Common shoulder conditions Flashcards
(24 cards)
Presentation of dislocated shoulder
- Visible swelling and bruising
- Movement restricted
- Anterior = external rotation and slight abduction
Anterior dislocation
- Most are anterior
- Glenoid fossa shallow and joint weak inferiorly
- Dislocates anteroinferiorly but then displaces anteriorly due to pull of muscles and disruption of anterior capsule and ligaments
- Hand behind head
Bankart lesion/labral tear
Force of humeral head leaving glenoid fossa causes part of glenoid labrum to be pulled off, this can also pull off a small piece of bone
Hill Sachs lesion
Tone of infraspinatus and teres minor muscle cause posterior aspect of humeral head to be jammed against anterior lip of glenoid fossa = dent in humeral head
Posterior dislocation
- Much rarer
- Violent muscle contractions - seizure, electrocution, lightning strike, blow to anterior shoulder
- Internal rotation and adduction
- Squaring of shoulder w prominent coracoid process
- Light bulb sign on XR and increased glenohumeral distance and scapular/Y view
Inferior dislocations
- Super rare
- Hyperabduction to displace humeral head from inferior glenoid
Recurrent dislocation
Complication of shoulder dislocation due to damage to stabilising tissues.
As age, tissues less elastic so risk of recurrent dislocation is big in youth and falls as we age.
Every dislocation = further damage to humeral head so risk of OA increases.
Damage to axillary artery in dislocation
- V rare
- More common w age as blood vessels less elastic
- Haematoma, absent pulses, cool limb
Damage to axillary nerve in dislocation
- More common than artery damage
- Wraps around neck of humerus and supplies deltoid and skin overlying insertion = regimental badge area
- Symptoms resolve when shoulder reduced
(could also damage cords of brachial plexus or musculocutaneous nerve)
Fractures in dislocation
- Traumatic mechanism of injury, first time dislocation and older people
- Head or greater tubercle of humerus
- Clavicle
- Acromion
Clavicle fractures
- Common, esp in children and YA
- Clavicle normally protects brachial plexus, subclavian vessels and apex of lung
- Most in middle third due to FOOSH
- Sling to fix in most cases
Indications for surgery in clavicle fractures
- Complete displacement - if bones aren’t in apposition they can’t unite
- Severe displacement = tenting of skin w risk of puncture
- Open fractures
- Neurovascular compromise
- Fractures w interposed muscle
- Floating shoulder
Position of arm in clavicular fracture
- Medial segment elevated by sternocleidomastoid muscle
- Trapezius muscle can’t hold lateral segment up against weight = shoulder drop
- Arm pulled medially by pectorals major
Complications of clavicular fractures
- Pneumothorax
- Injury to surrounding neurovascular structures
Rotator cuff tears
Tear of tendons of the rotator cuff muscles:
1. Supraspinatous !!!! at greater tubercle of humerus
2. Infraspinatous
3. Subscapularis
4. Teres minor
When tears occur - stabilisation of glenohumeral joint, abduction, external rotation and internal rotation of humerus compromised.
Chronic pain due to age related degeneration as blood supply decreases impairing body ability to repair minor injuries.
Recurrent lifting and repetitive over head activity.
Pain of rotator cuff tear
- Asymptomatic
- Anterolateral shoulder pain
- Radiates down arm
- Lean on elbow and push downwards and when reaching forwards
- Weakness of shoulder abduction
Impingement syndrome
Supraspinatous tendon impinges on acromial arch = inflame and irritation.
Space narrowed by eg. thickening of coracoacromial ligament or inflammation of tendon and when shoulder abducted or flexed space narrowed further = pain, weakness and reduced range of motion.
Pain in impingement syndrome
- Acute if injury
- Insidious if gradual process
- Dull and lingers = hard to sleep
- Grinding or popping
- Painful arc between 60-120 degrees of abduction
Calcific supraspinatous tendinopathy
- Macroscopic deposit of hydroxyapatite in tendon of most commonly supraspinatous (could be other rotator cuff)
- Acute or chronic pain when abducting or flexing
- Mechanical symptoms = stiffness, snapping, catching, reduce range of movement
- Multifactoral
- Crystalline deposits which are reabsorbed by phagocytes
Treatment of calcific supraspinatous tendinopathy
Rest and analgesia
Surgical treatment if persistent symptoms
Frozen shoulder/adhesive capsulitis
Inflam of glenohumeral joint capsule. Greatly restricts movement and causes chronic pain which is constant, worse at night and exacerbated by movement and cold.
- Severe pain
- Sleep deprivation
Risk factors of frozen shoulder
- Female gender
- Epilepsy w tonic seizures
- DM
- Trauma to shoulder
- Connective tissue disease
Treatment of frozen shoulder
- Physio
- Analgesia
- Anti inflam meds
OA
- Acromiocalvicular joint > glenohumeral
- Treatment ladder same as all others
- Arthroscopy = remove loose pieces of damaged cartilage
- Total shoulder replacement
- Replacement of humeral head
