Shoulder presentations Flashcards
What are the common presentations of shoulder problems?
Pain in neck, shoulder & upper arm
Stiffness in this very mobile joint
Weakness
Instability
Deformity (eg. acromioclavicular joint prominence)
Loss of function
What is the pattern of referred pain from gall bladder?
What is the problem of shoulder with touching the back or brushing the hair respectively?
Touching the back - internal rotation
Brushing the hair - external rotation
What is the time to recovery for shoulder problems?
One year/12 months
What are common shoulder problems in primary care?
Rotator cuff problems especially supraspinatus tendonitis (typically ager 35-65) - treatment not very different for inflammation of different muscles in the cuff
Sub-acromial bursitis
Acromioclavicular (joint) disease (trauma in younger adults, arthritis in older)
What are common shoulder problems in secondary care?
Frozen shoulder (age 40-60, more common in diabetics)
OA/RA of shoulder
Recurrent dislocation
What is supraspinatus tendonitis?
What is sub-acromial bursitis?
What is frozen shoulder?
Adhesive capsulitis
F>M, 40-60y/o (think OA if above 70)
How is frozen shoulder managed?
What is rotator cuff tear and how is it managed?
How to decide whether to do normal shoulder replacement or reverse shoulder replacement?
Reverse shoulder replacement is done when cuff function is presumably compromised
What is the general age presentation of shoulder problems?
20-30s – Instability
30-40s – Impingement
40-50s – Frozen Shoulder
50-60s – Cuff tear
>60 - Arthritis
What are the four extrinsic and four intrinsic muscles of the shoulder?
Describe the two forms of instability presentation
Acute in Trauma Clinic:
Emergency Department reduction
Painful
In sling
Chronic in Shoulder Clinic:
Atraumatic laxity/subluxations
Not painful
No support
Describe anterior and posterior dislocation of the shoulder respectively
Anterior Dislocation:
Common 95%
Traumatic
Sports
Posterior Dislocation:
infrequent 5%
Epileptic fit
Electrocution
Anterior dislocation - externally rotated
Posterior dislocation - internally rotated
What are the examination outcomes for instability?
Look – abnormal shoulder contour, muscle wasting
Feel – tenderness, muscle spasm
Move – good ROM, scapular winging/dyskinesia
Tests – RC strength, apprehension, relocation, general laxity
With X-rays, what are the two views of shoulder that would be taken?
AP and Garth view (apical-oblique)
What are associated injuries of instability?
What is the treatment for instability?
Non-operative: physio strengthening of RC, core and scapula stability
*The younger the patient, the higher the risk of recurrent dislocation
Operative:
Arthroscopic stabilisation (eg. repair of Bankart lesion)
What is impingement syndrome?
Pain originating from the sub-acromial space
Common and mostly transient
Intrinsic and Extrinsic Causes
What are the intrinsic and extrinsic causes of impingement syndrome?
Intrinsic:
Tendon vascularity
Watershed area
Tendon degeneration
Cuff dysfunction
External ‘pressure’:
Type of acromion
Coraco-Acromial ligament
Clavicular spur/osteophyte
What are the age group diagnoses of impingement syndrome?
RC Tendonitis/ subacromial bursitis – <30s
Calcific Tendonitis (F>M) - 30-40s
Tendinosis/ partial tears RC - 40-50s
Cuff tear – 50-60s
Cuff arthropathy – 70s
What is a ‘painful arc’ in impingement symptom?
For example with flexion of shoulder, pain is felt only at 60-120 degrees (this would be the pain arc)
How to treat impingement syndrome?
What are presentation characteristics of cuff tears?
Age 50-60s
Acute traumatic/Chronic attrition
Weakness
Pain
Describe the examination for cuff tears.
What are characteristics of frozen shoulder presentation?
40-50s
More females 1:2
Not uncommonly bilateral (often not simultaneous)
Gradual severe pain
Association w Diabetes, lipid & endocrine disease and Dupuytren’s
What is the pathology of frozen shoulder?
Contracture and thickening of coraco-humeral ligament, rotator interval (SSp-SSc), axillary fold (IGHL)
Decrease in joint volume
Not actually adhesion!
What is the presentation of frozen shoulder?
Quite sudden onset
Pain at rest
Pain at night
Anterior pain
Stiffness
Global restriction in ROM
External Rotation <50% of normal
What is treatment for frozen shoulder?
How does glenohumeral arthritis present?
State a cause of superior subluxation of humerus
When supraspinatus is torn, the pull of deltoid might lead to superior subluxation of humerus
