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MC > Shoulder pain > Flashcards

Shoulder pain Flashcards

1
Q

By the age of 50 about _____of people have some wear and tear of the rotator cuff, making it more injury-prone.

A

25%

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2
Q

Disorders of the rotator cuff are common,
especially ________. The most effective tests to diagnose these problems are the
________

A

supraspinatus tendonopathy

resisted movement tests

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3
Q

Apart from the AC joint there
are two most significant functional joints—
1
2

A 
the glenohumeral (the primary joint) and the
subacromial complex (the secondary joint)
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4
Q

a ball and socket joint enveloped by a loose capsule

It is prone to injury from traumatic forces and develops osteoarthritis
more often than appreciated.

A

glenohumeral joint

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5
Q

The clinically important ________ lies
above the glenohumeral joint between the head of the humerus and an arch formed by the bony acromion, the thick coracoacromial ligament and the coracoid process

A

perihumeral space

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6
Q

The socalled_________ is the space between the undersurface of the acromion and the superior aspect of the humeral head.

This space is normally
narrow (6–14 mm), especially when the arm is
abducted.

A

‘impingement interval’

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7
Q

The commonest causes of pain in the shoulder zone ______ and ______

A

are cervical disorders and periarthritis

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8
Q

The outstanding common

disorders of the shoulder joint are the __________ and ______

A

rotator

cuff disorders and adhesive capsulitis

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9
Q

Labrum/capsule

15–35

Dislocations

History of dislocation, apprehension sign

A

Instability

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10
Q

Capsule

40–60

Pain, night pain, loss of movement

Loss of external rotation

A

Stiffness

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11
Q

Rotator cuff (fatigue)

30–60

Night pain, pain with overhead activities

Impingement signs

A

Impingement

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12
Q

Rotator cuff esp. supraspinatus

50 +

Impingement signs, weakness external
rotation, weakness supraspinatus

A

Rotator cuff tear

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13
Q

AC joint cartilage

25–45

Localised AC joint pain

Paxinos sign

A

AC joint pain

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14
Q

Glenohumeral joint cartilage

70 +

Pain, loss of movement

Crepitus

A

Arthritis

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15
Q

The tendon disorders are diagnosed by_______

A

pain on resisted movement

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16
Q

1 Abduction _______
2 Internal rotation ______
3 External rotation*
4 Adduction

A

Supraspinatus
Subscapularis
Infraspinatus Teres minor* Biceps
Pectoralis major Latissimus dorsi*

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17
Q

but with capsulitis and subacromial bursitis there is usually restriction in
________

A

most directions.

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18
Q

Dxtics for posterior dislocation

A

shoot-through axillary views (posterior

dislocation

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19
Q

MRI—a useful imaging method but not

routinely required except for the____

A

unstable joint

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20
Q

_______may be caused by local musculoskeletal trauma or inflammation or can be referred from blood or other irritants in the peritoneal cavity

A

Pain at the shoulder tip

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21
Q

American studies of college and

national competition swimmers showed ______ had suffered significant pain

A

40–60%

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22
Q

Swimmers’ shoulders are forced through
thousands of revolutions each day, so the susceptible area tends to impinge on the coracoacromial arch, leading to the _________, which can
progress with continued stress and age

A

impingement syndrome

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23
Q

Stages of Swimmer’s shoulder

  • Stage 1: pain only after activity
  • Stage 2: ____
  • Stage 3:_______
A

pain at beginning only, then after activity

pain during and after activity, affects
performance

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24
Q

Mx of Swimmer’s shoulder

A

Refer for physiotherapy for scapular stabilisation and cervicothoracic mobilisation

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25
Q

DDx of shoulder pain in the elderly

A

• polymyalgia rheumatica (increased incidence
with age)
• supraspinatus tears and persistent ‘tendonitis’
• other rotator cuff disorders
• stiff shoulder due to adhesive capsulitis
• osteoarthritis of AC and glenohumeral joints
• cervical dysfunction with referred pain
• the avascular humeral head

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26
Q

The humeral head may become avascular after major _________

A

proximal humeral fractures

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27
Q

Once the humeral head has collapsed, there is ______

A

secondary

capsular contracture

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28
Q

________ also referred to as

‘impingement syndrome’, is the commonest cause of shoulder pain.

A

Rotator cuff tendonopathy,

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29
Q

Rotator cuff tendonopathy,

It may involve one tendon, usually the
__________, or more of the rotator cuff tendons

A

supraspinatus

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30
Q

The severe cases usually involve calcification (calcific periarthritis) of the tendon, which has a very rapid onset, and spread to the subacromial bursa (subacromial bursitis).

A

Supraspinatus tendonopathy

31
Q

The impingement tests

These are effective tests for supraspinatus lesions as they force impingement of the _____ and ________ under the acromion

A

rotator cuff and bursa

32
Q

The impingement tests

One of these tests is the_______

A

‘emptying

the can’ resistance test

33
Q

What muscle is tested

Elevation of the arm is resisted against the therapist’s downward push.

A

supraspinatus.

34
Q

Mx of Supraspinatus tendonopathy

A

Physiotherapy—an active program including
scapular stabilising exercises and rotator cuff
strengthening

35
Q

The ideal injection for supraspinous tendinopathy is a specific injection onto the
_______ rather than

A

tendon rather than general infiltration into the

subacromial space

36
Q

Injection for Supraspinatus tendonopathy

A

The recommended injection is 1 mL of a soluble or long-acting corticosteroid with 5 mL of 1% lignocaine

37
Q

Persistent supraspinatus tendonopathy

There are three factors to consider with this problem:

A

A very tight subacromial space
Rotator cuff tear or degeneration
Calcification of the tendon

38
Q

Mx of tight subacromial space

A

Refer for subacromial decompression by division of the thickened coracoacromial ligament

39
Q

Indication of subacromial decompression

A

pain persisting beyond 12 months

40
Q

_________ are common, being present in 4% of people <40 years old and in more than 50% of those over 60 years, but a significant number will become symptomatic over time.

A

Asymptomatic rotator cuff tears

41
Q

Diagnsois of rotator cuff tears

A
  • supraspinatus weakness
  • weakness in external rotation
  • impingement (in external or internal rotation or both)
42
Q

Specificity of 3 signs of rotator cuff tears

A

98%

43
Q

It is the only inflammatory disorder around the shoulder joint where localised tenderness is a reliable sign.

A

Subacromial bursitis

44
Q

Mx of Subacromial bursitis (injection)

A

Large local injection of 5–8 mL of local
anaesthetic into and around the bursa just beneath the acromion, followed immediately by
1 mL of corticosteroid (long-acting) into the
focus of the lesion

45
Q

_________ is an acute
inflammation affecting the glenohumeral joint,
which becomes fibrotic and contracted

A

Adhesive capsulitis or capsulosis

46
Q

AKA froxen shoulder

A

Adhesive capsulitis or capsulosis

47
Q

ddx for Adhesive capsulitis or capsulosis

A

monoarticular rheumatoid arthritis, a crystal arthropathy such as gout, and
septic arthritis.

48
Q

3 stages of adhesive capsulitis

A

1 ‘freezing, frozen and thawing’—an inflammatory
painful phase of 2–9 months
2 a fibrotic contracted phase of 4–12 months
3 partial or complete resolution of 5–26 months

49
Q

Adhesive capsulitis:

For severe pain oral _______ rapidly
alleviate pain, improve function and may provide sustained benefit

A

corticosteroids

50
Q

Modern Tx of adhesive capsulitis

A

The modern treatment is arthrographic
hydrodilatation of the glenohumeral joint with a large quantity of sterile solution (to stretch the capsule) ± corticosteroid.

51
Q

Modern Tx of adhesive capsulitis

The rule is: if very stiff use ______ if more mobile use a _____

A

arthroscopy;

distension procedure

52
Q

_____of people with adhesive capsulitis do not regain full normal movement if untreated

A

Fifty per cent

53
Q

Exercises in adhesive capsulitis

A

Exercise in the acute phase can exacerbate pain but

a gentle program is useful when it settles.

54
Q

______ is a lesion such as fraying or tearing of the long head of the biceps, which causes pain in front of the shoulder

A

Bicipital tendonopathy

55
Q

Yergason test for bicipital tendonopathy

A

pain on resisted flexion of the elbow joint and on
resisted supination with the elbow flexed to 90 ° and
forearm pronat

56
Q

bicipital tendonopathy

Sometimes it is possible to elicit local tenderness by palpation along the course of the tendon in the ______

A

bicipital groove

57
Q

bicipital tendonopathy CX

A

complete rupture and subluxation

of the tendon out of its groove.

58
Q

It may be spontaneous or occur
after lifting or falling on the outstretched hand. The patient usually feels a tearing or snapping sensation in the shoulder.

A

Rupture of the biceps tendon

59
Q

surgical intervention for ruptured biceps tendon is appropriate for

A

young, active people, especially those in power sports.

60
Q

It is very important not to misdiagnose _________ in the older person (over 50 years) presenting with bilateral pain and stiffness in the shoulder girdle

A

polymyalgia rheumatica

61
Q

Consider this condition if there is a history
of electric shock or a tonic–clonic convulsion. The major clinical sign is painful restriction of external rotation, which is usually completely blocked

A

Posterior dislocation of the shoulder

62
Q

______ and ________ or

both, are probably more common than recurrent dislocations, yet frequently are not diagnosed

A

Recurrent anterior or inferior subluxations,

63
Q

_________

is considered the best investigation for Recurrent anterior or inferior subluxations,

A

Air-contrast CT arthrography

64
Q

The ________ is the ring of fibrous
tissue attached to the rim of the glenoid and
provides volume to the cavity and stability to the glenohumeral joint

A

glenoid labrum

65
Q

Injuries to the labrum are divided into :

A

superior labrum anterior to posterior

(SLAP) or non-SLAP lesions and further into stable and unstable lesion

66
Q

________ lesions include degenerative, flap and vertical labral tears as well as unstable lesions such as the classic Bankart lesion

A

Non-SLAP

67
Q

_________the labrum and

capsule is detached from the rim

A

Bankart lesion,

68
Q

This is usually secondary to local trauma, longstanding rotator cuff lesions and multiple surgical interventions.

Shoulder movements are stiff and
usually restricted in all directions

A

Osteoarthritis of the glenohumeral joint

69
Q

This condition is usually traumatic or degenerative and is relatively common in builders and sportspeople, especially rowers, and the elderly

A

Acromioclavicular osteoarthritis

70
Q

What test

A key test for AC joint pain

pain is elicited on compression of
the joint by placing one hand on the back of the acromion and one on the clavicle.

A

Paxinos sign

71
Q

_______ and ______ are very refractory to

treatment and tend to last for several months.

A

Tendonitis and bursitis

72
Q

Test for ________ (including

swimmer’s shoulder) with the impingement tests, including the ‘emptying the can’ test

A

supraspinatus disorders

73
Q

_______ is the investigation of choice for painful disorders of the rotator cuff, especially to investigate tears in tendons

A

Modern ultrasound

74
Q

An elderly person presenting with bilateral

shoulder girdle pain has ________until proved otherwise

A

polymyalgia rheumatica

MC (90 decks)

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