shoulder problems plus carpal and cubital tunnel Flashcards
how many joints in shoulder girdle and what are they
4 acromioclavicular glenohumeral sternoclavicular scapulothoracic
muscles of the shoulder
rotator cuff muscles:
- supraspinatus
- infraspinatus
- subscapularis
- teres minor
what ligament runs inside the glenoid process
capsular ligament
where is the origin of the two heads of the biceps
short head- coracoid process
long head - glenoid tubercle
what is a joint bursa
fluid filled sac or sac like cavity countering friction at a joint
what is shoulder impingement
a syndrome not a diagnosis
very common
pain on movement
night pain unusual
physical signs of shoulder impingement
painful arc hawkins sign other impingement tests no muscle wasting loss of range of movement
what suggests a painful arc
pain on abduction from 50-120 degrees
crescendo arc - not impingement
burial shoulder pain causes
……
bigliani acromial grading
….
calcific tendonitis
…..
OS acromiale
…
shoulder arthritis
no space left between ball and cup of joint
treatment for shoulder arthritis
conservative (NSAIDS, physio)
operative - high risk
causes of shoulder instability
traumatic - bankhart hill Sachs rotator cuff tear fracture of glenoid atraumatic
what is a hill Sachs lesion
fracture of the humeral head causing shoulder instability
cause of hill sacs lesions
trauma
what is a bankart lesion
a labral lesion
most important injury associated with shoulder instability
cause of bankart lesion
trauma
features of atraumatic shoulder instability
A- atraumatic M-multidirectional B -bilateral R -rehabilitation I -inferior capsular shift
what is MDSI
abnormal soft tissue
often started by minor trauma
sulcus sign
beightons score
what is carpal tunnel syndrome
parathesiae in median nerve distribution
night time disturbance
compression of median nerve at carpal tunnel
how to treat carpal tunnel
night splints
surgery
injection??
investigation for carpal tunnel
nerve conduction studies
what is cubital tunnel syndrome
parasthesiae in ulnar nerve distribution
compression around elbow
three sites:
-cubital tunnel
-FCU tendon heads
-intermuscular fibrous bands just above elbow
treatment for cubital tunnel
surgical release
anterior transposition?
four main shoulder problems
instability cuff decrease -impingement -cuff tear frozen shoulder arthritis
who gets frozen shoulders
instability - 20-30 (young sporty people, usually traumatic)
how many muscles attach to the scapula
17
what causes a frozen shoulder
thickening of the coracohumeral ligament
4 important extrinsic muscles of the shoulder
deltoid
trapezium
pectorals major
latissimus dorsi
what are the intrinsic muscles of the shoulder
rotator cuff muscles
- supraspiatus
- infraspinatus
- teres minor
- subscapularis
where does the shoulder most commonly dislocate
anteriorly
what indicates whether a dislocation is anterior or posterior
subtle dislocation = posterior
gross dislocation = anterior
likely cause of a posterior dislocation
epileptic fit
alcohol
electrocution
first step in treating an anterior shoulder dislocation due to trauma
analgesia
reduce joint
questions to ask in shoulder dislocation
mechanism of injury
ease of dislocation
has it happened before
what is seen on examination of shoulder insability
abnormal shoulder contour muscle wasting tenderness spasm good range of movement scapular winging/dyskinesia
2 conditions associated with hyperlaxity
marfans
ehlers dans syndrome
how do you reduce a dislocated shoulder
kocher method
can give IV analgesia, O2 or IV sedation
hippocratic method (for large muscle people)
Stimson method (for multiple dislocations)
what are some post reduction treatments
3 weeks sling for pain relief
analgesia
gradual early mobilisation
physiotherapy
shoulder dislocation investigations
imagine MRI angiogram (if multiple dislocation)
surgical treatment for dislocations
arthroscopic/open stabilisation
what is rehab for shoulder instability
6 weeks sling 8-10 weeks no driving 12 weeks no heavy lifting no contact sports for 12 weeks training and no-contact sports after 6 weeks
where does pain originate from in impingement syndrome
pain originating from the sub acromial space
what is intrinsic impingement syndrome
tendon vascularity
watershed area
tendon degeneration
cuff dysfunction
what is extrinsic impingement syndrome
external pressure due to:
- type of acromion
- coraco acromial ligament
- clavicular spur/osteophyte
x ray signs of shoulder impingement
calcification (fluffy dots) in muscles
sclerosis on underside of acromion
treatment for shoulder impingement
rest pain relief physio steroid injections in subacromial space surgery - last resort
what is surgical treatment for shoulder impingement
arthroscopic/subacromial decompression
