Shoulder Problems Flashcards by Philip Meakin

What causes shoulder impingement?

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

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

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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How might someone with impingement present?

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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What two tests can be done to check for impingement?

Hawkins

Neers

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What makes up the subacromial space?

Acromion
Coracoacromial ligament
Coracoid process

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What causes impingement?

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

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What investigations can be done for impingement?

USS- Can guide steroid injections

Shoulder MRI- Looking at the rotator cuff integrity

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What treatment options are available for impingement?

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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What is calcifying tendinopathy?

Form on tendonitis characterised by deposits of hydroxyapatite

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Which tendon does calcifying tendinopathy commonly affect?

80% of cases are in the supraspinatus tendon

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What investigation can be done for calcifying tendinopathy?

X-Ray can show calcium deposits in the supraspinatus tendon

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What is the treatment for calcifying tendinopathy?

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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Who is ACJ osteoarthritis present in most often?

Weight lifters

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What test can check for ACJ dysfunction?

Scarf Test

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Where is pain felt for ACJ osteoarthritis?

At the ACJ- tender on palpation

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What is the treatment for ACJ osteoarthritis?

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

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For any dislocation what is it important to assess for?

Damage to blood vessels or nerves- do neurovascular examination

What investigation can be done for ACJ dislocation?

X-ray

What is the management for ACJ dislocation?

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

What is a frozen shoulder commonly associated with?

Thyroid disease and Diabetes

Check with HBA1c and TFTs

What are the features of a frozen shoulder?

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

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

ROM is reduced in all directions

There is loss of passive external rotation- unlike impingement

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

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

What is the management for adhesive capsulitis?

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

What surgical procedure may be carried out for adhesive capsulitis?

Arthroscopic capsular release

What are the symptoms of shoulder osteoarthritis?

Pain | Stiffness that improves within 30 minutes

What investigation should be requested to investigate for shoulder OA?

X-Ray

What management options are there for shoulder OA?

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.

What might cause rotator cuff tears?

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

What are some of the symptoms of rotator cuff tears?

Pain Weakness Typically aged >40 Symptoms similar to impingement

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

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

Why might cuff tears lead to arthropathy?

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

What is the treatment for rotator cuff tears?

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.

Where does the long head of the biceps arise?

The glenoid

What symptoms can biceps tendinopathy cause?

Pain on movement | Pain on tensing the bicep

What is the treatment for tendinopathy?

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

What is a Bankart lesion?

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

What is the most common form of shoulder dislocation?

Acute anterior dislocation

What is the management for shoulder dislocation?

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

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

Traumatic Unidirectional Bankart Lesion

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

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