T2 L4 Intro to surgery of shoulder

Question 1

Why is shoulder pain important?

Answer 1

3rd most common MSK consultation in GP
1% adults each year visit GP with shoulder pain
25% adults self-reported prevalence of shoulder pain

Question 2

What are some common shoulder symptoms?

Answer 2

Pain
Stiffness
Weakness
Instability

Question 3

What contributes to glenohumeral joint stability?

Answer 3

Rotator cuff

Capsule and labrum

Question 4

What are the 4 rotator cuff muscles?

Answer 4

Supscapularis
Infraspinatus
Supraspinatus
Teres minor

Question 5

What is the function of the rotator cuff?

Answer 5

Stabilise glenohumeral joint

Provides fulcrum for power muscles to move arm

Question 6

What are the power muscles used to move arm?

Answer 6

Deltoid
Pectoralis major
Trapezius
Latissimus dorsi
Teres major

Question 7

What are the risk factors for shoulder pain?

Answer 7

Sports related injuries
Traumatic injuries
Degenerative conditions
Work-related conditions

Question 8

What are some causes of glenohumeral joint problems?

Answer 8

Arthritis
Instability
Frozen shoulder

Question 9

What are some causes of rotator cuff problems?

Answer 9

Tears
Bursitis / impingement / calcific tendonitis
Subacromial impingement

Question 10

What are some causes of shoulder pathology?

Answer 10

Glenohumeral joint
Rotator cuff
Bone trauma
Biceps, pectoralis major

Question 11

Describe calcific tendonitis

Answer 11

Formation of calcium deposits within tendons of rotator cuff
Common condition
Extremely painful
Can be acute

Question 12

Describe subacromial impingement

Answer 12

Symptom, common
Rotator cuff and bursa rubs against bottom of acromion in narrow space causing impingement
Pain of abduction and rotation of arm
Felt over deltoid

Question 13

What are the causes of subacromial impingement?

Answer 13

Extrinsic - variation in shape of people’s acromion mean some have bony spurs
Intrinsic - tendinopathy / cuff weakness

Question 14

What is the treatment for subacromial impingement?

Answer 14

Non-surgical:
- activity modification
- physiotherapy
Surgical:
- subacromial decompression
- debridement of bony and soft tissue impinging the area

Question 15

Describe rotator cuff tears

Answer 15

Most common - supraspinatus / infraspinatus
Weakness and pain - will struggle to elevate arm
Tendon degeneration is normal
15% of 60 year olds have full thickness tear
Repair if symptomatic

Question 16

Why are rotator cuff tears not always symptomatic?

Answer 16

Compensation by other tendons

Question 17

What are the types of arthritis in the glenohumeral joint?

Answer 17

Osteoarthritis
Rheumatoid arthritis
Post-traumatic arthritis
Rotator cuff tear arthritis

Question 18

What are the symptoms of arthritis?

Answer 18

Stiffness
Crepitus and grinding
Pain at rest and at night
Pain with activity

Question 19

What are the 2 types of shoulder replacement?

Answer 19

Anatomic

Revered

Question 20

Describe an anatomic shoulder replacement

Answer 20

Done when rotator cuff is intact
Replace head with metal and socket with plastic
Fulcrum for the power muscles is provided by the rotator cuff

Question 21

Describe a reversed shoulder replacement

Answer 21

Creates mechanical fulcrum for power muscles

Done when rotator cuff isn’t present

Question 22

What are the symptoms of a frozen shoulder?

Answer 22

Stiffness and pain

Loss of passive motion

Question 23

Who commonly gets frozen shoulder?

Answer 23

40-60 year olds
Females
Diabetes

Question 24

What is the pathology behind frozen shoulder?

Answer 24

Inflamed thickened capsule

Question 25

What is the treatment for a frozen shoulder?

Answer 25

Non surgical:

• usually resolves over 2 years
• injections
• hydroxylation

Surgical:
- capsular release and manipulation

Question 26

What are the risk factors for shoulder dislocation?

Answer 26

Collision sports

Hyperlaxity

Question 27

What is the surgical treatment for shoulder dislocation?

Answer 27

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

Question 28

What are some traumatic conditions?

Answer 28

Bony trauma:

• fracture
• dislocations

Soft tissue trauma:

• biceps problem
• pectorals major rupture