Shoulder Flashcards Preview

Musculoskeletal > Shoulder > Flashcards

Flashcards in Shoulder Deck (47):
1

Two bursae associated with the shoulder

Subacromial bursa
Subascapular bursa

2

Name for the shoulder joint

Glenohumeral joint

3

Ligament round the shoulder joint

Capsular ligament

4

What forms the rotator cuff?

The tendons of the SITS muscles

5

Night pain and shoulder impingement?

Night pain not common

6

When will shoulder impingement hurt?

Pain on movement
Painful arc
Hawkins test
PAINFUL CRECENDO NOT ASSOCIATED WITH SHOULDER IMPINGEMENT

7

Differential diagnosis for shoulder impingement?

Shoulder impingement
Frozen shoulder
Shoulder instability

8

Bigliani acromial grading

flat inferiorly
curved
​​parallel to the humeral head with concave undersurface
considered most common type 3
hooked
​​most anterior portion of the acromion has a hooked shape
associated with increased incidence of shoulder impingement
convex (upturned)
most recent classification of acromion process shape
the undersurface of the acromion is convex near the distal end 4
no convincing correlation between a type 4 acromion and impingement syndrome exists 4, 5

9

OS acromiale

Unfused acceossory ossification centre

10

Rotator cuff tear signs & symptoms

Night pain
Weakness
Muscle wasting

11

Surgical ways of fixing shoulder problems

Cuff repair (feeding tendon through hole drilled in bone)
Suture anchor
Shoulder arthroplasty

12

Injection you could give into the shoulder
-From GPPC lecture

Steroid
Medrone with lignocaine (medrone is a steroid)

13

Which shoulder problem is more common in diabetics?

Frozen shoulder

14

Which bones form the shoulder girldle?

The scapula, the acromopn and the humerus and the supporting muscles including the deltoid and the muscles of the rotator cuff

15

Where do the supraspinatous, infraspinatous and teres minor attach to?

The greater tuberosity
Supraspinatous is responsible for initiating abduction
Infraspinatous and teres minor are external rotators

16

What does the subscapularis do?

Internal rotation
Subscapularis attaches to the lesser tuberosity

17

Shoulder condition with painful arc?

Shoulder impingement

18

Which tendons of the rotator cuff are usually compressed in shoulder impingement?

Supraspinatous

19

Where does pain of shoulder impingement typically radiate to?

The upper arm and deltoid
Pain may be felt under the lateral edge of the acromion

20

Which test can be used to re-create the pain of shoulder impingment?

Hawkins-kennedy test

21

Treatment for shoulder impingement

Treatment is conservative in the first instance with the majority of cases settling with NSAIDs, analgesics, physiotherapy and subacromial injection of steroid. Up to 3 subacromial injections may be required. Cases which do not improve with these interventions may benefit from subacromial decompression surgery to create more space for the tendon to pass through. This procedure can be done as an open procedure (through an incision large enough to visualise the subacromial space) or with minimally invasive arthroscopic techniques (when small instruments and a keyhole camera are inserted into the subacromial space to perform the surgery) .

22

The tendons of which muscle are usually involved in a rotator cuff tear?

Supraspinatous
Large tears can extend into the infrapinatous and subscapularis

23

How do you confirm a rotator cuff tear?

Ultrasound or MRI

24

What does supraspinatous do?

Initiation of abduction

25

What does subscapularis do?

Internal rotation

26

What does infraspinatous do?

External rotation

27

Treatment for rotator cuff tear

Surgery: Rotator cuff repair (open or arthroscopic) with subacromial decompression can be performed in an attempt to improve/maintain strength and to prevent subsequent arthritis from chronic cuff deficiency. However, the tendon is usually diseased and failure of repair occurs in around a third of cases. Very large tears may be irrepairable and the tendon may be retracted too far.

Non-operative: Many patients do well with physiotherapy to strengthen up the remaining cuff muscles which can compensate for the loss of supraspinatus. Subacromial injection may help symptoms.

28

Frozen shoulder

Progressive pain and stiffness of the shoulder in patients aged 40-60, resolving in 18-24 months

29

Principal clinical sign of frozen shoulder

Loss of external rotation

30

Which conditions are associated with frozen shoulder?

Diabetes
Hypercholesterolemia
Dupuytrens disease (similar thickened tissue is found histologically)
The capsule and the glenohumeral ligaments become inflamed and then thicken and contract

31

Which type of injection could you give in frozen shoulder?

Glenohumeral (glenohumeral rather than subacromial)

32

The 2 worst shoulder pains (says internet)

Calcific tendonitis
Frozen shoulder

33

Bankart operation

Can be used if recurrent shoulder dislocations
Re-attaches labrum and capsule to the anterior glenoid, which is where they were torn during the first dislocation

34

Conditions which cause ligamentous laxity?

Idiopathic
Marfans
Ehlers-Danlos
Treatment is difficult as soft tissue procedures may not work

35

What is the principal clinical sign of frozen shoulder?

Loss of external rotation
-Loss of external rotation also occurs in OA but patients affect tend to be elderly/older

36

What can cause a mucous cyst in your fingers?

Osteoarthritis

37

What injection may help to ease pain quickly in OA?

Steroid injection

38

Mucous cyst

outpouching of synovial fluid from DIPjt OA
typical appearance
may be painful
may fluctuate/discharge
may deform nail, cause ridge

Management:
you can leave them alone
excision

39

What type of joint is the thumb joint?

Saddle joint = moves in two planes

40

Which are the most common joints affected in OA?

1st most common: PIP/DIP
2nd most common: thumb CMP
SCAPHO-TRAPEZIAL-TRAPEZOID JOINT (STT)

41

Base of thumb OA

2nd most common joint for OA

thumb CMCjt is at 90˚ to hand

saddle joint, so moves in 2 planes

remember scapho-trapezial-trapezoid joint (STT)

often asymptomatic

pain at base of thumb

prevents pinch, grasp, sleep

Mx
rest, splint, NSAIDs
steroid injection
surgery
trapeziectomy (+/- tendon interposition)

42

How will base of thumb OA present?

Often asymptomatic
Pain at base of thumb
Prevents pinch, grasp, sleep

43

Treatment for base of thumb OA

Rest, splint NSAIDs,
Steroid injection
Surgery: trapeziectomy (+/- tendon interposition)

44

What is a ganglion?

Outpouching of synovial cavity
-usually painless but may feel tight

45

Rheumatoid arthritis

Auto-immune inflammatory joint disease

Results in ligament thinning + weakness
-capsules become lax, joints unstable

MCP joints dislocate, ulnar deviation
Swan-neck + Boutonniere deformity at PIP/DIP joints

46

Ligaments and joints in rheumatoid arthritis

Ligaments become thin and weak
Capsules become lax and joints unstable

47

Which hand deformities are found in rheumatoid arthritis?

Boutonniere and swan neck
(heberdens and bouchards are found in OA)