Upper limb - shoulder Flashcards
What is the age range associated with instability in the shoulder?
20-30s
What condition is commonly linked to the 30-40s age group in the shoulder?
Impingement
Which shoulder condition is typically seen in individuals aged 40-50s?
Frozen Shoulder
At what age is a rotator cuff tear most commonly seen?
50-60s
What shoulder condition is most prevalent in those over 60?
Arthritis
What movements are measured under shoulder range of motion (ROM)?
Forward Flexion
Extension
Abduction
External Rotation
Internal Rotation
What is the most common joint dislocation?
Shoulder dislocation, because the head of the humerus is substantially larger than the glenoid fossa
What should always be checked in a shoulder dislocation?
always check pulses and nerves (particularly AXILLARY - as commonly injured)
What is the most common type of shoulder dislocation?
Anterior shoulder dislocation
What is the key mechanism for anterior shoulder dislocation?
A fall with the shoulder in external rotation on the arm or shoulder
What is a characteristic feature of posterior shoulder dislocation?
The humeral head is positioned posterior to the glenoid
Posterior dislocation of shoulder cause and how should it be managed?
caused by seizure or electrocution + refer to orthopaedic surgeon
How is inferior shoulder dislocation different from the others?
The humeral head is inferior to the glenoid, and it is a rare type, caused by the shoulder being forced into hyperabduction
What is the most common clinical presentation of a shoulder dislocation?
(1) Severe shoulder pain
(2) Inability to move the shoulder
(3) Empty glenoid fossa (dent) may be visible
What sign is typically seen in posterior dislocations on X-ray?
The “light bulb sign”
What is the preferred imaging technique for assessing shoulder dislocation?
MRI arthrogram
What is the management of shoulder dislocation?
- Reduction of the dislocated joint
- Analgesia and O2
- Immobilise in a sling for 1-3 weeks
= A broad arm sling
A 40-year-old female comes to the emergency department after a fall while walking. She complains of pain in her right shoulder. On examination, the right arm is abducted and externally rotated, and she resists all movement. The acromion appears prominent. The humeral head is seen in a subcoracoid position in anteroposterior view on X-ray.
What percentage of shoulder dislocations are similar to that found in this patient?
> 95
A 24-year-old man presents to the emergency department after a fall whilst cycling a couple of hours ago. He is grasping his right shoulder and is in obvious pain. The patient does not report any fever or other systemic symptoms and there is no red skin around the joint. An anteroposterior x-ray is ordered which shows that the humeral head is dislodged from the glenoid cavity of the scapula anteriorly.
Given the likely diagnosis, what is the most appropriate initial management?
Kocher-technique reduction
A 25-year-old male attended the emergency department after dislocating his shoulder while playing rugby. His shoulder was reduced in the emergency department and then put into a sling. Following this, the emergency department doctor tested for sensation in the ‘ regimental badge area’, which was normal. Which nerve is commonly injured during a dislocation of the shoulder joint, and the one in which the emergency department doctor was testing?
Axillary nerve
What is commonly associated with shoulder instability?
Labral tear, teenagers and sporty
What is shoulder instability?
Painful abnormal translational movement, subluxation, and/or recurrent dislocation of the shoulder
What are the acute clinical symptoms of shoulder instability?
Painful in a sling
Why is treatment for atraumatic instability difficult?
Soft tissue procedures may not work effectively for atraumatic instability
What is the treatment for traumatic shoulder instability?
Bankart repair (open or arthroscopic), which reattaches the labrum and capsule to the anterior glenoid
What is the main test for shoulder instability?
The anterior apprehension test, which assesses pain or instability by placing the shoulder in a vulnerable position
A 45-year-old woman presents to the GP with pain in her left shoulder. She says this has been going on for the past 3 weeks and is limiting her ability to work. She works for a food packaging company and has to move heavy boxes and stack tall shelves as part of her job. She has no significant past medical history.
On examination, there is tenderness at the anterolateral aspect of her left shoulder. There is pain with active abduction of the arm at 90 degrees, limiting further abduction. There is a good range of movement elsewhere. Except for weakness attributed to pain, neurovascular examination of the upper limb is normal.
What is the most likely diagnosis? and why?
Subacromial bursitis
= (1) Pain with active abduction at 90 degrees
(2) Tenderness at the anterolateral shoulder
(3) Job-related overhead lifting
What is the painful arc range for subacromial impingement?
Between 60 and 120 degrees
In which range of abduction is pain present in rotator cuff tears?
Pain is typically in the first 60 degrees of abduction along with weakness
Which injury causes pain in the first 60 degrees of abduction?
Rotator cuff tears
What is a common symptom of rotator cuff injuries?
Shoulder pain, particularly worsened during abduction
What is the cause of a frozen shoulder?
Inflammation and fibrosis of the joint capsule, leading to contracture of the shoulder joint
What are the three stages of frozen shoulder?
(1) Freezing
= Pain and increased stiffness with minimal synovitis
(2) Frozen
= Limited range of motion (ROM), less pain, but capsule contraction and axillary recess adhesion
(3) Thawing
= Decrease in inflammation, gradual improvement in ROM.
What is the hallmark symptom of frozen shoulder?
Gradual severe pain, especially at night and at rest, along with stiffness in the shoulder.
What is a common sign of a frozen shoulder on examination?
Global restriction in range of motion (ROM), especially in external rotation
What is the main surgical procedure for a frozen shoulder and how long should a patient be in a sling after this surgery?
Surgical capsular release
= short period, followed by aggressive physiotherapy to regain motion
What are common risk factors for developing frozen shoulder?
(1) Age 40s-50s
(2) Higher incidence in females
(3) Associated with diabetes, hypercholesterolaemia, endocrine disease, and Dupuytren’s disease
Another name for frozen shoulder is what?
Adhesive Capsulitis
You review a middle-aged man with shoulder pain. He has limited movement of the right shoulder in all directions. What are the most consistent clinical findings regarding limited movements and those that are affected when the diagnosis is frozen shoulder (adhesive capsulitis)?
Active and passive movement limited + external rotation most affected
A middle-aged man presents with shoulder pain and limited movement in all directions. Upon examination, both active and passive movements are restricted, with the most significant limitation in external rotation. What is the most likely diagnosis?
Frozen shoulder (adhesive capsulitis)
