The Shoulder Joint

Question 1

what physical signs can you see when someone has a shoulder dislocation

Answer 1

visibly deformed, visible swelling and/or bruising

Question 2

How common are anterior dislocations

Answer 2

90-95% - head of humerus sits anterior to the glenoid fossa

Question 3

two types of anterior shoulder dislocation

Answer 3

Subcoracoid location = 60%

Subglenoid = 30%

Question 4

how to get an anterior shoulder dislocation

Answer 4

arm abducted and external roated , force arm posteriorly or direct blow to shoulder

Question 5

Bankart lesion

Answer 5

force of humeral head popping out of socket in anterior dislocation can cause part of the gleniod labrum to be torn off

Question 6

Hill Sachs Lesion

Answer 6

posterior aspect of the humeral head become jammed against the anterior lip of the glenoid fossa can cause a dent in the posterolateral humeral head

Question 7

How common are postior disloactions

Answer 7

2-4%

Question 8

posterior dislocations cause

Answer 8

violent muscle contractions due to epiletic seizures, electrocution or a lighting strike or blow to anterior shoulder or when the arm is flxed across the body and pushed posteriorly

Question 9

How do patient hold arm with posterior disloaction

Answer 9

internally rotated and adducted, flattening/squaring of the shoulder

Question 10

injuries common with posterior disloaction

Answer 10

fractures, rotator cuff tears and hill sachs lesions

Question 11

how common are inferior dislocations

Answer 11

0.5% head of humerus sits inferior to the glenoid

Question 12

mechanisms of getting an inferior dislocation

Answer 12

forceful traction on the arm when it is fully extended over the head

Question 13

how common are nerve damage, rotator cuff tears and injury to blood vessels in inferior dislocation

Answer 13

nerve 60%
cuff tear 80%
blood vessel damage 3%

Question 14

the most common complication of should dislocation in nay direction

Answer 14

recurrent dislocation

Question 15

recurrent dislocation occures why?

Answer 15

recurrent dislocation due to damage to the stabilising tissues surrounding the
shoulder (glenoid labrum, capsule, ligaments etc.).

Question 16

why does chance of further dislocation increase with age

Answer 16

as tissues lose elasticity

Question 17

why does rick of osteoarthitsis increase each time you discloacte your shoulder

Answer 17

. Each dislocation results in further

damage to the humeral head and glenoid,

Question 18

what arerty may be damanaged in dislocation and hpw common is it

Answer 18

axillary artery 2%

Question 19

signs is axially artery damnage

Answer 19

haematoma, absent pulses and/or a cool limb

Question 20

why is axially nerve damanage more common then axiaally artery damange

Answer 20

axillary
nerve wraps around the neck of the humerus, and supplies the deltoid muscle and
the skin overlying the insertion of deltoid (Apply Hilton’s law: the nerve supplying
the muscle [deltoid] also supplies the skin overlying the insertion of the muscle
[insertion of deltoid]). This is known as the regimental badge area as it corresponds
with where a shoulder badge would be worn on the sleeve of a jacket.

Question 21

when are fracture likely to occur in a disloaction

Answer 21

first time dislocation or if a person is aged over 40

Question 22

what bones are likely to break in a fracture

Answer 22

humeral

head, greater tubercle, clavicle and acromion

Question 23

rotator cuff muscule tears are more common in what kind of disloaction

Answer 23

inferior

Question 24

which 3rd do clavical fracture occur in most

Answer 24

middle third

Question 25

most clavical fracture are treated conservatively with a sling but when do you have to intervene?

Answer 25

Complete displacement (so the bone ends are not in apposition and cannot unite)  Severe displacement causing tenting of the skin, with the risk of puncture (see below)  Open fractures (fracture associated with a break in the integrity of skin)  Neurovascular compromise  Fractures with interposed muscle  Floating shoulder: clavicle fracture with ipsilateral fracture of glenoid neck

Question 26

What will happen to the position of the arm and clavicular fragments in a displaced mid-clavicular fracture (fracture at the mid-point of the clavicle)

Answer 26

The sternocleiodomastoid muscle elevates the medial segment  Because the trapezius muscle is unable to hold the lateral segment up, and also because of the weight of the upper limb, the shoulder drops  The arm is pulled medially by pectoralis major (adduction)

Question 27

rotator cuff tears

Answer 27

1 or more tears in the tendons of the 4 rotator cuff muscles

Question 28

impingement syndrome

Answer 28

supraspinatus tendon impinges (rubs or | catches) on the coraco-acromial arch, leading to irritation and inflammation.

Question 29

Impingement may be caused by anything that narrows | this space further

Answer 29

hickening of the coracoacromial ligament, inflammation of | the supraspinatus tendon, subacromial osteophytes (in osteoarthritis)

Question 30

when do people with impingement syndrome experience pain

Answer 30

``` When the shoulder is abducted or flexed, the space becomes narrowed further, resulting in symptoms of pain, weakness and reduced range of motion. ```

Question 31

most common form of impingement syndrome

Answer 31

common form is impingement of supraspinatus tendon under the acromion during abduction of the shoulder. This creates a ‘painful arc' between 60 and 120 degrees of abduction (below 60°and above 120°, patients experience significantly less, or no, pain). Patients often report pain on reaching upwards to brush their hair or to lift a food can from an overhead shelf. Treatment is directed at the underlying cause.

Question 32

Calcific supraspinatus tendinopathy

Answer 32

presence of macroscopic deposits of hydroxyapatite (a crystalline form of calcium phosphate) in the tendon of supraspinatus. It can occur in any tendon of the rotator cuff but is by far most commonly seen in supraspinatus.

Question 33

frozen shoulder

Answer 33

painful and disabling disorder in which the capsule of the glenohumeral joint becomes inflamed and stiff, greatly restricting movement and causing chronic pain.

Question 34

when is frozen shoulder pain at its worst

Answer 34

pain is usually constant, worse at night and exacerbated by movement and cold weather

Question 35

risk factors fro frozen shoulder

Answer 35

Risk factors include female gender, epilepsy with tonic seizures (i.e. sudden muscle contractions), diabetes mellitus (the theory is that glucose molecules bond to the capsular collagen), trauma to the shoulder, connective tissue disease, thyroid disease (hypo and hyperthyroidism), cardiovascular disease, chronic lung disease, breast cancer, polymyalgia rheumatica (an inflammatory condition causing muscle pain and weakness) and Parkinson's disease [Note: You will only need to recall a couple of these examples!]. Long periods of inactivity

Question 36

how is frozen shoulder treated

Answer 36

Treatment usually involves physiotherapy, analgesia and anti-inflammatory medication. Patients sometimes undergo manipulation under anaesthesia, which breaks up the adhesions and scar tissue in the joint to help restore range of motion. Intense post-operative physiotherapy then helps to maintain the movement that has been gained

Question 37

osteoarthritsis treatment

Answer 37

activity modification (avoiding activities that precipitate symptoms), analgesia, and anti-inflammatories (NSAIDs). Some patients report a benefit from taking nutritional supplements e.g. glucosamine and chondroitin sulfate. Steroid injections can be performed into the joint to reduce swelling and thereby alleviate shoulder stiffness and pain. Hyaluronic acid injections into the joint (viscosupplementation) may increase lubrication, although the evidence for this is limited. Arthroscopy (keyhole surgery) can be performed to remove loose pieces of damaged cartilage from the glenohumeral joint