Neurological shoulder disorders Flashcards

Question

What is seen on imaging of thoracic oulet sydrome?

Answer 1

* C spine- rule out cervical rib * cxr- rule out pancoast tumour * Angiography * will subclavian vessel disease/aneurysm

Answer 2

non operative * Physio, activity modifications * fist line * shoulder girdle strengthening, proper posture, relaxation techniques Operative * **Neurologic decompression** * adress site of compression * repair clavicle malunion * transaxillary 1st rib resection = 90% excellent results * sclene takedown * pectoralis minor tentomy * release of fibromuscular anomalous bands * **Vascular reconstruction** ( open bs interventional) * for subclavian aneursym

Answer 3

* **emboli to the hands** * tx with heparinisation, embolectomy. * 7-10 days of heparin then 3/12 warfarin

Answer 4

* AKA Pasonage- Turner syndrome * 1-30 cases per 100,00 * any age affected * typically middle aged individuals * M\>F * risk factors * viral infection * immunisation * medications * **extreme stress** * autoimmune disease * effects nerves of lower brachial plexus

Answer 5

* Autoimmune process, probably involving lymphocytes * Hereditary form is extremely rare but autosomal dominant

Answer 6

* **Sudden onset of pain that subsides in 1-2 wks** * typically awakens people from sleep * **Followed by Weakness period of up to 1 yr** in muscles supplied by involved nerve O/E * Severe weakness of ER/ Abductors * can have decreased sensation - up to 75% pts * esp in **lateral antebrachial cutaneous n** * commonly affects \>1 nerve

Answer 7

* MRI * show signal abnormalities in affected muscle bellies * EMG * abnormalities show acute degeneration w sharp waves and fibrillations

Answer 8

* Non operative * **Observation for resolution and physio** * follow pts monthly for improvement * outcomes * **90% pts recover at 3 years** * **only 35% of pt recover in 1 year**

Answer 9

* **Axillary nerve and posterior humeral artery compression in quadrilateral ( quardangular) space** * rare * often misdx as subacromial impingement * 20-40 years * most commonly affects **dominant shoulder** * risk factors * overhead athletes * contact throwing sports

Answer 10

* **Compression & reduction of quadrangular space** due to * **Iatrogenic** ( tight fibrous bands, muscle hypertrophy) * **Paralabral cysts (** with inferior labral tears) * **Trauma** ( scap fx, shoulder dislocation) * **Benign/Malignant masses** * Greatest amount of compression is when arm is in **late cocking phase of throwing ( abduction/ER)**

Answer 11

* Long-standing cases often causes atrophy/weakness of **teres minor and deltoid**

Answer 12

* location * lateral to triangular space * medial to triangular interval * Boundaries * superior- subscapularis & teres minor * inferior- teres major * medial - long head of triceps * lateral - surgcal neck of humerus * contents * **Axillary nerve** (C5 n root, post cord) * **Posterior circumflex humeral artery**

Answer 13

* Poorly localised pain of posteriolateral shoulder * often worse at night * worse with overhead activity or late cocking/acceraltion phase of throwing * non dermatomal distribution of parathesia * shoulder ER weakness O/E * Atrophy teres minor and deltoid * point tendereness over quadrangular space * ER weakness with arm abducted in throwing position * pain exacerbated by **active and resisted Abduction & ER of arm** * neurology - usually normal

Answer 14

* Xray * usually normal * MRI * rule out RC tears * may show... * atrophy teres minor( axillary innervation) * Compression of quadrilateral space * inferior paralbaral cyst asso w labral tear * Arteriogram * lesion in post humeral circumflex artery * EMG * used to confirm dx * show axillary n involvment

Answer 15

Non operative * **NSAIDS, activity restriction, physio** * first line of tx * glenohumeral mobilisation & strengthening * posterior capsule stretching * massage * most pt improve in 3-6 months * **diagnostic lidnocaine block** * inject lidnocaine into quadrilateral space * starting point is 2-3 cm inferior to standard post shoulder arthroscopy * positive if no point tenderness or pain on full rom Operative * _nerve decompression_ * **open release of quadrilateral space +/- arthroscopic repair of labral tear**

Answer 16

* Approach * lateral decubitus position * 3-4cm incision over quadrilateral space * identify post border of deltoid and reflect superiolateral * expose fat in quadrilangulr space between teres minor and teres major * Technique * identify axillary nerve by using the humeral neck as reference * avoid cutting the posterior circumflex artery * free any fibrous tissue aherence to the nerve * ensure n is completely free of compression by moving arm into abduction and ER * Post op sling * immediate for comfort * early pendulum exercises to avoid new adhesions * progress to full active rom with supervsiedphysio

Answer 17

* **Abnormal scapula motion leading to shoulder impingement & dysfunction** * cause multifactoral * neurological injury * pathological thoracic spine kyphosis * periscapular muscle fatigue * **poor throwing mechanics** * secondary to pain * seen in athletes

Answer 18

* Scapulothoracic power imbalance lead to **protraction of scapula** * leads to alteration of mechanics of GH joint * excessive stress placed on anterior capsule of shoulder and posterosuperior labrum * increase risk of injuring * labrum * RC * Capsule

Answer 19

* shoulder pain and dysfunction worse with arm elevation * loss of throwing velocity O/E * scapulothoracic crepitus * affected scapula may be lower and protected * symptom relieved with scapula stabilisation * [http://www.orthobullets.com/video/view?id=627](http://www.orthobullets.com/video/view?id=627)

Answer 20

* NSAIDS, PT local injections * main tx * physio emphasis on * core strengthening * scapular stabilisers , serratus ant , trapezius * RC muscles * core mechanics to throwers

Neurological shoulder disorders Flashcards

Scapular winging suprascapular neurology thoracic outlet syndrome brachial neuritis- parsonnage - turner syndrome quadrilateral space syndrome scapulothoracic dyskinesis (44 cards)