shoulder problems

Question 1

what causes anterior shoulder dislocation?

Answer 1

very common, caused by trauma and sports

Question 2

what causes posterior shoulder dislocation?

Answer 2

uncommon, epileptic seizures and electrocution

Question 3

what is the difference between anterior and posterior shoulder dislocations on an x-ray?

Answer 3

anterior will have head of humerus dropped- looks dislocated
posterior will have humerus still looking attached to glenoid

Question 4

what to examine for in shoulder instability

Answer 4

look- abnormal contour, muscle wasting
feel- tenderness, muscle spasm
move, good ROM, scapular winging or dyskinesia
tests- RC strength, apprehension, relocation & general laxity

Question 5

how do you treat an anterior shoulder dislocation?

Answer 5

first- analgesia IV, O2 and sedation IV
reduction my manipulation- Kocher method (patient sitting up), hippocratic method (patient lying on their back), stimson method (patient lying on their front)
then follow up with 2-3 weeks sling, analgesia, physio

Question 6

what are other types of shoulder instability and how do you treat them?

Answer 6

labral lesion (bankart tear)
humeral head fracture
glenoid fracture (bony bankart)
rotator cuff tear

all treated with physio if non operative
can be repaired with arthroscopic / open stabilisation
6 week sling, 8-10 weeks no driving, 12 weeks no heavy lifting

Question 7

what is impingement syndrome?

Answer 7

pain originating from the sub-acromial space, commonly and mostly transient

Question 8

what impingement syndrome will each age range get?

Answer 8

<30 = RC tendonitis / subacromial bursitis
30-40s = calcific tendonitis
40-50s= tendinosis / partial tears
50-60s = cuff tears
70+ = cuff arthropathy

Question 9

what examinations do you do for impingement syndrome?

Answer 9

look - contours, muscle wasting, scapula position
feel- tenderness, bursa, ACJ
move- ROM active/passive, painful arc, RC strength
tests- Hawkin’s, Jobe’s

Question 10

treatment for impingement syndrome?

Answer 10

rest & activity modification, analgesia, physio, steroid injections x2 - for at least 6 months before considering surgery
surgery- arthroscopic / subacromial decompression

Question 11

describe cuff tear & treatment

Answer 11

age 50s-60s (grey hair = cuff tear)

acute traumatic / chronic attrition (gradual)
pain and weakness
do US if good ROM, MRI if stiff
treatment- analgesia, rest sling, physio, steroid injections
surgery last resort

Question 12

describe frozen shoulder

Answer 12

gradual severe shoulder pain, can be bilateral, associated with diabetes and Dupuytren’s, more common in women
Contracture and thickening of coraco-humeral ligament, rotator interval (SSp-SSc), axillary fold (IGHL)
decrease in joint volume

Question 13

what is the presentation of frozen shoulder?

Answer 13

pain at rest, at night, anterior pain and stiffness

Question 14

describe radiological apperance and treatment of frozen shoulder

Answer 14

normal x-ray

treatment- gentle movements, analgesia, physio, glenohumeral steroid injections, fluoroscopic distension- last resort manipulation under anaesthetic, surgery

Question 15

what investigations do you do for shoulder problems?

Answer 15

FBC
viscosity
maybe x-ray
ultrasound