Orthopaedics: Upper Limb Flashcards Preview

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Flashcards in Orthopaedics: Upper Limb Deck (40)
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1

What forms the shoulder girdle?(5)

Scapula, Clavicle, Proximal Humerus, Deltoid, Rotator Cuff muscles

2

Primary source of stability within the shoulder joint

Rotator cuff muscles

3

Movement provided by supraspinatous

initiation of abduction

4

Movement provided by infraspinatous

external rotation

5

Movement provided by teres minor

external rotation

6

Movement provided by subscapularis

internal rotation

7

Shoulder problems commonly encountered by young adults

Instability problems

8

Shoulder problems commonly encountered by middle aged adults

Rotator cuff tears - grey hair = cuff tear

9

Shoulder problems commonly encountered by the elderly

Osteoarthritis

10

Which muscle tends to be most commonly affected by painful arc?

supraspinatous

11

Pathophysiology of painful arc?

tendons of the rotator cuff are compressed in the subacromial space during movement

12

What degree of movement is affected by painful arc (impingement syndrome)?

60-120 degrees

13

Causes of impingement syndrome (painful arc; 4)

tendonitis, subacromial bursitis; acromioclavicular OA with inferior osteophyte, hooked acromion rotator cuff tear

14

Where does pain from impingement syndrom radiate to?

deltoid and upper arm

15

Test for impingement syndrome (painful arc)

Hawkins-Kennedy test - flexion of the shoulder followed by internal rotation (turning the forearm down)

16

Treatment options for painful arc/impingement syndrome (2)

Conservative; physiotherapy, NSAIDs, subacromial steroid injections (up to 3), analgesia; surgical decompression either open or arthroscopically

17

Most common muscle to tear in the rotator cuff

Supraspinatous

18

Classic history of a rotator cuff tear injury

sudden jerk in a patient, >40 years old, subsequent pain and weakness

19

What change is seen with supraspinatous tears?

weakness initiating abduction

20

What change is seen with infraspinatous tears?

weakness of external rotation

21

What change is seen with subscapularis tears?

weakness of internal rotation

22

Test for supraspinatous tear

Jobes test

23

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

24

How do you test infraspinatous?

Arms locked by side, elbows at 90˚ and abduct forearms - test by pushing against your resistance

25

How do you test subscapularis?

have dorsum of the hand against the buttocks and ask patient to push hand back against you

26

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.

27

Adhesive capsulitis

progressive pain and stiffness of the shoulder in patients between 40 and 60. resolves after 18-24months

28

Stages of adhesive capsulitis

Freezing (2-9mnths, most painful); frozen (4-12mnths); thawing

29

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

30

Associations of adhesive capsulitis (3)

diabetes, hypercholesteraemia, duputrens disease