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shoulder problems Flashcards

1
Q

what shoulder problems are common in 20-30 yrs

A
  • instability
  • tendonitis
  • bursitis
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2
Q

what shoulder problems are associated with 30-40 yrs

A
  • calcific tendonitis

- tendinosis

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3
Q

what shoulder problems are associated with 40s-50s

A
  • tendinosis

- frozen shoulder

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4
Q

what shoulder problems are associated with 50s-60s

A

cuff tear

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5
Q

what shoulder problems are associated with over 60s

A

arthritis

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6
Q

what are the muscles of the rotator cuff

A
  • supraspinatus
  • infraspinatus
  • teres minor
  • subscapularis
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7
Q

which type of shoulder dislocation is most common

A

anterior dislocation

-caused by sport

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8
Q

where can you see shoulder dislocations in the hospital

A
  • acute in trauma clinic

- chronic in shoulder clinic

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9
Q

presentation of shoulder dislocation

A
  • abnormal shoulder contour
  • muscle wasting
  • tenderness
  • muscle spasm
  • good ROM
  • scapular winging
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10
Q

tests for shoulder dislocation

A
  • RC strength
  • apprehension
  • relocation
  • general laxity
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11
Q

treatment for anterior shoulder disclocation

A
  • analgesia IV
  • O2
  • sedation IV
  • reduction by manipulation
  • kocher method
  • hippocratic method
  • stimson method
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12
Q

post reduction treatment for dislocations

A
  • 2-3 weeks swing
  • analgesia
  • gradual early mobilisation
  • physio
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13
Q

investigations for shoulder instability

A
  • radiographs

- MRI arthrogram

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14
Q

other associated injuries for instability

A
  • labral lesion
  • fracture humeral head (Hill Sachs)
  • fracture of glenoid (Bony Bankart)
  • rotator cuff tear
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15
Q

instability treatment

A

PHYSIO
RC and core strengthening
scapula stabilising
arthroscopic stabilisation

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16
Q

instability rehab

A
  • 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
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17
Q

what is impingement syndrome

A

-pain originating from the sub-acromial space

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18
Q

diagnosis of impingement syndrome for under 30s

A
  • RC tendonitis

- subacromial bursitis

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19
Q

cause of impingement syndrome in 30-40s

A
  • calcific tendonitis

- early tendonitis

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20
Q

cause sof impingement syndrome in 40-50s

A
  • tendinosis

- partial tears

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21
Q

cause of impingement syndrome in 50-60s

A

cuff tear

22
Q

cause of impingement syndrome in 70s

A

cuff arthropathy

23
Q

presentation of impingement syndrome

A
  • wasting of muscles
  • tenderness bursa
  • tender ACP
  • painful arc
24
Q

investigations of impingement syndrome

A
  • radiographs
  • USS
  • MRI
25
Q

treatment for impingement syndrome

A
  • rest
  • pain relief
  • physio
  • corticosteroid injections in subacromial space
26
Q

presentation of cuff tear

A
  • age 50-60s
  • acute traumatic or chronic attrition
  • weakness
  • pain
  • wasting of muscles
  • tenderness in subdeltoid region
  • RC muscles weak
27
Q

cuff tear investigations

A
  • radiographs

- USS

28
Q

cuff tear treatment

A
  • rest
  • analgesia
  • sling
  • arthroscopic or open repair of RC
29
Q

chronic cuff tear treatment

A
  • physio

- steroid injections

30
Q

acute cuff tear treatment

A
  • urgent investigation
  • early physio
  • early reassessment
  • early intervention
31
Q

presentation of frozen shoulder

A
  • 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
32
Q

pathology of frozen shoulder

A
  • contracture and thickening of coraco-humeral ligament, rotator interval, axillary fold
  • decrease in joint volume
33
Q

non operative treatment for frozen shoulder

A
  • gentle movements
  • analgesia
  • physio
  • glenohumeral steroid injections
  • fluoroscopic distension
34
Q

operative treatment for frozen shoulder

A
  • manipulation under anaesthetic

- arthroscopic capsular release

35
Q

who gets glenohumeral osteoarthritis

A

over 60s

36
Q

presentation of GH arthritis

A

-gradual onset
-pain at rest and night
-stiffness
-intermittent exacerbations
-functional difficulties
-

37
Q

how would GH arthritis show on a radiograph

A
  • joint space narrowing
  • subchondral sclerosis
  • subchondral cysts
  • osteophyte formation
38
Q

non-operative treatment for GH arthritis

A
  • analgesia
  • physio
  • GH steroid injection
39
Q

operative treatment for GH arthritis

A

shoulder replacement

  • resurfacing
  • total shoulder arthroplasty
  • reverse polarity shoulder arthroplasty
40
Q

name two upper limb nerve entrapments

A

median neuropathy
-carpal tunnel syndrome
ulnar neuropathy
-cubital tunnel syndrome

41
Q

risk factors for carpal tunnel syndrome

A
  • over 30s
  • female
  • hormonal fluctuations
  • hypothyroidism
  • diabetes
  • obesity
  • rheumatoid arthritis
42
Q

pathology of carpal tunnel syndrome

A

relative reduction in blood supply

43
Q

what does the median nerve innervate

A

LOAF

Lumbricals IF and MF
Opponens
Abd pollicis brevis
Flexor pollicis brevis

44
Q

Carpal Tunnel syndrome symptoms

A

Early

  • pins and needles
  • pain
  • clumsiness

Late

  • numbness
  • weakness

Functional

  • early morning wakening
  • driving
  • phone use
  • reading
45
Q

signs of carpal tunnel syndrome

A
  • thenar atrophy
  • altered sensation
  • weakness APB
46
Q

carpal tunnel syndrome investigations

A
  • carpal tunnel questionnaire
  • nerve conduction studies
  • electomyogram
47
Q

treatment for carpal tunnel syndrome

A

mild/moderate symptoms

  • splintage
  • physiotherapy
  • steroid injection

severe
-carpal tunnel decompression

48
Q

who gets cubital tunnel syndrome

A
  • over 30s

- males

49
Q

symptoms of cubital tunnel syndrome

A

early

  • ulnar pins and needles
  • pain
  • clumsiness

late

  • numbness
  • weakness

functional

  • night
  • learning
50
Q

signs of cubital tunnel syndrome

A
  • hypothenar and interosseous atrophy
  • clawing of ring and small finger
  • altered sensation
  • weakness Abd Dig minimi
  • weakness of grasp and pinch
51
Q

test for cubital tunnel syndroms

A
  • tinnel’s test
  • modified Phalen’s test
  • Froment’s test
52
Q

treatment for cubital tunnel syndrome

A

mild/moderate

  • elbow splintage
  • physio
  • NSAIDs

severe
-ulnar nerve decompression

msk (45 decks)

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