Shoulder Pathology

Question 1

Name four diseases of the shoulder

Answer 1

• instability
• cuff disease
• frozen shoulder
• arthritis

Question 2

Who typically experiences shoulder instability?

Answer 2

Young/sporty trauma patients

Question 3

What type of instability is more common?

Answer 3

Anterior

Posterior - electrocution/epileptic fit

Question 4

What is the re-dislocation rate in young people?

Answer 4

80%

Question 5

Name three methods of relocation

Answer 5

Kocher
Hippocratic
Stimson

Question 6

How is shoulder instability diagnosed?

Answer 6

Oblique garth view Xray

Question 7

Name two types of lesion that can occur due to shoulder instability

Answer 7

Bankart

Hill Sachs

Question 8

Describe a Bankart lesion

Answer 8

Injury of anterior, inferior glenoid labrum

Question 9

Describe Hill Sachs lesion

Answer 9

Cortical depression in the posterolateral head of the humerus

Question 10

What is a bony bankart lesion?

Answer 10

Bankart lesion that includes a fracture to the glenoid cavity of the scapula

Question 11

How is shoulder instability treated?

Answer 11

Relocate shoulder
Physio
Repair labrum
Deepen socket to stabilise shoulder

Question 12

What is impingement syndrome?

Answer 12

Tendons of the rotator cuff are compressed in the sub-acromial space during movement producing pain

Question 13

How do patients with impingement present?

Answer 13

Painful arc 60-120 degrees

Question 14

Name the causes of impingement

Answer 14

Tendonitis 
Subacromial bursitis 
Acromioclavicular OA with oesteophyte 
Hooked acromion 
Rotator cuff tear

Question 15

Where does impingement pain typically radiate to?

Answer 15

Deltoid and upper arm

Question 16

Name the test that recreates the impingement pain

Answer 16

Hawkins Kennedy

Question 17

How is impingement treated?

Answer 17

Conservative with NSAIDs, analgesia, physio
2 steroid injections
Subacromial decompression surgery

Question 18

Name the two types of cuff tear

Answer 18

Acute - trauma

Chronic - degenerative

Question 19

Who usually gets a rotator cuff tear?

Answer 19

Older patients with a history of sudden jerk

Question 20

Describe the affected muscle related to the weakness

Answer 20

Supraspinatus - abduction
Subscapular - internal rotation
Infraspinatus - external rotation

Question 21

What investigation will confirm a rotator cuff tear?

Answer 21

Ultrasound

MRI

Question 22

Describe rotator cuff tear treatment

Answer 22

Chronic - self limiting, physio, steroid

Acute - Open or arthroscopic repair with subacromial decompression

Question 23

Describe the disease progression of frozen shoulder

Answer 23

Pain
Stiffness
Resolves in 18-24 months

Question 24

How will frozen shoulder present?

Answer 24

Loss of external rotation

Question 25

What diseases are frozen shoulder associated with?

Answer 25

Diabetes
Hypercholesterolaemia
Dupuytren’s
Trauma

Question 26

What is the pathology of frozen shoulder?

Answer 26

The capsule and glenohumeral ligaments become inflamed then thicken and contract - adhesive capsulitis

Question 27

How is frozen shoulder diagnosed?

Answer 27

Scapular thoracic movement
Normal xray
Lack of external rotation

Question 28

Describe the non-operative management of frozen shoulder

Answer 28

Physio

Analgesics and steroids

Question 29

Describe the operative management of frozen shoulder

Answer 29

Manipulation under anaesthetic or surgical capsular release

Question 30

What is acute calcific tendonitis?

Answer 30

Acute onset severe shoulder pain characterised by calcium deposition in the supraspinatus tendon

Question 31

Where is the calcium seen on X-ray?

Answer 31

Proximal to the greater tuberosity

Question 32

How is acute calcific tendonitis managed?

Answer 32

Self limiting

Pain - subacromial steroid or local aesthetics