Shoulder Pathology Flashcards
Name four diseases of the shoulder
- instability
- cuff disease
- frozen shoulder
- arthritis
Who typically experiences shoulder instability?
Young/sporty trauma patients
What type of instability is more common?
Anterior
Posterior - electrocution/epileptic fit
What is the re-dislocation rate in young people?
80%
Name three methods of relocation
Kocher
Hippocratic
Stimson
How is shoulder instability diagnosed?
Oblique garth view Xray
Name two types of lesion that can occur due to shoulder instability
Bankart
Hill Sachs
Describe a Bankart lesion
Injury of anterior, inferior glenoid labrum
Describe Hill Sachs lesion
Cortical depression in the posterolateral head of the humerus
What is a bony bankart lesion?
Bankart lesion that includes a fracture to the glenoid cavity of the scapula
How is shoulder instability treated?
Relocate shoulder
Physio
Repair labrum
Deepen socket to stabilise shoulder
What is impingement syndrome?
Tendons of the rotator cuff are compressed in the sub-acromial space during movement producing pain
How do patients with impingement present?
Painful arc 60-120 degrees
Name the causes of impingement
Tendonitis Subacromial bursitis Acromioclavicular OA with oesteophyte Hooked acromion Rotator cuff tear
Where does impingement pain typically radiate to?
Deltoid and upper arm
Name the test that recreates the impingement pain
Hawkins Kennedy
How is impingement treated?
Conservative with NSAIDs, analgesia, physio
2 steroid injections
Subacromial decompression surgery
Name the two types of cuff tear
Acute - trauma
Chronic - degenerative
Who usually gets a rotator cuff tear?
Older patients with a history of sudden jerk
Describe the affected muscle related to the weakness
Supraspinatus - abduction
Subscapular - internal rotation
Infraspinatus - external rotation
What investigation will confirm a rotator cuff tear?
Ultrasound
MRI
Describe rotator cuff tear treatment
Chronic - self limiting, physio, steroid
Acute - Open or arthroscopic repair with subacromial decompression
Describe the disease progression of frozen shoulder
Pain
Stiffness
Resolves in 18-24 months
How will frozen shoulder present?
Loss of external rotation
What diseases are frozen shoulder associated with?
Diabetes
Hypercholesterolaemia
Dupuytren’s
Trauma
What is the pathology of frozen shoulder?
The capsule and glenohumeral ligaments become inflamed then thicken and contract - adhesive capsulitis
How is frozen shoulder diagnosed?
Scapular thoracic movement
Normal xray
Lack of external rotation
Describe the non-operative management of frozen shoulder
Physio
Analgesics and steroids
Describe the operative management of frozen shoulder
Manipulation under anaesthetic or surgical capsular release
What is acute calcific tendonitis?
Acute onset severe shoulder pain characterised by calcium deposition in the supraspinatus tendon
Where is the calcium seen on X-ray?
Proximal to the greater tuberosity
How is acute calcific tendonitis managed?
Self limiting
Pain - subacromial steroid or local aesthetics
