Flashcards in Orthopaedics: Upper Limb Deck (40)
What forms the shoulder girdle?(5)
Scapula, Clavicle, Proximal Humerus, Deltoid, Rotator Cuff muscles
Primary source of stability within the shoulder joint
Rotator cuff muscles
Movement provided by supraspinatous
initiation of abduction
Movement provided by infraspinatous
Movement provided by teres minor
Movement provided by subscapularis
Shoulder problems commonly encountered by young adults
Shoulder problems commonly encountered by middle aged adults
Rotator cuff tears - grey hair = cuff tear
Shoulder problems commonly encountered by the elderly
Which muscle tends to be most commonly affected by painful arc?
Pathophysiology of painful arc?
tendons of the rotator cuff are compressed in the subacromial space during movement
What degree of movement is affected by painful arc (impingement syndrome)?
Causes of impingement syndrome (painful arc; 4)
tendonitis, subacromial bursitis; acromioclavicular OA with inferior osteophyte, hooked acromion rotator cuff tear
Where does pain from impingement syndrom radiate to?
deltoid and upper arm
Test for impingement syndrome (painful arc)
Hawkins-Kennedy test - flexion of the shoulder followed by internal rotation (turning the forearm down)
Treatment options for painful arc/impingement syndrome (2)
Conservative; physiotherapy, NSAIDs, subacromial steroid injections (up to 3), analgesia; surgical decompression either open or arthroscopically
Most common muscle to tear in the rotator cuff
Classic history of a rotator cuff tear injury
sudden jerk in a patient, >40 years old, subsequent pain and weakness
What change is seen with supraspinatous tears?
weakness initiating abduction
What change is seen with infraspinatous tears?
weakness of external rotation
What change is seen with subscapularis tears?
weakness of internal rotation
Test for supraspinatous tear
How is Jobes test carried out?
Testing Supraspinatous - arms out in front, slight abducted, straight and hands pronated so thumbs are facing floor. Ask patient to maintain position while you push down
How do you test infraspinatous?
Arms locked by side, elbows at 90˚ and abduct forearms - test by pushing against your resistance
How do you test subscapularis?
have dorsum of the hand against the buttocks and ask patient to push hand back against you
Treatment of impingement syndrome/painful arc
Conservative - physiotherapy to strengthen other muscles to compensate for supraspinatous +/- subacromial injection; Surgical repair which may fail as tendons are usually diseased.
progressive pain and stiffness of the shoulder in patients between 40 and 60. resolves after 18-24months
Stages of adhesive capsulitis
Freezing (2-9mnths, most painful); frozen (4-12mnths); thawing
Principle sign of adhesive capsulitis is...
loss of external rotation (tested for by having arms at 90˚ by the side and asking to push out