Upper Limb conditions Flashcards
Dislocated shoudler
- visibling might see bruising /swelling - movement is restricted
- 90-95% are anterior (humerus sits in glenoid cavity wc is shallow, and is well supported superior, anterior and posteriorly but weak inferiorly therefore head of humerus dislocates anteroinferioly
- 60% d to subcoracoid location d pull pf muscles disturbs the anterior capsule ad ligament
- 30% subglenoid - frist episode of dislocation when person as hadn’t behind head then pushed arm a little more posterity sodislates anterior
- inferiorly - another way to dilate is blow from posterior
Labral tear aka? and whats is it
- Bankart lesion
- look at the labrum inferioraspect on x rays
- force of the humerus coming out the labrum c glenoid labrum to be torn off, and sometimes a small piece of bone can leave too
what happens also in terms of muscles involved in anterior disolcation
the tone of infraspinaus and teres minor muscle c posterior aspect of humeral head to become jammed against the anterior lip of glenoid fossa c dent known as the ‘indentation fraction’ in postolateral humerus head known as Hill-Sachs Lesion
-50% of those under 40 get anterior shoulder dislocation , 80% with recurrent shoulder dislocations get Hill-Sachs lesion, wc increases risk of secondary osteoarthritis in shoulder joint
posterior dislocations
- less common only (2-4% fo cases)
- occurs with violent muscle contractions d epileptic seizures , electrocution or lightening or when blow to anterior shoulder or flexed across the body elbow and fall/ rotator cuff tears
- p presents with internally rotated arm and adducted,
- on x ray can be missed as it looks likes normal, but the projection of humeral head is a more bulb shape more runded
what bone help s detect shoulder dislocation and what test?
- scapular as you’re supoosed to see a Y view were birufication where glenoid fossa and humerus are in line, you take x ray from end on lateral view ‘scapular y view’
inferior dislocatiosn
- rare (0.5%)
- head humerus inferior to the glenoid , patient presents with forced hand extended over head can’t get hand down
- c due to hyperadbuction
- associated with damages to nerves(60%), rotator cuff tears(80%) and injury to b vessels (3%)
whats the most issue common shoulder dislocation complication
recurrent dislocation wc c damage to stabilising tissues
chances of dislocation and age?
increases60% dependent on age and activity level
how often does damage to axillary nerve occur and artry
artery = 1-2%
n = 10-40% (most recover when shoulder put back into place) less commonly this can also c damage to the cords of brachial plexus
how often do fractures occur in shoulder dislocations
- depends on traumatic mechanism that c the dislocationadn in first time dislocation or nor to if person over 40, if fractured occurs mostly to humerus, (head and greater tubercule) ,clavicle and acromion
rotator cuff muscle tears
- can be associated with shoulder dislocation and is most commonly in older people (80% have them both together)
- tendon tears are common
- supraspinatus tendon one mostly affected where it tears at place of insertion
- c are shoulder displation or age
- related degradation or degenerative
- microtrauma model where d age micro minor injury will c it to tear d v supply and toe d age..then inflammatory cells come to site and oxidative stress leads to tenocyte apoptosis (tendon cell) leading to further degeneration creaticycle known as ‘vicious cycle’ -most are asymotic but experience pain when lean on their elbow and push downwards or when reaching forward
clavicular fractures
- mostly kids and young adult
- 3-5% of all fractures
- 80% are middle of clavicle
- c by fall into affected shoulder or onto outstretched hand
- most treated w/o surgery
- free moving arm
- complete or incomplete displacement
what will happen if …..
-
complications of fracture healing genrally
union =failure to unite
malunion = uniting in suboptimalposition
what are some complications for clavicular fraction
- fracture healing issues
- penumothroaz image to surrounding neuromuscular structures like the suprascpaular nerve
impingement syndrome and whats a special type?
- soft tissue irritation the subacromail space
- supraspinatus tendon impinges creating painful arc between 60-120 degree abduction
- it is with rotator cuff damage or not?
- usually middle age
- MID PAINFUL ARC?cant do work at 90 angle because the tendons are being squashed
- sometimes d bone in the area
calcified Supraspinatus tendiopathy
present of hydroxapaptite in the tendon of supraspinatus (can occur in any rotator cuff muscle tendon but commonly spinatus)
- throes is tenches damaed transform into chondrocytes and lay down cartilafe
- treatment is rest and analgesia and sometimes surgery
adhesive capsulitis (frozen schouder)
- inflamed gelohuemrual joint c it to become stiff exacerbated in cold and at night many risk factors eg.femal, thyroid disease,trauma, daibee -patients complain fo sleep deprivation -treamnt s physio alagesia and anitinlamtomnu 90% of patients regain shoulder function
