Locomotor: PBL 1 (Glenoid Labral/SLAP Tear) Flashcards Preview

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Flashcards in Locomotor: PBL 1 (Glenoid Labral/SLAP Tear) Deck (58)

Why may a labral tear not show up on x-ray?

Soft tissue, so may be distorted by the clear white bone in the surrounding region. In addition, the labrum is a ligament which lies beneath the anterior surface of the humerus so this layer would be obstructed by structures in front..


What is the action of the biceps brachii muscle at the glenohumeral joint?

Stabilises the shoulder joint


What is the action of the biceps brachii muscle at the humero-ulna joint?

Flexion of the elbow


What is the action of the biceps brachii muscle at the proximal radio-ulnar joint?



What is the normal ratio of movement at the glenohumeral joint and the physiological scapulothoracic joint

Glenohumeral joint 2:1 scapulothoracic joint.


What is a SLAP lesion?

Injury to the glenoid labrum, SLAP = superior labral tear, anterior to posterior


What is the glenoid labrum?

Fibrocartilaginous ring rim attached around the margin of the glenoid cavity


What is an arthrogram?

An X-Ray of the inside of a damaged joint after iodine has been injected into the joint


What are the rotator cuff muscles?

Group of muscles and their tendons which act to stabilise the shoulder: infraspinatus, supraspinatus, subscapularis and teres minor


What is diclofenac?

NSAID (non-steroidal anti inflammatory drug) which is used to reduce pain and inflammation


What is meant by 'nerve block'?

Production of anaesthesia in part of body by injecting substance into nerves which supply an area


What is a type II SLAP lesion?

Separation of the superior portion of the glenoid labrum and tendon of biceps brachii from the glenoid rim


What is a thrombosis?

The formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system


What type of joint is they glenohumeral joint?

Synovial ball and socket


What is the antecubital fossa?

a fossa in the anterior elbow which is bound medially and laterally by the humeral origins of the flexor and extensor tendons of the forearm, and superiorly by an imaginary line between the humeral condyles


Define 'paraesthesia'

an abnormal sensation, typically of tingling or pricking (pins and needles), which is mainly caused by pressure on/damage to peripheral nerves


What is a Doppler ultrasound?

Non-invasive test used to estimate blood flow through blood vessels by bouncing high-frequency sound waves off of circulating red blood cells


What is DVT?

Deep vein thrombosis - thombrosis in a vein lying deep below the skin, usually in the legs and often precipitated by immobility during illness of long-distance travel


What is enoxaparin sodium used for?

It's an anticoagulant which is used to prevent DVT or to treat acute DVT


What is warfarin used for?

Anticoagulant usually used in prevention of thrombosis


What allows the large freedom of movement at the shoulder joint?

Laxity of the articular capsule and the large humeral head in comparison to the shallow glenoid cavity


What are the chief flexors of the shoulder?

Pectoralis major and deltoid (anterior)


What are the chief extensors of the shoulder?

Latissimus dorsi and deltoid (posterior)


What are the chief shoulder abductors?

First 10 degrees is supraspinatus, thereafter is deltoid


What are the chief shoulder adductors?

Mainly gravity, but also latissimus dorsi and pectoralis major


What is the chief medial rotator of the shoulder?



What is the chief lateral rotator of the shoulder?

Infraspinatus and teres minor


What is often the cause of a SLAP tear/lesion?

Initial forceful movement most commonly associated in sports with a pull on the arm, weightlifting, throwing injury or a tackle


What type of sports increase the risk of a SLAP tear?

Overhead and contact sports


Describe a type 1 SLAP lesion

Partial tear, degeneration of superior labrum, edges of ligament are rough and fray but labrum not completely detached. TREATMENT: debride edges of labrum


Describe a type 2 SLAP lesion

Superior labrum completely torn off glenoid leaving gap between articular cartilage and labral bone attachment


Describe a type 3 SLAP lesion

Bucket-handle tear; torn labrum hands into the joint causing locking and popping


Describe a type 4 SLAP lesion

Labral tear extends into long head of biceps tendon


What is the most common type of SLAP tear?

Type 2


How can SLAP tears be distinguished from acromioclavicular joint problems?

SLAP tears have pain with biceps loading (going down in bench press) whereas in AC joint issues, pain usually felt when pressing out at the end of a bench press


What are the common symptoms of a SLAP tear?

Pain at the top of shoulder, clicking and pain with overhead activities


What clinical test can be performed to diagnose a SLAP tear?

O'Briens test


Describe O'Briens test

Place patients arm straight in front of them (elbow extended fully, then slightly adduct the arm into the midline (15 degrees), then maximally internally rotate the arm and push down on arm (get them to resist) and repeat in supination


What is a positive O'Briens test?

If there is pain elicited by the first manoeuvre (full internal rotation) that is reduced or eliminated by the second manouvre


How can O'Briens test distinguish between ACJ and SLAP tears?

ACJ - there will be pain in the ACJ region
SLAP - there will be pain or clicking deep in the glenohumeral joint


What treatments may be used for a SLAP tear?

Physiotherapy, diclofenac (NSAID) and surgery


Describe how physiotherapy can help to treat a SLAP tear

Promotes growth of rotator cuff muscles to try and increase stability


Describe how diclofenac can help to treat a SLAP tear

NSAID used to reduce swelling and allow healing


Describe how surgery can help to treat a SLAP tear

Glenoid cavity and labrum are roughened to increase contact surface area and promote re-growth, bone anchor locations selected, glenoid is drilled for anchor implantation, anchors inserted into glenoid, suture component of implant is tied through labrum and knotted --> labrum now in tight contact with glenoid surface


What are the spinal roots of the brachial plexus?



What are the 5 terminal branches of the brachial plexus?

Lateral cord - musculocutaneous nerve
Posterior cord - axillary and radial nerves
Medial cord - median and ulnar nerves


Describe the arterial supply to the upper limb

See anatomy diagram


Describe the venous supply to the upper limb

See anatomy diagram


Describe the nervous innervation to the upper limb

See anatomy diagram


What is the main cause of DVT?

Poor blood flow, as when blood flow is slow then it can pool, giving cells a greater chance to stick together and start clotting


Why does surgery increase the likelihood of developing DVT?

If surgery reduces blood flow to a part of your body OR and major surgery on legs/belly/chest as there will be bed rest (stagnant blood flow) AND the procedure could set tissue, protein and fats loose in the veins and if the vein wall gets accidentally damaged, it can release chemicals that trigger blood clotting


Describe what is involved in conducting an interscalane brachial plexus nerve block

The interscalene block is performed by injecting local anaesthetic to the nerves of the brachial plexus as it passes through the groove between the anterior and middle scalene muscles, at the level of the cricoid cartilage.


Describe the cause of reduced elbow flexion after DVT?

Compression of the median nerve in the antecubital fossa


Describe the cause of mild paraesthesia and weakness of the muscles that flex the wrist and fingers

Compression of the median nerve


How is DVT diagnosed?

Doppler ultrasound


Describe how a Doppler ultrasound is conducted

A handheld transducer is passed over skin above blood vessel and sends/receives sound waves which bounce off solid objects, including blood cells. Movement of blood cells causes a change in pitch of reflected sound waves - if there is no blood flow then the pitch doesn't change therefore there is a clot/obstruction


Why is enoxaparin sodium prescribed to treat DVT?

Binds to antithrombin (circulating anticoagulant) to form a complex that irreversibly inactivates clotting factor Xa to prevent any further clot formation


Why is enoxaparin sodium initially used in treatment instead of warfarin?

Don't have to be monitored as much and has more immediate effects