Flashcards in COMMON CONDITIONS OF THE UPPER LIMB Deck (74)
Name the four muscles that make up the rotator cuff.
What movement(s) is the supraspinatus involved in?
Abduction of the shoulder
How do you test the function of the supraspinatus?
Empty can test - patient's arms out at 45 degrees, get them to internally rotate so that their thumbs point downwards, then test abduction against examiner. Looking for pain or weakness.
What movement(s) are the infraspinatus and teres minor involved in?
External rotation at the shoulder
How do you test the function of the infraspinatus and the teres minor?
Jobe's test - External rotation whilst examiner stabilises shoulder to prevent abduction. Looking for pain or weakness.
What movement(s) is the subscapularis involved in?
Internal rotation at the shoulder
How do you test the function of the subscapularis?
Wall push off test - patient puts their arm behind their back placing their palm on the wall and tries to push off from the wall using their arm. Looking for pain or weakness.
Belly press test - patient pushes their hands into their abdomen. This should push their arms out forwards. Looking for pain or weakness.
What is shoulder impingement?
Tendinopathy of one of the rotator cuff muscles. Most commonly affects the supraspinatus.
What is the underlying pathology in supraspinatus impingement?
Narrowing of the subacromial space will cause irritation and inflammation of the tendon as it passes through the space.
What are the causes of supraspinatus impingement?
Bony structures such as subacromial spurs, osteoarthritic spurs on the acromialclavicular joint.
Thickening or calcification of the coracoacromial ligament.
Thickening of the subacromial bursa.
In a shoulder examination, which special test might you do to look for shoulder impingement?
Hawkin's test - looking for pain when the elbow is flexed to 90 degrees, the shoulder is flexed to 90 degrees and the arm is internally rotated. This narrows the subacromial gap and hence will elicit the symptoms of supraspinatus impingement.
What might you see on a radiograph of a patient with supraspinatus impingement?
Soft tissue inflammation
What are the management options for a patient diagnosed with shoulder impingement?
Laparoscopic shaving of the subacromial space to reduce irritation.
Which of the rotator cuff muscles is most frequently torn?
What might cause an acute tear of the supraspinatus?
Dislocation of the shoulder
In a shoulder examination, how might you test whether there was a tear in the supraspinatus?
Drop arm sign - passively abduct the arm and then ask patient adducts it slowly. If there is damage to the supraspinatus, they will feel a catching pain at 30 degrees of abduction.
How would you treat a patient with a tear of the one of the rotator cuff muscles?
Reverse polarity replacement - the ball is placed where the glenoid cavity was and the cup is attached to the humerus. This moves the point of leverage medially and allows the deltoid muscle to play a greater role in initiating abduction.
What are the causes of ACJ arthritis?
Wear and tear
In a shoulder examination, what special test might you use to help you diagnose ACJ arthritis?
Scarf test - patient brings a forward flexed arm across the front of their body and around their neck. Looking for pain or weakness.
What are the treatment options for a patient with ACJ arthritis?
Excision of the AC joint is often done to relieve symptoms of ACJ arthritis. The bone ends will scar over which along with increased joint space will alleviate the pain.
What is the proper name for frozen shoulder?
What will a patient with adhesive capsulitis initially complain of?
Pain on external rotation
Will adhesive capsulitis heal without intervention?
Yes. After about 18 months.
What is the underlying pathophysiology of adhesive capsulitis?
The connective tissue surrounding the glenohumeral joint becomes inflamed and stiff. There is also a lack of synovial fluid.
What symptoms might a patient with suspected adhesive capsulitis present with?
Pain/stiffness on external rotation
Pain/stiffness on abduction
Worse at night
Worse in cold weather
Is the loss of movement in adhesive capsulitis passive as well as active?
What are the risk factors for adhesive capsulitis?
Reduction in use
Connective tissue disease
What are treatment options for someone with adhesive capsulitis?
Manipulation under anaesthetic
What is phase 1 of adhesive capsulitis?
Phase 1 - severe generalised pain associated with stiffness. Daily activities are limited (eg, putting on a jacket). It can last up to nine months.