Shoulder Problems Flashcards
most common problems in 10-20 y/o
fractures and instability
most common problems in 30-40 y/o
rotator cuff and capsulitis
most common problems in 50-60 y/o
impingement and AC joint
most common problems in 70+ y/o
degenerative rotator cuff and joint
what things might indicate a fracture was pathological
preceding bone pain or swelling
other abnormalities on x-ray
hx of malignancy
Paget’s disease
the majority of shoulder dislocations are anterior/posterior/inferior?
90% anterior
why is the shoulder so commonly dislocated
because it’s so mobile - ball and socket
mechanism of injury of anteriorly dislocated shoulder
fall on an outstretched arm OR abduction, extension and a posteriorly directed force
what else is damaged by a shoulder dislocation
the shoulder capsule and the labrum is detached from the glenoid
clinical significance of the labrum
a bit of fibrocartilage that keeps the humeral head in place.
A tear requires surgery reattachment and may lead to joint instability and subsequent dislocations
what is a posteriorly dislocated shoulder associated with
epileptic or electrocution seizures
what % of shoulder dislocations are posterior
9%
how is an anteriorly dislocated arm held
at side in external rotation
how is a posterior dislocated arm held
at side in internal rotation
what type of dislocation may resemble a frozen shoulder
posterior
what movements are resisted in anterior dislocation
abduction and internal rotation
what movement are resisted in posterior dislocated
abduction, external rotation and supination
order of treatment options for a dislocated shoulder
manipulation –> immobilisation –> physiotherapy –> surgery
what age group are labrum tears most common in
<20s
what is a Bankart tear
a labrum tear
what is the most common cause of shoulder pain
subacromial impingement
what degrees is the pain in in subacromial impingement
70-120
what kinds of activities can increase the risk of subacromial impingement
heavy lifting or repetitive movements above shoulder level
pathophysiology of subacromial impingement
decrease in volume of subacromial space or increase in size of contents (swollen supraspinatus tendon, bursa or extra bone)
what movement is painful in subacromial impingement
abduction past 70 degrees
treatment of subacromial impingement
subacromial steroid injection
physiotherapy
arthroscopic subacromial decompression
what tendon is likely to be swollen in subacromial impingement
supraspinatus tendon
what is a frozen shoulder
shoulder pain where external rotation is <50% of full range
natural history of frozen shoulder
pain –> stiffness –> thawing
pain - generalised up to 9 months
stiffness - pain subsides and becomes stiff esp. on external roation for 4-12 months
thawing - gradually becomes less stiff over 1-3 years
why would you do an x-ray to investigate a frozen shoulder
to exclude other causes
what is the likely diagnosis of painful abduction with no hx of trauma
subacromial impingement
treatment of a frozen shoulder
analgesia physiotherapy corticosteroid injection into joint hydrodilation surgery
pathopysiology of a frozen shoulder
glenohumeral capsule becomes inflamed and restricted –> pain and loss of movement
function of hydrodilation as a treatment of frozen shoulder
distending or rupturing the joint capsule to advance them through the stages faster and allow more movement
what is adhesive capsulitis also called
frozen shoulder
what are the rotator cuff muscles
supraspinatus, infraspinatus, teres minor and subscapularis
what type of tear is one in which the muscle is frayed or damaged
partial tear
what type of tear is one in which the muscle is torn right through or pulls the tendon off the bone
complete tear
how does treatment differ for rotator cuff tears on the basis of the cause
acute traumatic –> surgery
chronic degenerative –> physio then surgery if still symptomatic
what special surgery might be used to repair a rotator cuff tear
superior capsular reconstruction - using a cadaveric skin graft to reconstruct the shoulder joint capsule
what muscle group are you concerned about maintaining in shoulder arthritis
rotator cuff muscles
types of shoulder arthritis
osteo, inflammatory (rheumatoid) and post-traumatic
