T&O: Shoulder and rotator cuff Flashcards
What does Neer’s test assess?
Shoulder impingement
A patient comes in with tendonitis of the rotator cuff muscles. You are worried about shoulder impingement. What test could you do?
Neer’s test
Describe a positive Neer’s test
Hand is positioned in the empty can position. Arm is passively raised into full flexion. When arm is raised = subacromial space narrows = impinge tendon and cause pain.
Name the rotator cuff muscles and identify their function
Suprspinatus- abduction
Infraspinatus- external rotation
Teres minor- external rotation
Subscapularis- internal rotation
Where is the attachment of rotator cuff muscles?
Greater tuberosityof the humerus- Suprspinatus, Infraspinatus and Teres minor
Lesser tuberosity of the humerus- Subscapularis
What is the mechanism of injury for anterior shoulder dislocation
FOOSH, playing sport, trauma, ?recurrent trauma
How would the patient look on examination with an anteriorly dislocated shoulder?
Shoulder is tender, loss of roundness of the deltoid, held externally rotated , swelling
What are you worried about in an anterior shoulder dislocation?
Rotator cuff injuries, associated fractures, potential nerve injuries
What views of an X-ray would you request for an anterior shoulder dislocation and what would you see?
AP and Y Lateral, you would see the head towards the corocoid process in a Y lateral view
What is a Bankart lesion?
- When the labrum is pulled from the glenoid (injury to anterior part of the glenoid labrum).
- This needs urgent repair as it makes the shoulder unstable
How do you manage an anterior shoulder dislocation?
- If NO ASSOCIATED FRACTURE- reduce it in ED- traction and counter traction.
- Immobilise in sling- 2 weeks in elderly as stiffness is an issue, longer in young people.
- Physio
- Follow up and assess for any rotator cuff injuries
What is the mechanism of injury for a posterior shoulder dislocation?
Electrocution or epileptic seizure
Why and what do we need to be aware of with posterior shoulder dislocations?
EASILY MISSED! The arm will be held in an internally rotated position, therefore we need to ask them to externally rotate
How would you investigate a posterior shoulder dislocation? What would you find?
XRAY- AP- light bulb sign
Y lateral- head of humerus towards the acromion
How do you manage posterior shoulder dislocation?
Surgical reduction, potentially a humeral head replacement or partial replacement
How would a patient with an inferior shoulder dislocation present?
Arm abducted with hand running down
What is frozen shoulder?
Stiff painful shoulder due to adhesive capsulitis
QM: Frozen shoulder, clinically known as adhesive capsulitis, is a condition characterized by a painful and stiff shoulder, which results in a limited range of motion.
How does the pain from frozen shoulder present?
- Gradual onset pain and stiffness of the shoulder with reduced movement, most notably external rotation.
- Pain worsens initially and persists for weeks- months
How is frozen shoulder managed?
Analgesia(NSAIDS), Physiotherapy and exercise and local intraarticular steroid injection
What does an xray of a frozen shoulder look like?
Normal
What muscle is tested by the empty can test?
Supraspinatus
How do you test for subscapularis function?
Gebers lift off test
Pt had a FOOSH or fell laterally on an adducted arm gets a mid humeral shaft fracture where might she get reduced sensation and weakness and why?
If the radial nerve is involved, complain of reduced sensation over the dorsal 1st webspace and weakness in wrist extension.
