Shoulder Flashcards
(29 cards)
What makes the shoulder so susceptible to fractures, joint dislocations and soft-tissue cartilage injuries?
Less mechanical protection and less bony stability than any other large joint in the body
What radiographs does the ACR recommends for trauma cases to rule out fractures and dislocations?
AP and axillary (or scapular Y)
When is an MRI recommended?
If initial radiograph is normal and if RTC, instability or labral tear suspected
When is CT recommended?
If MR unavailable or contraindicated
When is ultrasound recommended?
With appropriate expertise in evaluation of soft tissue pathology
What traumatic events might cause a RTC tear?
GH dislocation
Fall on outstretched hand
Forceful abduction of arm
What chronic actions might lead to RTC tears?
Progressive tendon irritation from repetitive overhead movements or impingement
What may predispose someone to a rupture even with relatively minor trauma?
Degenerative changes in hypovascular region of the cuff (>50 yo)
What is the most common area for a tear?
hypovascular critica zone in supraspinatus tendon, 1 cm above its insertion on greater tuberosity
What occurs in an arthrography with a complete tear of the supraspinatus tendon?
Contrast medium travels up and fills the subacromial-subdetloid bursa, making it radiopaque
When are arthographies recommended?
If patient can’t have MRI and ultrasound not available
Why are MRIs preferred?
Noninvasive, provides surgeon with info regarding tendons involved, location, size, quality of torn edges, amount of muscle atrophy and tendon retraction
What are the secondary changes evident on radiographs for a chronic RTC tear?
Irregularity of greater tuberosity, may appear flattened, atrophied, sclerotic
Narrowing of distance b/w acromion and humeral head
Erosion of inferior aspect of acromion, changes can include: sclerosis, subchondral cyst formation and loss of bone
What is the treatment for RTC tears?
Conservative = rest, NSAIDS, cortisone Sugical = most don't heal well with time, require surgery
What is the rehabilitation for RTC?
extensive beginning in acute phase with controlled motion and culminating with return to full function in 4-6 months
What complications can occur from RTC injury?
- degenerative joint changes at GH and AC
- failure to regain full ROM and strength following surgery (impaired scapulohumeral rhythm, chronic tendon irritation/inflammation, poor function)
What does SICK stand for?
Scapular malposition
Inferior medial border prominence
Coracoid pain and malposition
Dyskinesis of scapula
What does SICK present as clinically?
Postero-superior shoulder pain Anterior shoulder pain Proximal lateral arm pain C-spine pain TOS
What are the 3 types of dyskineis?
I = inferior medial scapular prominence II = medial scapular border prominence III = superomedial border prominence
What are types I and II associated with? Type III?
I and II = SLAP lesion
III = impingement and RTC lesion
What are the 2 functions of the labrum?
1 = deepen glenoid fossa so humeral head stays in place 2 = serves as attachment site for capsular ligaments and biceps tendon
What are the symptoms for a labral tear?
Pain worse with overhead movements, clicking or catching, sense of instability
How can the labrum be injured acutely?
associated with dislocations, forceful lifting manuevers, falls on outstretched hand
How can the labrum be injured chronically?
Repetitive arm movements, overhead athletes susceptible to biceps tendon stress at superior labrum
Muscle imbalances that decentralize position of humeral head
