Shoulder Conditions

Question 1

What is a shoulder dislocation?

Answer 1

Head of humerus comes entirely out of the glenoid cavity

Question 2

What is subluxation?

Answer 2

Partial dislocation

Question 3

What are the majority of shoulder dislocations?

Answer 3

Anterior- 90%
Head of humerus moves anteriorly in relation to the glenoid cavity

Question 4

What are posterior dislocations associated with?

Answer 4

Electric shocks
Epileptic seizures

Question 5

What damage does dislocation cause?

Answer 5

Bankart lesions
Hill- Sachs lesions
Axillary nerve damage
Fractures- humeral head, acromion, clavicle
Rotator cuff tears

Question 6

What are Bankart lesions?

Answer 6

Tears to anterior labrum due to repeated dislocations

Question 7

What are Hill-Sachs lesions?

Answer 7

Compression fractures of the humeral head

Question 8

What is the presentation of shoulder dislocation?

Answer 8

Muscles go into spasm and tighten around the joint
Patient holding arm against body
Flattened deltoid
Palpable bulge at front of shoulder

Question 9

What investigations are carried out in shoulder dislocation?

Answer 9

X ray- confirm dislocation, exclude fracture
MRI- Bankart and Hill-Sachs lesions
Arthroscopy

Question 10

What is acute management of dislocation?

Answer 10

Relocate ASAP
Analgesia, muscle relaxants, sedation
Gas and air
Arm sling
Surgery if a fracture
Immobilisation

Question 11

What is ongoing management of dislocation?

Answer 11

Physiotherapy
Shoulder stabilisation surgery

Question 12

What is frozen shoulder?

Answer 12

Adhesive capsulitis
Causes shoulder pain and stiffness

Question 13

What is primary adhesive capsulitis?

Answer 13

Occurs spontaneously without any trigger

Question 14

What is secondary adhesive capsulitis?

Answer 14

Occurs in response to trauma, surgery or immobilisation

Question 15

What is the pathology of frozen shoulder?

Answer 15

Inflammation and fibrosis in the joint capsule lead to adhesions (scar tissue)
The adhesions bind the capsule, tightening it around the joint and restricting movement

Question 16

What are the 3 phases of frozen shoulder?

Answer 16

Painful phase
Stiff phase
Thawing phase

Question 17

What is painful phase of frozen shoulder?

Answer 17

Shoulder pain
First symptom
Worse at night

Question 18

What is stiff phase of frozen shoulder?

Answer 18

Shoulder stiffness
Affects active and passive movements
Lateral rotation most affected
Pain settles

Question 19

What is thawing phase of frozen shoulder?

Answer 19

Gradual improvement in stiffness and return to normal

Question 20

How long does frozen shoulder last?

Answer 20

1- 3 years before resolving
Persists in 50%

Question 21

How is frozen shoulder diagnosed?

Answer 21

History and examination
X ray normal
MRI shows thickened joint capsule

Question 22

What are the non surgical treatment options for frozen shoulder?

Answer 22

Continue using the arm
Analgesia
Physio
Intra-articular steroid injections
Hydro dilatation- inject fluid into joint to stretch capsule

Question 23

What are the surgical treatment options for frozen shoulder?

Answer 23

Manipulation under anaesthesia- to stretch the capsule
Arthroscopy- key hole surgery to cut the adhesions

Question 24

What muscles make up the rotator cuff?

Answer 24

Supraspinatus- abduction
Infraspinatus- lateral rotation
Teres minor- lateral rotation
Subscapularis- medial rotation

Question 25

What is a rotator cuff injury?

Answer 25

Full or partial tear of the tendons of the rotator cuff muscles

Question 26

What is the typical presentation of rotator cuff injury?

Answer 26

Shoulder pain
Weakness and pain with specific movements
Sleep disruption

Question 27

What investigations are carried out for rotator cuff injury?

Answer 27

Ultrasound or MRI as this is a soft tissue injury

Question 28

What is the management of rotator cuff injury?

Answer 28

Rest and adapted activity
Analgesia
Physio
Arthroscopic rotator cuff repair