Shoulder pathology Flashcards
Shoulder: Anterior dislocation
Falls from heights/sports
Presents with pain and inability to move arm, humeral head bulging anteriorly
Investigations
X-Rays
Need 2 - Lateral and Anterior view
Management
Conservative - closed reduction whilst awake/sedated + muscle relaxant (ketamine)
Reduce, POST-REDUCTION X-Ray, recheck neuromuscular status and use sling for comfort
Surgical - rarely required unless continually dislocating
*associated with Hills-Sachs fractures
Shoulder: Posterior dislocation
Much rarer than anterior
Occurs in epileptics during seizures, struck by lightning, elderly, electric shock victims
Investigations
X-Ray - lightbulb sign (away from the ribs)
Management
Closed reduction as per anterior
More likely to get Bankart or Hill-Sachs fractures (can require CT)
Acromio-clavicular joint separation
Joint disruption due to direct blow, athletes playing contact sports
Clinical presentation
Pain and swelling over ACJ, can be mild
Exclude C-spine injury
Investigations
X ray with stress views - ask patient to hold onto a weight and x ray
Get normal CXR to compare both ACJ to eachother
Management
Depends on patient baseline (young or old)
Conservative - if displacement up to 200%, 1 week of rest in sling
Surgical - >200% displacement or posterior displaced
Clavicle fracture
Direct blow, fracture middle third, proximal fragment pulled upwards by SCM
EXCLUDE PNEUMOTHORAX
Check neuromuscular status
Investigations
X ray
Management
Conservative - if < 100% displacement - broad arm sling
Surgical - >100% displacement and for active adults (leads to better function)
Biceps tendon rupture
Ruptures in dominant elbow
Bruising, pop eye sign, painful pop
Investigations
X ray, MRI to see partial and complete tears
Management
Older - pain relief and physio
young - repair within a few weeks
Rotator Cuff pathology
SITS muscles Supraspinatous Infraspinatoous Teres minor Subscapularis
Continuim of disease
- impingement and burtitis
- partial tear
- full thickness tear
- rotator cuff tear arthropathy
Impingement / subacromical bursisits
Can be due to extrinsic compression (of cuff between the joint bones) or intrinsic degeneration of supraspinatous
Presentation
Insidious onset pain, worsened by overhead activity, night pain
Positive Jobe’s test, painful arc between 60-120 degrees, positive internal impingement test
Investigations
X rays, MRI
Management
Conservative - physio, NSAID
Surgical if not worked -
Rotator cuff tear
Supraspinatous most common
Full or partial thickness
> 50 years old, low energy trauma OR young high energy
Presentation
Pain, localised tenderness, loss of function (unable to high arc/lift arm above shoulder)
History of preceding impingement
ABduction limited to 30degrees
Ix - Xray, US, MRI
Mx
Conservative - if partial thickness or not for surgery - NSAIDs, physio
Surgery - subacromial decompression, reattachment: for active patients or full thickness tears
Adhesive capsulitis
Frozen shoulder
1 - initial pain
2- decreased ROM
3 - gradual recovery over months / years
MUST have had a painful shoulder with restrictive active AND passive AND resistive movement for at least 1 month not getting better, pain worse at night
Investigations
X ray to rule out other causes
Managenet
Freezing stage - analgesia, gentle active ROM
Frozen stage - limited ROM can be improved with physio or maniplulation under anaesthesia and intra articular steroid
Shoulder OA
Acromioclavicular joint -
Glenohumeral joint - pain felt deep in the shoulder and lateral aspect of arm, may be stiff, may have reduced ROM due to osteophytes blocking, crepitus
Ix - Xray
Management
ACJ - conservative with NSAID, steroid injections
Surgical if does not get better
GHJ - NSAIDs, physio, hydrotherapy to retain ROM
Surgical if worsens - reverse arthroplasty only if deltoid works
Biceps tendonopathy
inflammation of the biceps tendon, usually long head (proximal) - goes through shoulder joint
Swimmings, baseball, weight lifting
Anterior shoulder pain, worsen on overhead lifting
Investigation
X-ray, USS, MRI
Mx
Conservative - rest, ice, NSAID
