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MSK Week 5 2017/18 > 3: Shoulder pathologies and upper limb nerve entrapment > Flashcards

3: Shoulder pathologies and upper limb nerve entrapment Flashcards

(73 cards)

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1
Q

What are five common shoulder pathologies?

A

Instability

Cuff impingement

Cuff tear

Frozen shoulder

Arthritis

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2
Q

What shoulder pathology do patients tend to get in their 20-30s?

A

Instability

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3
Q

What shoulder pathology do patients tend to get in their 30-40s?

A

Impingement

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4
Q

What shoulder pathology do patients tend to get in their 60s onwards?

A

Arthritis

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5
Q

The shoulder joint is the most ___ joint in the body.

A

mobile

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6
Q

Is the shoulder joint stable?

A

In terms of bones, no

But muscles provide a lot of stability

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7
Q

Which four joints make up the shoulder girdle?

A

Sternoclavicular

Acromioclavicular

Scapulothoracic (not a real joint)

Glenohumeral

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8
Q

What is a static stabiliser of the shoulder found in the glenoid fossa?

A

Labrum

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9
Q

What are the four rotator cuff muscles?

What movements are they responsible for?

A

Supraspinatus - first 15 degrees of abduction

Infraspinatus - external rotation

Teres minor - adduction and internal rotation

Subscapularis - adduction and internal rotation

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10
Q

What are the four extrinsic muscles of the shoulder?

A

Deltoid

Trapezium

Pec major

Latissimus dorsi

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11
Q

What are the six movements performed at the shoulder?

A

Flexion / extension

Internal / external rotation

Abduction / adduction

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12
Q

What type of patient tends to get shoulder instability?

A

Teenagers - 30s

Sporty

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13
Q

What is the usual mechanism of shoulder instability?

A

Trauma causing subluxation / dislocation

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14
Q

(Anterior / posterior) dislocations are the most common.

A

Anterior

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15
Q

What are some unusual causes of posterior dislocation?

A

Seizures

Electrocution

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16
Q

What is a sign of dislocation on X-ray?

A

Increased space between humeral head and glenoid

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17
Q

What is a long-term consequence of shoulder instability?

A

Recurrent subluxations/dislocations

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18
Q

Shoulder instability can be caused by ligamentous laxity - in which diseases is this seen?

A

Ehlers-Danlos syndrome

Marfan’s syndrome

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19
Q

Which sign of shoulder instability may be seen on examination?

What is this caused by?

A

Sulcus sign

Inferior instability of shoulder joint

think posterior dislocation (not common)

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20
Q

How is an acute shoulder dislocation treated?

A

Analgesia

Oxygen

Sedation

REDUCTION BY MANIPULATION

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21
Q

What methods can be used to reduce a shoulder dislocation?

A

Kocher method

Hippocratic method

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22
Q

How is a shoulder dislocation treated post-reduction?

A

Sling

Analgesia

Movement - physiotherapy

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23
Q

What imaging is used to visualise shoulder dislocations?

A

X-rays (AP)

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24
Q

If a patient is having recurrent shoulder dislocation, what imaging method is used to investigate?

A

MRI

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25
What is a Bankart lesion? Why is MRI used to identify it?
**Tear in labrum which shoulder can dislocate into repeatedly** Soft tissue lesion - labral tear
26
What is a Hill Sachs lesion?
**Fracture in humeral head which may predispose to recurrent dislocation**
27
All patients with shoulder instability receive \_\_\_.
**physiotherapy**
28
Is shoulder instability operated on?
**No**
29
The risk of recurrent shoulder dislocation **(increases / decreases)** with age.
**decreases**
30
How long should patients wait before they get back to contact sports following a shoulder dislocation?
**6 months**
31
**Impingement syndrome pain** originates from the ___ \_\_\_.
**subacromial space**
32
Impingement can be either ___ or \_\_\_.
**intrinsic -** problem with rotator cuff muscles themselves **extrinsic -** pressure from elsewhere
33
What are some possible rotator cuff pathologies causing impingement syndrome?
**Tendonitis** (+/- calcinosis) ## Footnote **Bursitis** **Cuff tear**
34
Many cuff tears are \_\_\_.
**asymptomatic**
35
Inability to REACH/STRETCH to pick up things is a typical presentation of what?
**Impingement syndrome** **Polymyositis**
36
Painful arc syndrome is a type of rotator cuff \_\_\_.
impingement
37
What test can be used to diagnose impingement?
**Hawkins-Kennedy test** **Painful arc on abduction**
38
What is seen on X-ray of a patient with impingement syndrome?
**Calcification of humeral head**, **subacromial space**
39
What other scans can be used in patients with impingement?
**Ultrasound** **MRI** both show soft tissue swelling, fluid, muscle damage
40
How is impingement syndrome treated?
**Rest** **Analgesia** **Physiotherapy** **2x steroid injections in subacromial space**
41
What is removed in decompression surgery for shoulder impingement?
**Subacromial bursae** **Bits of acromion** **CA ligament**
42
What is a major symptom following shoulder surgery for impingement?
**Pain**
43
Gray hair = ___ \_\_\_.
**cuff tear**
44
Who tends to get rotator cuff tears?
**Older patients (50s-60s)**
45
Most rotator cuff tears are (acute / chronic).
**chronic**
46
People with rotator cuff tears complain of ___ and \_\_\_.
**weakness** **pain**
47
What may be **seen** on examination of someone with a rotator cuff tear?
**Muscle wasting** **Weakness** (reduced passive movement, normal active movement)
48
What is reduced in the X-ray of someone with a rotator cuff tear?
**Subacromial space**
49
What bony landmark of the humerus is reduced in patients with rotator cuff tears?
Greater tuberosity
50
Apart from X-ray, what imaging can be used to view rotator cuff tears?
**MRI**
51
How are rotator cuff tears treated?
**Rest** **Analgesia** **Sling** **PHYSIOOOOO** **surgery if required**
52
Why are acute rotator cuff tears treated more urgently than chronic ones?
**Shoulder function may be preserved with treatment**
53
Is there any difference in outcome between keyhole and open shoulder surgery?
**No**
54
How long do people with rotator cuff injuries spend recovering compared to those with impingement?
**Longer**
55
What is the likelihood of a repaired rotator cuff muscle **re-tearing**?
30-40%
56
Who tends to get frozen shoulders?
**Females aged 40-50**
57
What conditions are associated with frozen shoulder?
**Diabetes** **Endocrine disease** **Lipid disease** **Dupuytren's**
58
What contracts and thickens in frozen shoulder?
**Gleno-humeral ligament** reduces joint space, eventually causing synovitis
59
What is the natural progression of frozen shoulder?
**Freezing** (0-6 months, pain disrupting sleep and daily life) **Frozen** (less pain, moreso stiffness) **Thawing** (movement returns)
60
How long does frozen shoulder take to resolve?
**3-4 years**
61
What MUST be obtained before you can diagnose a patient with frozen shoulder? Why?
**X-ray** OA and locked posterior dislocation also limit external rotation
62
Apart from the generic rest, analgesia, physio treatment, what non-operative treatment is available for frozen shoulder?
Fluroscopic something popping capsule with air
63
Frozen shoulder has a (sudden / gradual) onset.
**sudden**
64
The likely shoulder pathology in those over 60 is...
**arthritis**
65
What kinds of arthritis can affect the shoulder?
OA RA Post-traumatic arthritis
66
Glenohumeral joint arthritis sets in (acutely / chronically) and causes what kind of pain?
**chronic** **Pain at rest and at night**
67
Arthritic GH joints will also be \_\_\_.
**stiff**
68
What are the four signs of GH joint OA on X-ray?
**Loss of joint space** **Osteophytes** **Sclerosis** **Subchondral cysts**
69
How is GH joint RA treated?
Analgesia Physiotherapy Steroid injections +/- DMARDS, Biologics
70
What is the operative route for treating GH joint arthritis?
**Total shoulder replacement** or **arthroplasty** e.g resurfacing, partial replacement
71
In which neuropathy is the a) median nerve b) ulnar nerve compressed?
**a) Carpal tunnel** **b) Cubital tunnel**
72
Carpal tunnel syndrome is more common in (men / women).
**women**
73
What are some conditions associated with carpal tunnel syndrome?
**Pregnancy** **Diabetes** **Hypothyroidism** **RA**

MSK Week 5 2017/18 (12 decks)

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