Upper limb (1) pathologies Flashcards
Describe anterior dislocation of the shoulder
Presentation = visible deformity, swelling, bruising & movement is severely restricted
Most are anterior dislocations = head of humerus usually dislocated anteroinferiorly, but then displaces in an anterior direction due to the pull of the muscles
Arm is held in a position of external rotation & slight abduction
Bankart lesion = glenoid labrum is torn off
Hill-sachs lesion = posterior aspect of the humeral head becomes jammed against the lip of the glenoid fossa (INCREASES THE RISK OF SECONDARY OA)
Describe posterior dislocation of the shoulder
Posterior dislocations = violent muscle contractions
-internally rotated & adducted
Can easily be missed on x-ray (look for ‘light bulb’ sign)
Injuries that are commonly associated = fractures, rotator cuff tears & Hill-sachs lesion
Describe inferior dislocation of the shoulder
Rare
Cause: forceful traction on the arm when it is fully extended over the head (may occur when grasping an object above the head to break a fall)
-hyperabduction injury
Describe some complications of shoulder dislocation
Recurrent dislocation – due to damage to the stabilising tissues surrounding the shoulder
Risk of OA
Damage to the axillary artery
Damage to the axillary nerve (more common than arterial injuries) – most people with axillary nerve damage recover fully as the symptoms resolve when the shoulder is reduced
-regimental badge area
Describe clavicle fractures
Peak age in children & young adults
Most are in the middle third of the clavicle – falls into the affected shoulder/FOOSH
Most are treated conservatively using a sling
Indications for surgical fixation include = complete displacement, open fractures, neurovascular compromise etc
Medial segment will be elevated – sternocleidomastoid muscle
Lateral segment drops – trapezius is unable to hold it up
Arm is pulled medially by pectoralis major
Describe rotator cuff tears
A tear of one or more of the tendons of the four rotator cuff muscles of the shoulder
Supraspinatus tendon is most frequently torn when it passes beneath the coracoacromial arch
Most tears are chronic – overuse, age-related degeneration (blood supply to the rotator cuff tendons decreases – degenerative-microtrauma model)
Risk factors = overhead activity
Most are asymptomatic but most common presentation is anterolateral shoulder pain
Describe impingement syndrome
Occurs when the supraspinatus tendon impinges on the coracoacromial arch, leading to irritation and inflammation
Causes: anything that narrows the space – inflammation of tendon, thickening of ligament
Painful arc between 60 and 120 degrees of abduction
Describe calcific supraspinatus tendinopathy
Presence of macroscopic deposits of hydroxyapatite in the tendon of supraspinatus
Presentation = acute/chronic pain, mechanical symptoms due to physical presence of large deposits
Deposits are visible on x-ray
Treatment = initially conservation with rest & analgesia, surgical treatment is required for persistent symptoms
Describe adhesive capsulitis (“frozen shoulder”)
Capsule of the glenohumeral joint becomes inflamed & stiff, greatly restricting movement & causing chronic pain
Exact cause is unknown
Risk factors = females, trauma to shoulder, CVS disease & thyroid disease
Treatment = physiotherapy, analgesia & anti-inflammatory medication
Condition typically resolves with time & most patients ultimately regain 90% of their shoulder motion
Describe osteoarthritis of the shoulder
Usually affects people > 50 & typically acromioclavicular joint
Initial treatment = activity modification, analgesia & NSAIDs
Steroid injections can be performed to reduce swelling & this will alleviate pain
Arthroscopy can be performed to remove loose pieces of damage cartilage from the joint
List the main stages of adhesive capsulitis
Freezing = increasing pain & reduced range of motion Frozen = significant pain & extremely limited movement Thawing = slow improvement in range of movement & reduction in pain
