Session 7 - Common shoudler conditons

Question 1

Fractures of the Scapula

If these fractures occur, what are they an indication of?

Answer 1

An indication of severe chest trauma

Question 2

Fractures of the Scapula

Where are this fractures frequently seen?

Answer 2

They are frequently seen in

• high-speed road collisions
• crushing injuries
• high impact sports injuries

Question 3

Fractures of the Scapula

Why does this fracture not typically require fixation?

Answer 3

It does require fixation because the tone of the surrounding muscles hold the fragments in place whilst healing occurs

Question 4

Fractures of the surgical neck of the humerus

How does this fracture normally arise?

Answer 4

• Blunt trauma to the shoulder

- From falling on an outstretched hand

Question 5

Fractures of the surgical neck of the humerus

What are the 2 key neurovascular structures at risk here?

Answer 5

• The axillary nerve

- The posterior circumflex humeral artery

Question 6

Fractures of the surgical neck of the humerus

What does damage to the axillary nerve result in?

Answer 6

• Result in paralysis of the deltoid and teres minor muscles
• Patients will have difficulty performing abduction of the affected limb
• Sensation in the skin over the insertion of the deltoid muscle will be impaired

Question 7

Ruptures of the Biceps Tendon

What type of individuals do these ruptures take place and where?

Answer 7

Over the age of 50 - following quite minimal trauma - long head of biceps rupture near to its scapular origin

Weightlifters - distal tendon of biceps snaps near to its insertion

Question 8

Ruptures of the Biceps Tendon

What does the patient report and why don’t they notice much weakness?

Answer 8

• heard something snap in the shoulder whilst lifting
• not notice much weakness in the upper limb because the action of the brachialis (flexion at the elbow and shoulder joint and supination at the radioulnar joint) are intact

Question 9

Ruptures of the Biceps Tendon

What is the popeye sign?

Answer 9

A characteristic of a ruptured bicep tendon
- flexion of the arm at the elbow produces a frim lump in the lower part of the arm –> this is the unopposed contracted muscle belly of the biceps

Question 10

Dislocated shoulder

Features of a dislocated shoulder

Answer 10

• visibly deformed
• visible swelling
• bruising around the shoulder
• movement will be severely restricted
  (Loss of function)

Question 11

Dislocated shoulder

In which direction does 90-95% of shoulder dislocation occur? Why?

Answer 11

Anteroinferiorly, anterior

• the glenohumeral joint is weak at its inferior aspect

Question 12

Dislocated shoulder

Give examples of 2 types of anterior dislocation

Answer 12

In the Subcoracoid location 60% of cases - dislocation anteriorly due to the lull of the muscles and situation of the anterior capsule and ligaments

In the subglenoid location 30% of cases - head of humerus come to lie anterior-inferior to the glenoid

Question 13

Dislocated shoulder

What is the mechanism of a anterior/ anterior-inferior dislocation?

Answer 13

• fall; direct or indirect

- direct blow to the posterior shoulder

Question 14

Dislocated shoulder

Anterior dislocation

What is a Bankart lesion?

Answer 14

When the force of the humeral head popping out of the socket cause a part of the glenoid labrum to be torn off and there is a stretch of the glenohumeral ligaments

Question 15

Shoulder dislocation

Anterior dislocation

What is a Bony bankart lesion?

Answer 15

When a bit of Bone as well as a bit of the glenoid labrum is torn off when the head of the humerus is popped out of the glenoid cavity/ fossa