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MSK lectures > Shoulder Problems - 30/10/18 > Flashcards

Shoulder Problems - 30/10/18 Flashcards

1
Q

do you believe?

A

In life after love

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2
Q

What are 5 common shoulder pathologies and what ages do these occur?

A 
Instability 20-30
Cuff disease 
-Impingement 30-40
-Cuff tear 50-60
Frozen shoulder 40-50
Arthritis >60
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3
Q

How many joints are in the shoulder girdle?

A

4

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4
Q

How many muscles attach to the scapula?

A

17

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5
Q

What are the extrinsic muscles of the shoulder

A

Deltoid
Trapezium
Pectoralis major
Latissimus dorsi

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6
Q

What are the intrinsic muscles of the shoulder?

A

Rotator cuff muscles

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7
Q

What are the characteristics of shoulder instability?

A

Teenage to 30 years
Young
Sporty
Traumatic

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8
Q

What are the characteristics of shoulder instability?

A

Teenage to 30 years
Young
Sporty
Traumatic

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9
Q

When can posterior dislocation occur?

A

Epileptic fits
Electrocution
Alocholic fits
in 5% of cases

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10
Q

What are the characteristics of shoulder instability presentation?

A 
Acute
-ED
-Painful
-In sling
Chronic
-Atraumatic laxity
-Not painful
-No support
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11
Q

What are the first things to do in shoulder dislocations?

A

Give the patient analgesia

Reduce the joint

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12
Q

How does instability present?

A

Mechanism of injury
Ease of dislocation
Frequency
General laxity

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13
Q

WHat is seen on examination of shoulder instability?

A

Look - abnormal shoulder contour, muscle wasting
Feel - Tenderness, muscle spasm
Move - Good ROM, scapular winging/dyskkinedia
Tests - RC strength, apprehension, relocation, general laxity

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14
Q

What 2 conditions can cause shoulder laxity?

A

Marfans

EDS

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15
Q

How is a dislocation reduced?

A

Manipulation
Kocher method
Hippocratic method
Stimson method - tape a weight to the arm whilst lying face down

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16
Q

What is post reduction treatment?

A

2-3 weeks sling
Analgesia
Gradual early mobilization
Physiotherapy

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17
Q

What are some investigations for shoulder instability?

A

X-ray

MRI arthogram

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18
Q

What are some associated injuries with shoulder instability?

A 
Labral lesions (bankart)
# humeral head (hill sachs)
# glenoid (Bony bankhart)
Rotator cuff tear
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19
Q

What are some NON operative treatments for shoulder instability?

A

Physiotherapy
RC and core strengthening
Scapula stabilising

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20
Q

What patients are most likely to have redislocation?

A

Younger patients (15-20)

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21
Q

What is the rehab for instability?

A 
6 week sling
8-10 weeks no driving
12 weeks no heavy lifting
No contact sports for 12 weeks
Training and non contact sports after 6 weeks
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22
Q

What are the characteristics of shoulder impingment?

A

Pain originating from the sub acromial space
Common and mostly transient
Intrinsic and extrinsic causes

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23
Q

What are the intrinsic and extrinsic causes of impingement?

A 
Intrinsic
 - Tendon vascularity
- Watershed area
- Tendon degeneration
- Cuff dysfunction
Extrinsic 
- Pressure
- Type of acromion
- Coraco-acromial ligament
- Clavicular spur/osterophyte
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24
Q

What are some types of impingement and who do they occur in?

A 
RC tendonitis/subacromial bursitis - <30s
Calcific tendonitis - 30s-40s
Tendinosis/partial tears RC - 40s - 50s
Cuff tear 50-60s
Cuff arthropathy - 70s
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25
Q

Neers classification

A 
1 = Inflammation, oedema, haemorrhage
2 = ??/
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26
Q

WHat is important in the History of impingement?

A 
Age
Hand dominance
Pain
Reach and stretch
Painful arch
Neurology
Neck pain
Anaglesia
Physio
Injections
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27
Q

What may be seen on examination of shoulder impingement?

A

look - Contour, muscle wasting, scapula position
Feel - Tenderness bursa, ACJ
Move - ROM active/passive, painful arc, RC strength
Tests - Hawkins, Joes

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28
Q

What investigations are used for impingement?

A 
X-ray
(Shentens line?)
Calcifications
USS
MRI
29
Q

What are the treatments for impingement?

A 
Rest 
Activity modification
Pain relief
Physiotherapy
Cortico-steroid injections in sub acromial space
Minimal of 6 month non-operative therapy
30
Q

What occurs during Arthroscopic/open subacromial decompression?

A 
Subacromial/subdeltoid bursectomy
Acromioplasty
Release of CA ligament
Release of calcific deposits
Exision infraclavicular spur
31
Q

What is the rehab for impingement?

A

Painful
Sling 1-2 weeks
Early physio and ROM movements
RC strengthening

32
Q

How long does shoulder impingement surgery take to recover?

A

3-4 months

33
Q

How do cuff tears present?

A 
50-60yo
Grey hair - cuff tear
Acute traumatic
Chronic attrition
Weakness
Pain
34
Q

What is seen on cuff tear examination?

A

L - Contour, wasting
F - Tenderness subdeltoid region
M - ROM active

35
Q

How are cuff tears investigated?

A

Radiographs

MRI if stiff

36
Q

How are chronic cuff tears treated?

A 
Rest analgesia
Sling
Physiotherapy
Steroids
Weait and watch
37
Q

How are acture cuff tears treated?

A

Urgent investigation
Early physio
Early reassessment
Early intervention

38
Q

What is cuff tear rehabilitation?

A 
Sling 6 weeks
No driving for 6-8 weeks
12 weeks no heavy lifting
Prolonged physiotherapy
Prolonged recovery 6-9 months
39
Q

What are the frozen shoulder presentation?

A 
Females
40-50
Can be bilateral
Gradual severe pain
Associated with Diabetes, lipid and endocrine disease and dupuytren's
40
Q

What is frozen shoulder

A

Contracture and thickening of coracohumeral ligament in the rotator interval and axillary fold
Decrease in joint volume

41
Q

What are the three phases of frozen shoulder?

A

Freezing
Frozen
Thawing

42
Q

How long does frozen shoulder take to recover?

A

3-4 years

43
Q

What is seen on frozen shoudler history?

A

Pain at rest
At night
Anterior
Stiffness

44
Q

Examination

A

Global restriction

45
Q

Differentials of frozen shoulder

A

Locked posterior dislocation

Arthritis

46
Q

How is frozen shoulder treated?

A

NO - Gentle movements, analgesia, Physio, gleno-humeral injections, Fluerescence?
O - Manipulation under anaesthetic, Arthroscopic capsular releaase

47
Q

What is frozen shoulder rehab?

A

Short period in sling
Pain control
Physiotherapy

48
Q

WHat is GH OA presentation?

A 
Over 60
Uncommon location
OA
RA
Gradual onset
Intermittent exacerbations
49
Q

What are the history features in GHOA?

A 
Gradual onset
Pain at rest and at night
Stiffness
Intermittent 
Functional difficulties
50
Q

What is the treatment for GHOA?

A 
Analgesia
Physio
Steroid
Shoulder replacement
Resurfacing
Total shoulder arthroplasty
Reverse polarity shoulder replacement
51
Q

What is the Post arthroplasty rehabilitation?

A

Sling
Physio
No driving

52
Q

What is the Post arthroplasty rehabilitation?

A

Sling
Physio
No driving

53
Q

Carpal tunnel syndrome?

A 
>30s 
Common
Female
Pregnancy
Hypothyroidism
Diabetes
Obesity
RA
54
Q

What happens to the blood supply in CTS?

A

Reduced blood supply

55
Q

What nerve is compressed in carpal tunnel syndrome?

A

Median nerve

56
Q

What muscles are innervated by the median nerve?

A 
LOAF muscles
Lumbricals IF and MF
Opponens
Abductor pollicus brevis
Flexor polllicus brevis
57
Q

What are the symptoms of carpal tunnel syndrome?

A 
Pins and needles
Pain
Clumsiness
Numbness
Weakness
Early morning wakening
worse when:
Driving
Phone use
Reading
58
Q

SIgns of CTS?

A

Thenar atrophy
Altered sensation
Weakness APB

59
Q

What are 3 tests for CTS?

A

Durkings test - compression
Tinnels test - tapping
Phalens test - volar flexion

60
Q

What are CTS investigations?

A

Carpal tunnel questionsaire

Nerve conduction studies

61
Q

What is the treatment for CTS?

A 
Splintage
Physiotherapy
Steroid injections
Carpal tunnel Decompression surgery
-Day surgery
-Local anaesthetic
-Division transverse carpal ligament
-Anatomical variation
62
Q

CTS rehab?

A

2 days reduce dressings
5 days keep dry
???

63
Q

CBTS?

A 
>30s
2nd most comon
More males
Post trauma
Direct pressure
Arthritis
64
Q

Revise the ulnar nerve anatomy and Cubital tunnel

A

XOXO gossip girl

65
Q

Symptoms of CBTS?

A 
Ulnar pins and needles
Pain
CLumsiness
Numbness weakness
Leaning pain
Night pain
66
Q

CBTS tests?

A

Tinnels test
Modified phalens test
Froments test

67
Q

CBTS investigations?

A

Clinical examination

Nerve conduction studies

68
Q

Treatment of CBTS?

A 
Elbow splintage
Physio
NSAIDs
Ulnar nerve decompression
-Day surgery
-Local

MSK lectures (50 decks)

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