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Year 2 Medicine > Introduction to Surgery of the Shoulder > Flashcards

Introduction to Surgery of the Shoulder Flashcards

1
Q

Why is Shoulder Pain Important?

  • … most common MSK consultation in GP practice
  • …% adults each year visit GP with shoulder pain
  • …% of adults self reported prevalence of shoulder pain
A
  • 3rd most common MSK consultation in GP practice
  • 1% adults each year visit GP with shoulder pain
  • 25% of adults self reported prevalence of shoulder pain
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2
Q

Shoulder pain is the … most common MSK consultation in GP practice

A

Shoulder pain is the 3rd most common MSK consultation in GP practice

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3
Q

What % of adults each year visit GP with shoulder pain?

A

1% adults each year visit GP with shoulder pain

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4
Q

What % of adults self reported prevalence of shoulder pain?

A

25% of adults self reported prevalence of shoulder pain

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5
Q

Common Shoulder Symptoms

A
  • Pain
  • Stiffness
  • Weakness
  • Instability
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6
Q

The shoulder is an Inherently … Joint

A

The shoulder is an Inherently unstable Joint

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7
Q

Glenohumeral Joint Stability

  • Static stabilisers - C… and L
  • Dynamic stabilisers - … … Muscles
A
  • Static stabilisers - Capsule and Labrum
  • Dynamic stabilisers - Rotator Cuff Muscles
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8
Q

What are these muscles called?

A

Rotator cuff muscles (named based on position on scapula)

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9
Q

Anterior shoulder - … (rotator cuff muscle) - internal rotation

A

Anterior shoulder - subscapularis (rotator cuff muscle) - internal rotation

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10
Q

Posterior shoulder - …, …, … (rotator cuff muscles) - external rotation

A

Posterior shoulder - Supraspinatus, Infraspinatus, Teres minor (rotator cuff muscles) - external rotation

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11
Q

Rotator cuff muscles - Tendon - attachment to bones

A
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12
Q

Rotator Cuff Biomechanics

  • Rotator cuff - work in … couples
  • Not working - one of their roles keeps head … against glenoid, deltoid and pec cause instability type force on humeral head
A
  • Rotator cuff - work in force couples
  • A force couple is a system that exerts a resultant movement, but no resultant force. Two equal and opposite forces exert a purely rotation force. In the shoulder the body is the humeral head and the equal but opposite forces are the rotator cuff muscles.
  • Not working - one of their roles keeps head pressed against glenoid, deltoid and pec cause instability type force on humeral head
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13
Q

Rotator Cuff Role

  • Stabilise the … Joint
  • Provide a … for power muscles to move arm
A
  • Stabilise the Glenohumeral Joint
  • Provide a FULCRUM for power muscles to move arm
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14
Q

Superficial ‘Power’ Muscles include

A
  • Deltoid
  • Pec major
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15
Q

Risk Factors for Shoulder Pain

  • … related injuries
  • … injuries
  • … conditions
  • … related conditions
A
  • Sports related injuries
  • Traumatic injuries
  • Degenerative conditions
  • Work related conditions
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16
Q

Causes of Shoulder Pain

  • … space
    • Can get … arthritis, Rotator cuff …, calcific …
A
  • Subacromial space - region underneath the acromion and humeral head - rotator cuff tendon reside
    • Can get ACJ arthritis, Rotator cuff tears, calcific tendonitis
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17
Q

Subacromial region

A

can cause shoulder pain

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18
Q

Subacromial Impingement

  • Is it Common?
  • Pain on … & … of arm
  • Felt over …
  • Cause:
    • Extrinsic
      • … spurs
    • Intrinsic:
      • …/… weakness
A
  • Common
  • Pain on abduction & rotation of arm
  • Felt over deltoid
  • Cause:
    • Extrinsic
      • Bony spurs
    • Intrinsic:
      • Tendinopathy/cuff weakness
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19
Q

Treatment for Subacromial Impingement

  • Non surgical
    • … modification
    • …therapy
  • Surgical
    • Subacromial …
      • … of bony and soft tissue impinging areas
A
  • Non surgical
    • Activity modification
    • Physiotherapy
  • Surgical
    • Subacromial decompression
      • Debridement of bony and soft tissue impinging areas
20
Q

Subacromial decompression is an operation on your shoulder which treats a condition called shoulder …

A

Subacromial decompression is an operation on your shoulder which treats a condition called shoulder impingement

21
Q

An … is a type of keyhole surgery used to diagnose and treat problems with joints.

A

An arthroscopy is a type of keyhole surgery used to diagnose and treat problems with joints.

22
Q

Rotator Cuff Tears

  • Most common - …/…
  • Weakness & Pain
  • Tendon … is normal
  • …% in 60’s have a full thickness tear
  • Repair if …
A
  • Most common - supraspinatus/infraspinatus
  • Weakness & Pain
  • Tendon degeneration is normal
  • 15% in 60’s have a full thickness tear
  • Repair if symptomatic
23
Q

Most common Rotator cuff tears in which muscles?

A

supraspinatus/infraspinatus

24
Q

Rotator cuff tears present with … and …

A

weakness and pain

25
Q

Rotator cuff tears - …% in 60’s have a full thickness tear

A

15% in 60’s have a full thickness tear

26
Q

Glenohumeral Joint Problems

  • O..
  • I…
  • … shoulder
A
  • Osteoarthritis
  • Instability
  • Frozen shoulder
27
Q

Glenohumeral Arthritis

  • O..
  • R.. Arthritis
  • Post … arthritis
A
  • Osteoarthritis
  • Rheumatoid Arthritis
  • Post traumatic arthritis
28
Q

Symptoms of Arthritis - Shoulder

  • S…
  • C.. & g…
  • Pain at … and at …
  • Pain with …
A
  • Stiffness
  • Crepitus & grinding
  • Pain at rest and at night
  • Pain with activity
29
Q

Rotator cuff arthritis

A

Rotator cuff tear arthropathy is a type of shoulder arthritis that can develop after a massive and prolonged rotator cuff tear.

30
Q

Rotator Cuff Tear Arthritis - 68yo retired nurse

A
31
Q

Shoulder arthritis treatment is a shoulder …

A

Shoulder arthritis treatment is a shoulder replacement

32
Q

Shoulder replacement

  • Anatomic
    • Fulcrum for power muscles provided by … …
  • Reversed
    • Creates a … fulcrum for power muscles
A
  • Anatomic
    • Fulcrum for power muscles provided by rotator cuff
  • Reversed
    • Creates a mechanical fulcrum for power muscles
33
Q

Frozen Shoulder - Adhesive Capsulitis

  • Pathology = … thickened …
  • Presents with … and Pain, Loss of … motion (EXTERNAL ROTATION)
  • X ray …
  • Most common in …-… years old
  • More common in …
  • Especially common in D…
A
  • Pathology = Inflamed thickened capsule
  • Presents with Stiffness and Pain, Loss of PASSIVE motion (EXTERNAL ROTATION)
  • X ray normal
  • 40-60 years old
  • More common in Females
  • Especially common in Diabetics
34
Q

Frozen Shoulder Treatment

  • Non-…
  • Natural history is to resolve over … years
  • Injections
  • Hydro…
  • If fails - Surgical
    • … release and manipulation
A
  • Non surgical
  • Natural history is to resolve over 2 years
  • Injections
  • Hydrodilatation
  • If fails - Surgical
  • Capsular release and manipulation
35
Q

Arthroscopic capsular release is a surgical procedure to improve movement in the shoulder. A stiff shoulder may sometimes be called a ‘… shoulder’;

A

Arthroscopic capsular release is a surgical procedure to improve movement in the shoulder. A stiff shoulder may sometimes be called a ‘frozen shoulder’;

36
Q

Shoulder Instability

  • …% anterior dislocations
  • … age = higher chance of recurrence
  • Anterior labral tear (bankart lesion)
  • Risk factors
    • … sports
    • Hyper…
A
  • 95% anterior dislocations
  • Younger age = higher chance of recurrence
  • Anterior labral tear (bankart lesion)
  • Risk factors
    • Collision sports
    • Hyperlaxity
37
Q

95% of shoulder dislocations are … dislocations

A

95% of shoulder dislocations are anterior dislocations

38
Q

… age = higher chance of recurrence of shoulder dislocation

A

Younger age = higher chance of recurrence of shoulder dislocation

39
Q

Surgical Treatment for Shoulder Dislocation

  • … stabilisation - labral repair
  • Open stabilisation - … tightening
  • Bony procedures - augmenting …
A
  • Arthroscopic stabilisation - labral repair
  • Open stabilisation - capsule tightening
  • Bony procedures - augmenting glenoid
40
Q

Arthroscopic stabilisation (key hole)

A
41
Q

Traumatic Conditions - Shoulder

  • Bony Trauma
    • F…
    • D…
  • Soft Tissue Trauma
    • … Problems
    • Pec … Rupture
A
  • Bony Trauma
    • Fractures
    • Dislocations
  • Soft Tissue Trauma
    • Biceps Problems
    • Pec Major Rupture
42
Q

Shoulder Trauma

A
  • Fractures
  • Dislocations
  • Soft tissue injuries
43
Q

Proximal Humeral Fractures

A
  • Common
  • Nails for treatment, or plates, or non operative
44
Q

Acromioclavicular Joint Dislocations

A
  • An AC joint separation, often called a shoulder separation, is a dislocation of the clavicle from the acromion.
  • Issues with Shoulder blade movement
45
Q

Anatomically, why is impingement of the supraspinatus tendon a common sports injury?

A

Shoulder impingement syndrome is the result of a vicious cycle of rubbing of the rotator cuff between your humerus and top outer edge of your shoulder.

Supraspinatus tendinopathy is a common source of shoulder pain in athletes that participate in overhead sports

Year 2 Medicine (162 decks)

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