Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

2 MSK Clinical Conditions > Shoulder (Session 7) > Flashcards

Shoulder (Session 7) Flashcards

1
Q

How does a dislocated shoulder present?

A

Visibly deformed shoulder, swelling/bruising, movement= severely restricted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

In which position are the majority of shoulder dislocations?

A

Anterior (90-95%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Why are the majority of shoulders dislocated anteriorly?

A
  • Humerus sits anterior to glenoid fossa and glenoid foss=shallow
  • Joint=weak on anterior aspect
  • Pull of muscles anteriorly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the 2 types of anterior dislocation? shoulder

A

1, Subcoracoid location (60% cases)

2, Subglenoid location (30% cases)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How is the arm held in an anterior dislocation? shoulder

A

External rotation

Slight abduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How might an anterior dislocation (of the shoulder) occur?

A

1, Arm positioned in abduction and external rotation–> arm forced slightly posteriorly.
2, Direct blow to posterior shoulder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is a Bankart Lesion?

A

(aka labral tear) part of glenoid labrum torn off- due to force of humeral head popping out of socket

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is a Hill-sachs lesion?

A

Dent in posterolateral humeral head.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What causes a Hill-sachs lesion?

A

Posterior aspect of humeral head jammed against anterior lip-glenoid fossa due to infraspinatus and teres minor muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How prevalent are Hill-sachs lesions?

A

80% with recurrent dislocation with have lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What may cause a posterior dislocation? shoulder

A 
1,Violent muscle contraction due to:
a, Epileptic seizure
b, Electrocution- lighting
2,Blow to anterior shoulder
3, Arm= flexed across body and pushed posteriorly.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do patients present with a posterior dislocation (usually)? shoulder

A

1, Internally rotated and adducted.
2, Flattening/Squaring of shoulder
3, Prominent coracoid process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What other (secondary) injuries are commonly associated with posterior dislocation? shoulder

A

Fractures, rotator cuff tears, Hill-sachs lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the prevalence of posterior shoulder dislocations?

A

2-4%?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the prevalence of inferior dislocations? shoulder

A

0.5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What causes an inferior dislocation? shoulder

A

Forceful traction on arm when fully extended over head. (e.g. fall holding only branch)(hyperabduction injury)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What injuries are associated with inferior dislocation? shoulder

A

Nerve damage 60%, Rotator cuff tears 80%, blood vessel injury 3%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the most common complication of a shoulder dislocation?

A

Recurrent dislocation (due to damage to stabilising tissues surrounding shoulder)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the chance of dislocation your shoulder again? (roughly)

A

60% (but decreases with with age)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Apart from recurrent dislocation, what else increases in risk following each dislocation?

A

Developing osteoarthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How common is damage to the axillary artery in shoulder dislocations?

A

1-2%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Why is damage to the axillary artery more common in older age groups?

A

Blood vessels less elastic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How will a patient present if they have damaged their axillary artery?

A

Haematoma, absent pulses/ cool limb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How common are axillary nerve injuries in shoulder dislocations?

A

10-40% dislocations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the outcome for the patient is their axillary nerve gets damaged?

A

Full recovery (most) when shoulder put back

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Apart from the axillary nerve- what other nerves can be damaged from a shoulder dislocation?

A

Chords of brachial plexus

Musculocutaneous nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How common are fractures in shoulder dislocations?

A

25% dislocations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What factors would make a fracture more common in a shoulder dislocation?

A

1- Traumatic mechanism of injury
2- First-time dislocation
3-Aged over 40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Which bones are most commonly affected by fractures in a shoulder dislocation?

A

Humeral head
Greater tubercle
Clavicle
Acromion

30
Q

In which circumstances are rotator cuff muscle tears common?

A

Inferior dislocations
Older people
(should always be checked after reduction of dislocated shoulder)

31
Q

Where to fractures usually occur within the clavicle?

A

Middle third (80%)

32
Q

What causes most clavicle fractures?

A

Falls onto shoulder/outstretched hand

33
Q

How are clavicle fractures treated?

A

Conservatively (using sling)

34
Q

In what instances would surgical fixation be necessary after a clavicle fracture?

A

1, Complete displacement (bone ends can’t unite)
2, Severe displacement w./ tenting of skin (risk of puncture and open fracture)
3, Neurovascular compromise
4, Fractures with interposed muscle
5, Floating Shoulder- clavicle fracture w./ ipsilateral fracture of glenoid neck

35
Q

What happens to the position of the arm and clavicular fragments in a displaced mid–clavicular fracture?

A

1- Strenocleiodomastoid muscle elevates medial segment (2 segments)
2- Shoulder drops- trapezius muscle unable to hold lateral segment up + weight of upper limb

36
Q

What are the complications associated with fracture healing?

A
  • Non-union
  • Malunion (uniting in wrong place)
  • Pneumothorax (collapsed lung)
  • Injury to neurovascular structures
37
Q

Which nerves may be damaged by the elevation of the medial part of a displaced mid-clavicular fracture?

A
  • Suprascapular

- Supraclavicular nerves (C3,4)

38
Q

What would damage to supraclavicular nerves result in?

A

Parasthesia over upper chest anteriorly

39
Q

What is the role of the rotator cuff?

A

1- Stabilising glenohumeral joint

2- Abducting, externally and internally rotating humerus

40
Q

Which of the rotator cuff tendons is most frequently affected?

A

Supraspinatus tendon (passes beneath coracoacrominal arch) (tears at site of insertion(greater tubercle of humerus)

41
Q

What are the two types of tears of the rotator cuff that can occur?

A

Acute-eg. shoulder dislocation

Chronic

42
Q

What causes a chronic rotator cuff tear in the shoulder?

A

1- Age related degeneration- blood supply= decreases- impairs ability to repair injuries
2-Extended use + other factors (e.g. poor biomechanics/muscular imbalance)

43
Q

What is the ‘Degenerative-microtrauma model’?

A

Age related degeneration- compounded by chronic micro trauma- results in partial tendon tears- then rotator cuff tears-Inflammatory cells recycled-oxidative stress- apoptosis- further degeneration- cycle

44
Q

How do rotator cuff tears commonly present clinically?

A

-Anterolateral shoulder pain, often radiating down arm
(at rest/ with certain activity)
- Pain restricted movement above horizontal position
-Weakness of shoulder abduction

45
Q

When might a patient who has rotator cuff tears experience pain?

A

When leaning on their elbows + pushing down

When reaching forward

46
Q

Apart from taking a history and examination, what else is used to diagnose rotator cuff tears?

A

MRI/ Ultrasound

47
Q

How might rotator cuffs be managed?

A

Conservatively (rest&analgesia)

48
Q

What is ‘Impingement Syndrome’?

A

When supraspinatus tendon impinges (rubs and catches) on coraco-acrominal arch= leads to irritation and inflammation

49
Q

What may cause the space (1-1.5cm) between the coracoacromial arch and the head of the humerus to shrink?

A
  • Thickening of coracoacrominal ligament
  • Inflammationof supraspinatus tendon
  • Subacrominal osteoarthritis
50
Q

When do the symptoms of impingement syndrome: pain, weakness and range of motion present?

A

When shoulder= abducted/flexed- further narrowing of space

Worsened- overhead movement / lying on shoulder

51
Q

In what circumstance would the pain from impingement symdrome be acute?

A

If= injury

52
Q

Apart from pain, weakness and range of motion, what other symptoms might impingement syndrome present with?

A

Grinding/popping sensation during movement

53
Q

What’s the painful arc?

A

(Impingement of supraspinatus tendon under acromion during shoulder abduction. )
Between 60-120 degrees- pain experienced
Outside range- less/no pain
(patients report pain reaching upwards e.g. brushing hair)

54
Q

How is impingement syndrome treated?

A

Treat underlying cause

55
Q

What is ‘Calcific supraspinatus tendionopathy’?

A

Presence- macroscopic deposits- hydroxyapatite (crystals) in supraspinatus tendon. (can occur in any tendon of rotator cuff)

56
Q

How does Calcific supraspinatus tendionopathy present?

A

=Acute/chronic pain- aggravated by abducting/flexing arm above level of shoulder
=Pain when lying on shoulder
MECHANICAL SYMPTOMS (due to presence of large deposit):
- Stiffness
- Snapping sensation
- Catching
-Reduced range of movement

57
Q

What causes calcific supraspinatus tendionapathy ?

A

=Multifactorial- possible causes:

  • Regional hypoxia- tenocytes- transformed to chondrocytes- laying cartilage in tendon then calcium deposits (like bon formation)
  • Etopic bone formation- metaplasia of mesenchymal stem cells- osteogenic cells
58
Q

How does calcific supraspinatus tendionopathy present on an x-ray?

A

Calcific deposits visible
=crystaline in resting stage
= toothpaste appearance when reabsorbed by macrophages

59
Q

How is calcific supraspinatous tendionpathy treated?

A

1- conservative- rest and analgesia

2- surgical- is persistent symptoms

60
Q

What is a ‘frozen shoulder’?

A

(aka adhesive capsulitis) capsule of glenohumeral joint= inflamed + stiff–> restricting movement and causing chronic pain (constant, worse at night, exacerbated by movement and cold weather)

61
Q

What are the risk factors for a frozen shoulder?

A

1- autoimmune condition- triggered by localised trauma to shoulder
2- being female
3- epilepsy with tonic seizures
4- Diabetes - glucose binds to capsular collagen
5- CVS disease
6- Long periods of inactivity
7- having the shoulder problems

62
Q

What secondary symptoms might a patient with a frozen shoulder present with?

A 
Sleep deprivation (due to sever pain)
Depression (due to disability)
63
Q

How is a ‘frozen shoulder’ treated?

A

1, Physiotherapy, analgesia, anti-inflammatory medication
2, Manipulation under anaesthesia- breaks adhesions and scar tissue- restore range of motion. Then intense post operative physiotherapy.

64
Q

What are the outcomes for patients with frozen shoulders?

A

Typically resolves with time- patients regain 90% motion

BUT 6-17% of other shoulder will be affected within 5 years

65
Q

What age group does osteoarthritis usually affect?

A

Over 50 years

66
Q

Which joint does of the shoulder does the osteoarthritis usually affect?

A

Acromioclavicular joint rather than glenohumeral shoulder joint.

67
Q

How is osteoarthritis treated?

A
  1. Activity modification, analgesia, anti-inflammatories. Hyaluronic acid injections into joint (increase lubrication)
  2. Steroid injections- reduce swelling- alleviate stiffness and pain.
  3. Arthroscopy (keyhole surgery)- removes loose pieces- damaged cartilage from joint.
  4. Complete replacement- humeral head
  5. Complete shoulder replacement (humeral head and glenoid)
68
Q

What’s the likely mechanism of injury of rupture to the biceps tendon? (Near its scapula origin)

A

Patients over 50yrs
Minimal trauma
Patient reports ‘snap’ whilst lifting

69
Q

How does a patient with a ruptured biceps tendon near to its scapula origin present?

A

Flexion at elbow- firm lump produced- lower part of arm

‘Popeye sign’

70
Q

How is a ruptured biceps tendon near to its scapula origin managed?

A

Conservative

2 MSK Clinical Conditions (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions