Upper Limb Conditions - SHOULDER Flashcards
4 causes of Impingement
Tendonitis, subacromial bursitis, acriomioclavicular OA with inferior osteophyte, hooked acromium
Pathogenesis of Impingement
Tendons of the rotator cuff are inflamed and become compressed in the subacromial space during movement causing pain
Symptoms of Impingement
Painful arc at 60-120 degrees of abduction, pain can radiate down the deltoid and upper arm, tenderness at lateral edge of acromium
Diagnosis of Impingement
Pain on Hawkin’s Kennedy Test
Treatment of Impingement
NSAIDS, analgesia, physiotherapy, subacromial steroid injections (up to 3), if no improvement then subacromial decompression with surgery
Epidemiology and causes of rotator cuff tear
Over 40s (manual workers, painters, athletes in throwing events), due to age related degeneration + sudden jerk (holding onto bus + it brakes)
Symptoms of rotator cuff tear
Dull/achy pain + weakness that gradually increases, difficulty seeing on affected side, tenderness at glenohumeral + AC joint
Pain on external rotation= infraspinatus
Pain on abduction= supraspintaus
Pain on internal rotation= subscapularis
Diagnosis of rotator cuff tear
Scarf + Hawkin’s Kennedy test
Gold standard= dynamic MRI
Most commonly partial/fullthickness tear of the supraspinatus
Treatment of rotator cuff tear
Surgery: Repair + subacromial decompression (tendon is diseased so often fails) Non-surgical: Physio to strengthen remaining cuff muscles Subacromial injections (steroid + anaesthetic) to help symptoms
Epidemiology + Risk factors of adhesive capsulitis
40-60s: Diabetes, hypercholesterolaemia, Duputyren’s disease
Symptoms of adhesive capsulitis
Pain for 2-9 months –> stiffness for 4-12 month –> recovery + normal shoulder motion
Diagnosis of adhesive capsulitis
LOSS OF EXTERNAL ROTATION
Treatment of adhesive capsulitis
Resolves after 18-24 months
Physiotherapy + analgesia
Steroid injections in the painful phase
MUA surgical capsular release in the stiffness phase
Describe the differences between traumatic and atraumatic instability
Traumatic: Following anterior dislocation that fails to stabilise, recurrence is higher if the first dislocation happened when young. Treated with Bankart repair (reattach labrum + capsule to the anterior glenoid)
Atraumatic: Ligamentous laxity due to (idiopathic, EDS, Marfans), pain from recurrent multidirectional dislocations/subluxations, difficult to treat
Causes of anterior and posterior dislocation
Anterior: MOST COMMON (young adults + sports) fall with arm in external rotation
Posterior: (Epilepsy/seizures) fall with arm in internal rotation or direct blow from behind
Define a barkart lesion vs a hill sachs lesion
Bankart Lesion: Detachment of inferior anterior glenoid labrum + capsule
Hill-sachs lesion: Impaction of humeral head against anterior glenoid causing posterior humeral head compression fracture
Diagnosis of dislocation
Anterior: XR loss of symmetry, roundness of shoulder, regimental badge patch area sensory assessment (axillary nerve_
Posterior: Lightbulb sign
Treatment of dislocation
Closed reduction + sedation (Hippocratic manoeuvre)
Open reduction for delayed presentation/greater tuberosity fracture
Stabilisation/rehab with sling for 2-3 weeks + physio
Biceps tendinopathy causes, symptoms, treatment
Due to overuse, instability, impingement
Symptoms: Anterior shoulder pain, radiates to elbow + pain on resisted biceps contraction, aggravated by shoulder flexion, forearm pronation, elbow flexion
Popeye deformity from tendon rupture
Treatment: Rest + physio, long head not repaired surgically short head can be
Describe Acute Calcific tendonitis
Calcium deposition on the supraspinatus tendon giving severe acute onset shoulder pain. XR shows calcium deposition proximal to greater tuberosity, usually self-limiting can give subacromial steroid + anaesthetic injections
ACJ dislocation causes, diagnosis, treatment
Due to fall onto point of shoulder
Can be sprained, sublimed (AC ligaments disrupted), or dislocated (AC + Coracoclavicular ligaments ruptured)
POSITIVE SCARF TEST
Treated with physio + sling (surgery + chronic pain)
Causes + treatment of Humeral neck fracture
FOOSH or direct fall on shoulder, most common is fracture of the surgical neck Treated with sling or if persistent displacement then internal fixation, shoulder replacement if comminuted/head splitting fractures
Causes and complications of humeral shaft fracture
Due to direct trauma, can cause radial nerve damage=wrist drop + loss of sensation in first dorsal web space
