerative tears

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6
Q

What is superior capsular reconstruction?

A

Option for massive, irreparable rotator cuff tears, involving a cadaveric skin graft to reconstruct capsule, not the tendon

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7
Q

What is adhesive capsulitis?

A

Glenoid/shoulder capsule becomes inflamed, tight and constructive for unknown reason

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8
Q

What age group is adhesive capsulitis common in?

A

40/50s

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9
Q

What causes adhesive capsulitis?

A

Idiopathic/primary, accounts for 90%

Secondary

  • Trauma
  • Cardiac surgery

Associated conditions

  • DM
  • Stroke
  • Connective tissue disease
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10
Q

How long does the pain stage of adhesive capsulitis last?

A

0-9 months, peaking at 4.5

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11
Q

How long does the stiffness stage of adhesive capsulitis last?

A

4.5-14 months, peaking at 14

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12
Q

How long does the thawing stage of adhesive capsulitis last?

A

14-24 months

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13
Q

How does adhesive capsulitis present?

A

Pain in all directions, external rotation is particuatly impaired

Progressive pain followed by progressive stiffness

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14
Q

What investigations are used in adhesive capsulitis diagnosis?

A

Radiograph is normal but allows us to exclude mimicking conditions

Diagnosis is based purely on presentation

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15
Q

How is adhesive capsulitis managed?

A

Physiotherapy

Injected corticosteroid in joint capsule, to reduce inflammation during early painful stage

Surgery, to loosen joint capsule during late stiff stage

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16
Q

What is subacromial impingement?

A

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

17
Q

What causes subacromial impingement?

A

Inflammation of supraspinatus tendon

Bony outgrowth under the acromion

Subacromial bursitis

18
Q

How does subacromial impingement present?

A

Painful arc of abduction

Unable to lie on affected side

No pain on palpation

19
Q

How is subacromial impingement managed?

A

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
20
Q

Why are shoulder dislocations so common?

A

Shoulder joint is the most mobile joint in the body, so therefore most commonly dislocated

Stability sacrificed for mobility

21
Q

What are the types of shoulder dislocation?

A

Anterior

  • 90%
  • Fall on outstretched, adducted arm

Posterior

  • 9%
  • Consider epilepsy and electrocution

Inferior

  • 1%
22
Q

How do shoulder dislocations present?

A

Palpable dent at glenoid fossa

Posterior

  • Shoulder locked in internally rotated position
23
Q

What X-ray sign is seen in posterior shoulder dislocations?

A

Light bulb sign as the humeral head also internally rotates

24
Q

How are shoulder dislocations managed?

A

Manipulation/reduction

  • Movement of shoulder joint back into place under anaesthesia

Immobilisation/sling

Surgically move back into place

Adjuvant Physiotherapy

Morphine/analgesia

25
Q

Give complications of shoulder dislocations

A

Rotator cuff injury

Axillary nerve damage

Bankart Tear

26
Q

What is a Bankart tear?

A

Tearing of glenoid labrum between glenoid and humeral head due to anterior shoulder dislocation

27
Q

What causes upper limb fractures?

A

Young high energy injuries

Elderly osteoporotic (low impact) injuries

28
Q

Give complications of upper limb fractures

A

Trauma of shoulder means higher risk of arthritis

29
Q

What are the two types of tendinopathies?

A

Golfers/medial epicondylitis

  • Pain

Tennis/lateral epicondylitis

  • Pain worse on wrist and elbow extention/cozen test positive
30
Q

What is the management of tendinopathies?

A

Platelet rich plasma injection into most tender spot

Physiotherapy

Musculoskeletal + Rheumatology (16 decks)

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