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NMSK 2 - upper limb > shoulder soft tissue injuries > Flashcards

shoulder soft tissue injuries Flashcards

1
Q

what kind of joint is the shoulder joint?

A

a synovial ball and socket

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2
Q

what % of the humeral head is in contact with the glenoid fossa at any time?

A

25-35%

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3
Q

what are the static stabilisers of the shoulder joint?

A

-labrum
-glenohumeral ligaments

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4
Q

what are the dynamic stabilisers of the shoulder?

A

-rotator cuff muscles
-deltoid muscle

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5
Q

how much synovial fluid does a normal shoulder joint hold?

A

10-30 mls

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6
Q

what are the attachments of the shoulder joint capsule?

A

-around the margins of the labrum proximally
-around the anatomical neck of humerus distally
-attaches a fingers breath below the surgical neck

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7
Q

what is the shoulder joint capsule re-inforced by?

A

-ligaments - superior, middle and inferior GH ligaments and the coraco-humeral ligament
-Rc muscles
-long head of biceps gives anterior support

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8
Q

what can occur if the inferior GH ligament is torn?

A

multidirectional instability

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9
Q

what is the function of the glenoid labrum?

A

deepens the socket to increase stability

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10
Q

what part of the labrum is most vulnerable to injury as a result of anterior dislocation?

A

@ 2 o clock - there is a fold of synovial membrane - most vulnerable part

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11
Q

what is the matsen classification?

A

divides shoulder instability events into the traumatic, unidirectional, Bankart lesion, and surgery (TUBS) and AMBRI classification

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12
Q

what does TUBS stand for- ie what are the types of recurrent shoulder instability?

A

-traumatic aetiology
-unidirectional instability
-bankart lesion
-surgery required

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13
Q

what does AMBRI stand for in terms of shoulder instability?

A

-atraumatic
-multidirectional instability may be present
-bilateral
-rehabilitation is the treatment of choice
-inferior capsular shift -surgery required if conservative treatment fails

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14
Q

according to matsen what are the 2 ways to classify shoulder instability?

A
  • TUBS
    -AMBRI
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15
Q

what is laxity in relation to a joint

A

laxity refers to the degree of looseness or instability in a joint

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16
Q

what is the stanmore triangle classification of shoulder instability?

A

-Stanmore classification system proposes three types of shoulder instability
-It looks at both the things that are part of the shoulder’s structure and those that are not. It also says that there’s a range of issues that can happen, not just one specific problem

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17
Q

what are the 3 types of instabilities according to the Stanmore triangle?

A

-polar type I
-polar type II
-polar type III

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18
Q

Describe polar type I

A

-these patients usually present with a positive apprehension test in an anterior direction
-traumatic injury -TUBS
-may have RC weakness

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19
Q

Describe polar type Ii

A

-Patients in this group present with positive anterior apprehension test with signs of increased capsular laxity, excessive external rotation
-atraumatic - AMBRI

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20
Q

Describe polar type III

A

patients in this group show suppression of rotator cuff muscles, abnormal muscle patterning - ie delta and pecs compensate for mvt

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21
Q

in what direction does dislocation of the shoulder joint occur most often?

A

anterior direction

then inferior

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22
Q

what are examples of tests that test for anterior instability?

A

-apprehension test
-apprehension relocation test

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23
Q

what is an example of a test that examines posterior instability?

A

the jerk test

24
Q

what is an example of a test that examines inferior instability?

A

sulcus sign

25
Q

what test examines multidirectional instability?

A

rowe test

26
Q

how is shoulder instability defined?

A

-pathological increase in translators mvt that interfere with joint mvt and produce pain

27
Q

what factors is should instability classified on?

A

-severity- ie subluxation or dislocation
-duration - acute or chronic
-occurence - single of recurrent
-mechanism - traumatic or non-traumatic
-direction - anterior/inferior / posterior/multidirectional

28
Q

what might the patient history include with an anterior Glenohumeral dislocation?

A

-trauma -forced into excessive abduction & ER, or direct trauma onto humeral head
-pain NB
-they may report a feeling of the shoulder ‘popping out’
-report loss of function

29
Q

upon examination, what might a physio observe in a patient with an anterior shoulder dislocation?

A

-loss of AROM and PROM
-positive apprehension test

30
Q

what does the apprehension test involve?

A

-physio externally rotates shoulder with elbow flexed to 90 degrees in an abducted position
-patient will feel extreme pain and discomfort and express apprehension

31
Q

what does the apprehension relocation test involve?

A

-physio abducts and externally rotates the shoulder and pushes the head of the humerus from anterior to posterior
-if this relocates or relieves the patients discomfort, they have a GH joint that has subluxed anteriorly

32
Q

what does the management of an acute shoulder dislocation involve - initially, 2 weeks and 6 weeks post op?

A
  • x ray to rule out fracture
    -rest in sling for 2 weeks
    2 weeks post: scapular strengthening exercises and active range of motion exercises (but avoid positions w/ abduction and ER)
    6 weeks post op: gradual restoration of ROM & strength, continue scapular strengthening and RC strengthening etc
33
Q

what is the recurrence rate of an acute anterior shoulder dislocation?

A

-17-96% - mean of 67%

34
Q

in what positions does anterior shoulder instability occur?

A

-abduction
-lateral rotation

35
Q

compare traumatic vs atraumatic anterior shoulder instability

A

-traumatic - following an acute episode of anterior shoulder dislocation
-atraumatic - as a result of repetitive stressing of external rotatory mvts eg swimmers & tennis players

36
Q

describe posterior shoulder instability

A

traumatic
falling with arm in flexion/ adduction and internal rotation
seen in people who have seizures eg epilepsy - therefore NB subjective

37
Q

what does the jerk test involve?

A

-stabilising the scapula with one hand, while the other hand holds the elbow w/ the arm in 90 degree abduction and IR and firm compression is applied to the shoulder joint
-arm is then horizontally adducted while maintaining the firm axial load

38
Q

what are the signs of a positive jerk test?

A

-sudden jerk or clunk as the head of hummus moves back off the back of the glenoid

39
Q

describe the management of a posterior dislocation

A

-reduction, immobilise in ER
-avoid horizontal flexion and IR for 6 weeks
-strengthening the posterior cuff muscles
-may be associated with posterior labrum tear which may need surgical repair

40
Q

what are the clinical features of multi-directional shoulder instability?

A

-increase in joint volume - ie hypermobiity
-enlarged joint capsule
-lax and thin glenohumeral ligaments
-generalised laxity throughout the body
-positive instability ests

41
Q

how is multidirectional instability managed - conservative and surgically ?

A

-physio - strengthening of rotator cuff and scapular stabilisers and proprioception retraining
-surgical - capsular shift - aims to tighten the ligaments and decreases the size of the shoulder capsule or a glenoid osteoplasty

42
Q

what happens when there is a glenoid labrum tear?

A

-joint looses the negative pressure mechanism as the labrum creates a suction seal on capsule
-increase in mvt esp in anterior direction

43
Q

what is a SLAP labrum tear?

A

-superior labrum anterior to posterior
- involves the attachment site of the biceps tendon located at the top of the shoulder joint.

44
Q

what does the patient usually report with a SLAP lesion?

A

-clicking sounds
-locking of the shoulder
-a feeling that the shoulder doesnt feel right

45
Q

what is a Bankart lesion of the labrum?

A

-injury to the anterior inferior part of the labrum
-involves the inferior Glenohumeral ligament
-humeral head shifts towards the front of the body

46
Q

what are examples of clinical features of a SLAP or Bankart lesion?

A

-vague pain with overhead activities eg throwing or hitting
-pain in posterior/lateral shoulder
-mechanical symptoms of catching, locking, grinding etc
-pain while lying on shoulder
-decreased ROM
-loss of strength

47
Q

describe MOI’s for a slap lesion

A

-traction / compression injuries
1. traction - sudden pull downwards - one loses hold of a heavy object
-pull of arm in upward direction -grabbing an overhead object
-forward pull of arm - eg water skiing
-overhead throwing
2. compression
-fall onto outstretched arm
-direct blow to shoulder

48
Q

Explain the 4 types of SLAP lesion

A

-type 1 - degenerative & attachment of LHB to labrum is stable
-type 2 - damaged/frayed - attachment of LHB is unstable
- type 3- bucket handle tear of superior labrum, but doesn’t extend to LHB tendon but attachment is unstable
-type 4- bucket handle tear of superior labrum extending to the LHB tendon

49
Q

what are examples of tests that can be done to see if a labral tear is present?

A

-biceps load test
-O’Briens active compression test
-crank test

50
Q

what are the physio aims with a labral tear?

A

-reduce pain
-restore ROM
-stabilise joint via rotator cuff strengthening
-post surgical rehab
-functional re-education to facilitate return to work and normal activity

51
Q

what are other terms to describe frozen shoulder?

A

adhesive capsulitis
contracted shoulder

52
Q

what are important clinical features of a ‘frozen’ shoulder?

A

-pain is greater than stiffness or stiffness is greater than pain
-limited or blocked rotation NB
-loss of AROM=PROM
-must be accompanied by normal radiographic finding’s

53
Q

what characteristics is a frozen shoulder commonly associated with?

A

-female gender
-40-60 years
-trauma
-diabetes - due to cell changes
-thyroid disease - due to cell changes
-prolonged immobilisation
-post op

54
Q

what are the principles of management of a frozen shoulder?

A

-advice and education - easy to understand explanation to the patient about their condition
-reduce pain - relative rest avoiding aggravating activities and doing exercises in pain free ROM
-correct joint and ST mobility - maximise joint mobility ROM exercises
-local and global muscle control strength, endurance and proprioception
-re education to facilitate return to work

55
Q

Describe shoulder OA

A
  • 3rd most common joint to be affected by OA
    -cartilage covering joint surfaces becomes thin and roughens up
    -the bone underneath the cartilage reacts by growing thicker and becoming broader
    -pain , swelling and reduced ROM
56
Q

describe OA of the AC joint

A
  • degeneration of the AC joint
    -joint space narrows due to inflammation or formation of osteophytes which can aggravate the subacromial bursa and decrease ROM
    -ache into the deltoid region

NMSK 2 - upper limb (16 decks)

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