The Shoulder Flashcards
What is impingement?
A syndrome where the tendons of the rotator cuff (predominately supraspinatus) are compressed in the tight subacromial space during movement producing pain
What is the typical sign of impingement?
A painful arc between 60-120 degrees of abduction
What are the causes of impingement?
Tendonitis Subacromial bursitis Acromioclavicular OA with inferior ostephyte A hooked acromion Rotator cuff tear
Where may the pain of impingement radiate to?
The deltoid and upper arm
Where is tenderness felt in the shoulder joint in impingement
Lateral edge of the acromion
What is test will recreate the patient pain?
Hawkins test - internally rotating the flexed shoulder
What is the treatment of impingement
NSAIDS analgesia Physio Subacromial steroid injection (up to 3) May need subacromial decompression surgery - if does not respond to conservative management
Which muscle is usually involved in a rotator cuff tear?
Supraspinatous
What is a sign of a supraspinatous tear
Weakness in initiaton of abduction
What is a sign of a subscapularis tear
weakness of internal rotation
What is a sign on infra spinatous
weakness of external rotation
What is the usual cause of rotator cuff tears in oldr people
tendon degeneration
What is a frozen shoulder
adhesive capsulitis - progressive pain and stiffness in shoulder in patients around ages 40-60, resolving around 18-24 months
What is the characteristic picture of a roxen shoulder
pain which subsides followed by stiffness which gradually thaws out over time
What is the principle clinical sing of a frozen shoulder
loss in external rotation
Who is particularly prone to a frozen shoulder
diabetes
hypercholesterolaemia
dupuytrens disease
What happens to the joint in a frozen shoulder
the capsule and glenohumeral ligaments become inflamed then thicken and contract
What is shoulder instability
painful adnormal translational movement or subluxation and or recurrent dislocation
What are the two types of instability
traumatic
atraumatic
What usually results in a traumatic instability
previous anterior dislocation of the shoulder joint can result in an unstable shoulder
What determines how likely someone is to get a traumatic instability
age- the younger the first dislocation occurred the more likely the patient is to develop instability - particualry if under 20
What surgical procedure can be used to repair a traumatic unstable shoulder
Bankart - labrum and capsule are reattached
When does an atraumatic instability usually occur
Ligamentous laxity (idiopathic, Ehlers- Danlos, Marfan’s)
What is an acute calcific tendonitis
calcium deposits in the supraspinatous tendon results in acute onset of severe shoulder pain
Where on an xray are the calcium depostits in calcific tendonitis seen
just proximal to the greater tuberosity
What is the treatment of calcific tendonitis
Subacromial steroid and local anaesthetic
What can cause anterior shoulder pain and pain on resister biceps contraction
biceps tendonitis
What relieves a biceps tendonitis
surgical division of the tendon
What is a popeye deformity
bunched up biceps as a result of a ruptured biceps tendon
describe how rotator cuff tears are managed
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
how is frozen shoulder managed
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
what is acute calcific tendonitits
acute onset shoulder pain due to calcium deposition in supraspinatour tendon which can be seen on xray
treatment of acute caclific tendonitis
subacromial steroid injection and local anaesthetic injections
self limiting
what are the two types of shoulder instability
traumatic
atraumatic
what predicts likelyhood of redislocation of the shoulder
age at first dislocation - younger more likely to redislocate
causes of atraumatic shoulder dislocation
idiopathic
marfans
ehlers danlos
treatment of traumatic shoulder instability
generally conservative
bankart repair (open or arthroscopic) can stabilise by reattaching labrum and capsule to the anterior glenoid
what is a SLAP tear
anterior glenoid labrum tear where the biceps tendon attaches
“superior labrum anterior and posterior”
diagnosis of a SLAP tear
MRI arthrogram
treatment of a slap tear
biceps tenotomy
or labral resection
