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SPC- MSK > Shoulder Problems > Flashcards

Shoulder Problems Flashcards

1
Q

What causes shoulder impingement?

A

Inflammation of the subacromial bursa causes inflammation of the rotator cuff tendon which leads to impingement

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2
Q

What test can be done during shoulder examination to check for impingement? What is the name for the sign?

A

Neer’s test- internally rotate the arm with passive elevation.

A painful arc is een where pain is experienced from 50-60 degrees to 110-120 degrees

Also Hawkins test where the arm is abducted and moved across the body.

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3
Q

How might someone with impingement present?

A 
Pain on certain movements
Weakness
Reduced ROM
Pain felt at night
May radiate to the deltoid region or the length of the arm
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4
Q

What two tests can be done to check for impingement?

A

Hawkins

Neers

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5
Q

What makes up the subacromial space?

A

Acromion
Coracoacromial ligament
Coracoid process

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6
Q

What causes impingement?

A

Inflammation of the bursa which leads to inflammation of the rotator cuff tendons

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7
Q

What investigations can be done for impingement?

A

USS- Can guide steroid injections

Shoulder MRI- Looking at the rotator cuff integrity

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8
Q

What treatment options are available for impingement?

A

Physiotherapy with active shoulder movements
Analgesia- WHO Pain Ladder
Steroid injections into subacromial space
Surgery- Subacromial decompression, repairs to rotator cuff tendons (considered if there are refractory symptoms for 6 months)

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9
Q

What is calcifying tendinopathy?

A

Form on tendonitis characterised by deposits of hydroxyapatite

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10
Q

Which tendon does calcifying tendinopathy commonly affect?

A

80% of cases are in the supraspinatus tendon

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11
Q

What investigation can be done for calcifying tendinopathy?

A

X-Ray can show calcium deposits in the supraspinatus tendon

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12
Q

What is the treatment for calcifying tendinopathy?

A

Physio
Analgesia- WHO Pain Ladder
Steroid injections into subacromial bursa to reduce inflammation
Extracorporeal shock waves
Rarely surgery to remove calcium deposits

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13
Q

Who is ACJ osteoarthritis present in most often?

A

Weight lifters

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14
Q

What test can check for ACJ dysfunction?

A

Scarf Test

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15
Q

Where is pain felt for ACJ osteoarthritis?

A

At the ACJ- tender on palpation

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16
Q

What is the treatment for ACJ osteoarthritis?

A

Like other osteoarthritis
Analgesia- WHO Pain Ladder
Steroid injections
Surgical excision of ACJ if failure of above

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17
Q

For any dislocation what is it important to assess for?

A

Damage to blood vessels or nerves- do neurovascular examination

18
Q

What investigation can be done for ACJ dislocation?

A

X-ray

19
Q

What is the management for ACJ dislocation?

A

Analgesia- WHO Pain Ladder
Minimal displacement- Sling and Rest
Severe displacement- Surgical repair

20
Q

What is a frozen shoulder commonly associated with?

A

Thyroid disease and Diabetes

Check with HBA1c and TFTs

21
Q

What are the features of a frozen shoulder?

A

Reduced range of movement in all directions
Very painful
Worse at night and unable to lie on affected side

22
Q

What is a key feature of frozen shoulder/adhesive capsulitis?

A

ROM is reduced in all directions

There is loss of passive external rotation- unlike impingement

23
Q

What are the three phases of frozen shoulder/adhesive capsulitis?

A 
Painful phase
Frozen phase (pain settles but stiffness remains)
Thawing phase- ROM gradually returns
24
Q

What is the management for adhesive capsulitis?

A

Physiotherapy
Analgesia- NSAIDs are helpful at early stage
Steroid injections
Manipulation under analgesia to reduce capsule tightness
Surgical- arthroscopic capsular release

25
Q

What surgical procedure may be carried out for adhesive capsulitis?

A

Arthroscopic capsular release

26
Q

What are the symptoms of shoulder osteoarthritis?

A

Pain

Stiffness that improves within 30 minutes

27
Q

What investigation should be requested to investigate for shoulder OA?

A

X-Ray

28
Q

What management options are there for shoulder OA?

A

Conservative- exercise (swimming is good), weight loss, physio, stop smoking

Medical- Analgesia (WHO Pain Ladder), Steroid Injections

Surgical- Failure of above or significant impacts on QoL a joint replacement or resurfacing might be done.

29
Q

What might cause rotator cuff tears?

A

Trauma or injury
Degenerative change
Prolonged inflammation e.g. long term impingement

30
Q

What are some of the symptoms of rotator cuff tears?

A

Pain
Weakness
Typically aged >40
Symptoms similar to impingement

31
Q

What investigations can be done to investigate for rotator cuff tears?

A

Shoulder USS
MRI Scan

Note- MRI should always be done if there is diagnostic uncertainty

32
Q

Why might cuff tears lead to arthropathy?

A

They can cause the humeral head to move and it can then wear against the acromion.

33
Q

What is the treatment for rotator cuff tears?

A

If not problematic conservative
Analgesia- WHO Pain ladder
Surgery- Cuff Repair/ Joint replacement

Note a reverse shoulder replacement is carried out if the cuff cannot be repaired.

34
Q

Where does the long head of the biceps arise?

A

The glenoid

35
Q

What symptoms can biceps tendinopathy cause?

A

Pain on movement

Pain on tensing the bicep

36
Q

What is the treatment for tendinopathy?

A

Rest
Analgesia- WHO
Steroid injections- into space around the tendon not the tendon itself
Surgical repairs

37
Q

What is a Bankart lesion?

A

Avulsion of the glenoid labrum from the glenoid cavity- causes shoulder instability and surgery is indicated

38
Q

What is the most common form of shoulder dislocation?

A

Acute anterior dislocation

39
Q

What is the management for shoulder dislocation?

A

Analgesia- Opioids and LA in shoulder joint
Simple reduction- Kocher Method
Surgical relocation and repair to damaged structures

40
Q

For what causes is surgical repair of a shoulder dislocation indicated?

A

Traumatic
Unidirectional
Bankart Lesion

41
Q

What needs to be checked if someone presents with a shoulder dislocations?

A

Neurovascular screen
Check pulses and sensation in arm
Also do an x ray to rule out fracture

SPC- MSK (18 decks)

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