T2 L4 Intro to surgery of shoulder Flashcards
Why is shoulder pain important?
3rd most common MSK consultation in GP
1% adults each year visit GP with shoulder pain
25% adults self-reported prevalence of shoulder pain
What are some common shoulder symptoms?
Pain
Stiffness
Weakness
Instability
What contributes to glenohumeral joint stability?
Rotator cuff
Capsule and labrum
What are the 4 rotator cuff muscles?
Supscapularis
Infraspinatus
Supraspinatus
Teres minor
What is the function of the rotator cuff?
Stabilise glenohumeral joint
Provides fulcrum for power muscles to move arm
What are the power muscles used to move arm?
Deltoid Pectoralis major Trapezius Latissimus dorsi Teres major
What are the risk factors for shoulder pain?
Sports related injuries
Traumatic injuries
Degenerative conditions
Work-related conditions
What are some causes of glenohumeral joint problems?
Arthritis
Instability
Frozen shoulder
What are some causes of rotator cuff problems?
Tears
Bursitis / impingement / calcific tendonitis
Subacromial impingement
What are some causes of shoulder pathology?
Glenohumeral joint
Rotator cuff
Bone trauma
Biceps, pectoralis major
Describe calcific tendonitis
Formation of calcium deposits within tendons of rotator cuff
Common condition
Extremely painful
Can be acute
Describe subacromial impingement
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
What are the causes of subacromial impingement?
Extrinsic - variation in shape of people’s acromion mean some have bony spurs
Intrinsic - tendinopathy / cuff weakness
What is the treatment for subacromial impingement?
Non-surgical: - activity modification - physiotherapy Surgical: - subacromial decompression - debridement of bony and soft tissue impinging the area
Describe rotator cuff tears
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
Why are rotator cuff tears not always symptomatic?
Compensation by other tendons
What are the types of arthritis in the glenohumeral joint?
Osteoarthritis
Rheumatoid arthritis
Post-traumatic arthritis
Rotator cuff tear arthritis
What are the symptoms of arthritis?
Stiffness
Crepitus and grinding
Pain at rest and at night
Pain with activity
What are the 2 types of shoulder replacement?
Anatomic
Revered
Describe an anatomic shoulder replacement
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
Describe a reversed shoulder replacement
Creates mechanical fulcrum for power muscles
Done when rotator cuff isn’t present
What are the symptoms of a frozen shoulder?
Stiffness and pain
Loss of passive motion
Who commonly gets frozen shoulder?
40-60 year olds
Females
Diabetes
What is the pathology behind frozen shoulder?
Inflamed thickened capsule
What is the treatment for a frozen shoulder?
Non surgical:
- usually resolves over 2 years
- injections
- hydroxylation
Surgical:
- capsular release and manipulation
What are the risk factors for shoulder dislocation?
Collision sports
Hyperlaxity
What is the surgical treatment for shoulder dislocation?
Arthroscopic stabilisation - labral repair
Open stabilisation - capsule tightening
Bony procedures - augmenting glenoid
What are some traumatic conditions?
Bony trauma:
- fracture
- dislocations
Soft tissue trauma:
- biceps problem
- pectorals major rupture
