shoulder problems Flashcards
what shoulder problems are common in 20-30 yrs
- instability
- tendonitis
- bursitis
what shoulder problems are associated with 30-40 yrs
- calcific tendonitis
- tendinosis
what shoulder problems are associated with 40s-50s
- tendinosis
- frozen shoulder
what shoulder problems are associated with 50s-60s
cuff tear
what shoulder problems are associated with over 60s
arthritis
what are the muscles of the rotator cuff
- supraspinatus
- infraspinatus
- teres minor
- subscapularis
which type of shoulder dislocation is most common
anterior dislocation
-caused by sport
where can you see shoulder dislocations in the hospital
- acute in trauma clinic
- chronic in shoulder clinic
presentation of shoulder dislocation
- abnormal shoulder contour
- muscle wasting
- tenderness
- muscle spasm
- good ROM
- scapular winging
tests for shoulder dislocation
- RC strength
- apprehension
- relocation
- general laxity
treatment for anterior shoulder disclocation
- analgesia IV
- O2
- sedation IV
- reduction by manipulation
- kocher method
- hippocratic method
- stimson method
post reduction treatment for dislocations
- 2-3 weeks swing
- analgesia
- gradual early mobilisation
- physio
investigations for shoulder instability
- radiographs
- MRI arthrogram
other associated injuries for instability
- labral lesion
- fracture humeral head (Hill Sachs)
- fracture of glenoid (Bony Bankart)
- rotator cuff tear
instability treatment
PHYSIO
RC and core strengthening
scapula stabilising
arthroscopic stabilisation
instability rehab
- 6 week sling
- 8-10 weeks no driving
- 12 weeks no heavy lifting
- 12 weeks to return to non contact sports
- 6 months to return to contact sport
what is impingement syndrome
-pain originating from the sub-acromial space
diagnosis of impingement syndrome for under 30s
- RC tendonitis
- subacromial bursitis
cause of impingement syndrome in 30-40s
- calcific tendonitis
- early tendonitis
cause sof impingement syndrome in 40-50s
- tendinosis
- partial tears
cause of impingement syndrome in 50-60s
cuff tear
cause of impingement syndrome in 70s
cuff arthropathy
presentation of impingement syndrome
- wasting of muscles
- tenderness bursa
- tender ACP
- painful arc
investigations of impingement syndrome
- radiographs
- USS
- MRI
treatment for impingement syndrome
- rest
- pain relief
- physio
- corticosteroid injections in subacromial space
presentation of cuff tear
- age 50-60s
- acute traumatic or chronic attrition
- weakness
- pain
- wasting of muscles
- tenderness in subdeltoid region
- RC muscles weak
cuff tear investigations
- radiographs
- USS
cuff tear treatment
- rest
- analgesia
- sling
- arthroscopic or open repair of RC
chronic cuff tear treatment
- physio
- steroid injections
acute cuff tear treatment
- urgent investigation
- early physio
- early reassessment
- early intervention
presentation of frozen shoulder
- 40s - 50s
- more females
- can be bilateral
- gradual severe pain
- assoc with diabetes, lipid and endocrine disease and dupuytren’s
- pain at rest
- pain at night
- anterior pain
- stiffness
pathology of frozen shoulder
- contracture and thickening of coraco-humeral ligament, rotator interval, axillary fold
- decrease in joint volume
non operative treatment for frozen shoulder
- gentle movements
- analgesia
- physio
- glenohumeral steroid injections
- fluoroscopic distension
operative treatment for frozen shoulder
- manipulation under anaesthetic
- arthroscopic capsular release
who gets glenohumeral osteoarthritis
over 60s
presentation of GH arthritis
-gradual onset
-pain at rest and night
-stiffness
-intermittent exacerbations
-functional difficulties
-
how would GH arthritis show on a radiograph
- joint space narrowing
- subchondral sclerosis
- subchondral cysts
- osteophyte formation
non-operative treatment for GH arthritis
- analgesia
- physio
- GH steroid injection
operative treatment for GH arthritis
shoulder replacement
- resurfacing
- total shoulder arthroplasty
- reverse polarity shoulder arthroplasty
name two upper limb nerve entrapments
median neuropathy
-carpal tunnel syndrome
ulnar neuropathy
-cubital tunnel syndrome
risk factors for carpal tunnel syndrome
- over 30s
- female
- hormonal fluctuations
- hypothyroidism
- diabetes
- obesity
- rheumatoid arthritis
pathology of carpal tunnel syndrome
relative reduction in blood supply
what does the median nerve innervate
LOAF
Lumbricals IF and MF
Opponens
Abd pollicis brevis
Flexor pollicis brevis
Carpal Tunnel syndrome symptoms
Early
- pins and needles
- pain
- clumsiness
Late
- numbness
- weakness
Functional
- early morning wakening
- driving
- phone use
- reading
signs of carpal tunnel syndrome
- thenar atrophy
- altered sensation
- weakness APB
carpal tunnel syndrome investigations
- carpal tunnel questionnaire
- nerve conduction studies
- electomyogram
treatment for carpal tunnel syndrome
mild/moderate symptoms
- splintage
- physiotherapy
- steroid injection
severe
-carpal tunnel decompression
who gets cubital tunnel syndrome
- over 30s
- males
symptoms of cubital tunnel syndrome
early
- ulnar pins and needles
- pain
- clumsiness
late
- numbness
- weakness
functional
- night
- learning
signs of cubital tunnel syndrome
- hypothenar and interosseous atrophy
- clawing of ring and small finger
- altered sensation
- weakness Abd Dig minimi
- weakness of grasp and pinch
test for cubital tunnel syndroms
- tinnel’s test
- modified Phalen’s test
- Froment’s test
treatment for cubital tunnel syndrome
mild/moderate
- elbow splintage
- physio
- NSAIDs
severe
-ulnar nerve decompression
