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Orthopaedics > The Shoulder > Flashcards

The Shoulder Flashcards

1
Q

What is impingement?

A

A syndrome where the tendons of the rotator cuff (predominately supraspinatus) are compressed in the tight subacromial space during movement producing pain

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2
Q

What is the typical sign of impingement?

A

A painful arc between 60-120 degrees of abduction

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3
Q

What are the causes of impingement?

A 
Tendonitis
Subacromial bursitis
Acromioclavicular OA with inferior ostephyte
A hooked acromion
Rotator cuff tear
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4
Q

Where may the pain of impingement radiate to?

A

The deltoid and upper arm

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5
Q

Where is tenderness felt in the shoulder joint in impingement

A

Lateral edge of the acromion

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6
Q

What is test will recreate the patient pain?

A

Hawkins test - internally rotating the flexed shoulder

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7
Q

What is the treatment of impingement

A 
NSAIDS
analgesia
Physio
Subacromial steroid injection (up to 3) 
May need subacromial decompression surgery - if does not respond to conservative management
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8
Q

Which muscle is usually involved in a rotator cuff tear?

A

Supraspinatous

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9
Q

What is a sign of a supraspinatous tear

A

Weakness in initiaton of abduction

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10
Q

What is a sign of a subscapularis tear

A

weakness of internal rotation

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11
Q

What is a sign on infra spinatous

A

weakness of external rotation

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12
Q

What is the usual cause of rotator cuff tears in oldr people

A

tendon degeneration

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13
Q

What is a frozen shoulder

A

adhesive capsulitis - progressive pain and stiffness in shoulder in patients around ages 40-60, resolving around 18-24 months

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14
Q

What is the characteristic picture of a roxen shoulder

A

pain which subsides followed by stiffness which gradually thaws out over time

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15
Q

What is the principle clinical sing of a frozen shoulder

A

loss in external rotation

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16
Q

Who is particularly prone to a frozen shoulder

A

diabetes
hypercholesterolaemia
dupuytrens disease

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17
Q

What happens to the joint in a frozen shoulder

A

the capsule and glenohumeral ligaments become inflamed then thicken and contract

18
Q

What is shoulder instability

A

painful adnormal translational movement or subluxation and or recurrent dislocation

19
Q

What are the two types of instability

A

traumatic

atraumatic

20
Q

What usually results in a traumatic instability

A

previous anterior dislocation of the shoulder joint can result in an unstable shoulder

21
Q

What determines how likely someone is to get a traumatic instability

A

age- the younger the first dislocation occurred the more likely the patient is to develop instability - particualry if under 20

22
Q

What surgical procedure can be used to repair a traumatic unstable shoulder

A

Bankart - labrum and capsule are reattached

23
Q

When does an atraumatic instability usually occur

A

Ligamentous laxity (idiopathic, Ehlers- Danlos, Marfan’s)

24
Q

What is an acute calcific tendonitis

A

calcium deposits in the supraspinatous tendon results in acute onset of severe shoulder pain

25
Q

Where on an xray are the calcium depostits in calcific tendonitis seen

A

just proximal to the greater tuberosity

26
Q

What is the treatment of calcific tendonitis

A

Subacromial steroid and local anaesthetic

27
Q

What can cause anterior shoulder pain and pain on resister biceps contraction

A

biceps tendonitis

28
Q

What relieves a biceps tendonitis

A

surgical division of the tendon

29
Q

What is a popeye deformity

A

bunched up biceps as a result of a ruptured biceps tendon

30
Q

describe how rotator cuff tears are managed

A

remains controversial

surgery - repair open or arthrocopic with subacrommial decompression - tendon is usually diseased and so failure rate is 1/3

non operative - phsyio to strengthen remaining muslces to compensate, subacromial injections

31
Q

how is frozen shoulder managed

A

typically resolves over about 18-24 months

treatment aims to relieve symptoms in the meantime - analgesia and physio, intra articular joint injections (glenohumeral rather than subacromial)

manipulations under anaesthetic or surgical capsular release in severe cases with significant functional losses

32
Q

what is acute calcific tendonitits

A

acute onset shoulder pain due to calcium deposition in supraspinatour tendon which can be seen on xray

33
Q

treatment of acute caclific tendonitis

A

subacromial steroid injection and local anaesthetic injections
self limiting

34
Q

what are the two types of shoulder instability

A

traumatic

atraumatic

35
Q

what predicts likelyhood of redislocation of the shoulder

A

age at first dislocation - younger more likely to redislocate

36
Q

causes of atraumatic shoulder dislocation

A

idiopathic
marfans
ehlers danlos

37
Q

treatment of traumatic shoulder instability

A

generally conservative

bankart repair (open or arthroscopic) can stabilise by reattaching labrum and capsule to the anterior glenoid

38
Q

what is a SLAP tear

A

anterior glenoid labrum tear where the biceps tendon attaches

“superior labrum anterior and posterior”

39
Q

diagnosis of a SLAP tear

A

MRI arthrogram

40
Q

treatment of a slap tear

A

biceps tenotomy

or labral resection

Orthopaedics (25 decks)

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