Upper Limb Flashcards
A 52 year old male presents with gradual-onset, anterolateral shoulder pain, worse on overhead movements. It is worse at night. On examination he has a painful arc. He is investigated with an MR arthrogram. What is the diagnosis and most appropriate management?
Rotator cuff related shoulder pain.
Relative rest and active rehab
What is the Hawkin’s test used to diagnose?
Impingement
What is the Neer’s test used to diagnose?
Impingement
What is the Jobe’s test used to diagnose
Impingement
What are the stages of rotator cuff syndrome?
I: oedema and haemorrhage, <25, reversiblele with conservative management
II: Fibrosis and tendinitis, 25-40, recurrent pain with activity
III: Bone spurs and tendon rupture, >40, progressive disability, Needs cuff repair
A 47 year old man presents with gradual onset lateral deltoid pain and shoulder weakness, it is worse with overhead activity. He has a positive painful arc and weakness in ER but negative drop arm test. What is the most likely diagnosis and management?
Partial thickness rotator cuff tear.
Relative rest, analgesia and active rehab.
Surgery if chronic
A 47 year old man presents with acute onset lateral deltoid pain and shoulder weakness, it is worse with overhead activity. He has a positive painful arc and weakness in ER with positive drop arm test. What is the most likely diagnosis and management?
Full thickness rotator cuff tear.
Early surgical repair
A rugby player receives a blow to an abducted ER, extended arm and presents after acute pain and restricted ROM. He has loss of the normal shoulder contour. What is the management?
Early reduction using Spazo technique. Check neuromuscular status, Polysling then x-ray.
Refer to T&O within 1 week
What pathologies can occur alongside shoulder dislocation?
Banklart lesion: soft - labrum (90% of <30s), bony: bone avulsion
Hill-Sachs: Cortical depression in humeral head created from compression of glenoid rim
What are the risk factors suggesting possible fracture after a dislocation?
- Age >40
- 1st time dislocation
- Significantly traumatic mechanism
Which patients need early surgery after shoulder dislocation?
- Irreducible dislocations
- Displaced greater tuberosity fractures
- Bankart fractures with instability
What is TUBS instability?
Traumatic, Unidirectional with Bankart lesion, needing Surgery
- Mostly anterior shoulder dislocations
Which surgery has faster return to sport after shoulder dislocation?
Lararjet procedure
8 weeks: full ROM, RTS 12 weeks
(Vs 3-4 months for Bankart repair)
What is the cardinal sign of posterior shoulder dislocation?
Limited ER
What is the classic presentation for someone with AIOS?
Recurrent pain when throwing, recurrent subluxations, ‘dead arm’ syndrome.
What is AIOS instability?
Acquired Instability Overuse Syndrome
What examination findings would there be for an individual with AIOS?
Positive apprehension and relocation test
Scapular dyskinesia, GIRD, labral pathology
What is AMBRI instability?
Acquired Multidirectional Bilateral instability, that often responds to Rehab but may require Inferior Capsular shift
What is the typical presentation of someone with AMBRI?
Hypermobile, or repetitive trauma, especially at extremes of motion
What are the examination findings of someone with AMBRI?
Positive Posterior subluxation test
Weak ER
What is the management of someone with AMBRI?
Avoid stretching, rehab
May require inferior capsular shift
What is the Polar classification of shoulder instability?
Type I: Traumatic/structural
Type II: Atraumatic/structural
Type III: Muscle patterning/non-structural
An individual falls onto an outstretched elbow and reports anterior shoulder pain. They have clicking and pain in the cocking position. What is the likely underlying diagnosis?
Labral tear
What is the O’Brien’s test used to diagnose?
SLAP lesions