Surgery of the shoulder

Question 1

Which structures provide stability to the glenohumeral joint?

Answer 1

Rotator cuff -> dynamic

Capsule + labrum -> static

Question 2

What are the functions of the rotator cuff muscles?

Answer 2

Stabilise GHJ

Provide fulcrum for power muscles to move arm -> deltoid, pec major, trapezius, lat. dorsi teres major.

Question 3

What are the superficial power muscles?

Answer 3

Deltoid, pec. major, serratus anterior

Question 4

What are the risk factors for shoulder pain?

Answer 4

Sports related injuries, traumatic injuries, degenerative conditions, work related conditions

Question 5

What are subacromial problems?

Answer 5

ACJ arthritis, rotator cuff tears, calcific tendonitis

Question 6

What is subacromial impingement and what are the causes?

Answer 6

Common, pain on abduction + rotation of arm, felt over deltoid.
Extrinsic -> bony spurs
Intrinsic -> tendinopathy / cuff weakness

Question 7

What is the treatment of subacromial problems?

Answer 7

Non surgical -> activity modification, physiotherapy.

Surgical -> subacromial decompression, debridement of bony + soft tissue impinging areas, arthroscopic surgery.

Question 8

What are the features of rotator cuff tears?

Answer 8

Most common -> supraspinatus / infraspinatus
Weakness + pain, tendon degeneration is normal
15% in 60’s have a full thickness tear
If symptomatic -> arthroscopic rotator cuff repair

Question 9

What are the glenohumeral joint problems?

Answer 9

Osteoarthritis, frozen shoulder, instability

Question 10

What are the types of glenohumeral arthritis?

Answer 10

Osteoarthritis, rheumatoid arthritis, post traumatic arthritis

Question 11

What are the symptoms of arthritis?

Answer 11

Stiffness, crepitus + grinding, pain at rest + at night, pain with activity

Question 12

What are the types of shoulder replacement?

Answer 12

Anatomic -> fulcrum for power muscles provided by rotator cuff.
Reversed -> creates mechanical fulcrum for power muscles.

Question 13

What are the signs, symptoms, typical patient and pathology of frozen shoulder?

Answer 13

Adhesive capsulitis
Stiffness + Pain
Loss of passive motion (external rotation), X ray normal
40-60 year old female diabetics
Inflamed thickened capsule

Question 14

What is the treatment for frozen shoulder?

Answer 14

Non surgical -> usually resolves over 2 years, injections,
hydrodilatation.
Surgical -> arthroscopic capsular release + manipulation

Question 15

What are the features and risk factors of shoulder instability?

Answer 15

95% anterior dislocations
Younger age -> higher chance of recurrence
Anterior labral tear (bankart lesion)
Risk factors -> collision sports, hyperlaxity

Question 16

What is the surgical treatment for shoulder instability?

Answer 16

Arthroscopic stabilisation -> labral repair
Open stabilisation -> capsule tightening
Bony procedures -> augmenting glenoid

Question 17

What are the types of trauma?

Answer 17

Bony -> fractures, dislocations

Soft tissue -> biceps problems, pec major rupture