Flashcards in Shoulder Deck (68):
6 possible presenting symptoms of shoulder pathology?
instability- may complain of shoulder coming out, popping? must check not voluntary
4 causes of acute shoulder pathology?
parsonage turner syndrome (acute brachial neuropathy/radiculitis)
causes of shoulder joint instability?
atraumatic= repeated microtraumas lead to joint capsule stretching over time
ligament laxity (muscular?)
common causes of shoulder pain in middle aged?
impingement (chronic tendinitis)- may be just inflammation, or can be tears in rotator cuff
adhesive capsulitis (frozen shoulder)
people with what condition is frozen shoulder more common in?
duration between onset of frozen shoulder and resolution?
what might cause a ptnt to have passive movements more than active movements?
what does wasting of the deltoid muscle indicate?
axillary nerve damage
what joint is likely to be the cause of pain in a ptnt with pain in a pinpoint location around the shoulder?
where does the deltoid muscle insert?
deltoid tuberosity on antero-lateral aspect of humerus
cause of shoulder joint wkness?
rotator cuff tear?
4 articulations making up the shoulder?
scapulathoracic (physiological joint between scapula and chest wall as no synovial cavity)
what is unique about the tendon of biceps brachii?
what does the conjoint tendon of the shoulder comprise?
tendon of short head of biceps brachii
tendon of coracobrachialis
what is a Bankart lesion?
an avulsion of the anteroinferior glenoid labrum at its attachment to the inferior glenohumeral ligament complex
lesion results from anterior dislocation of shoulder
primary lesion in recurrent anterior instability
what is a hill-sachs lesion?
a compression fracture of the posterolateral humeral head that occurs with anterior dislocations as head is forced against anterior glenoid rim
what name is given to a fracture of the anterior glenoid following an anterior shoulder dislocation?
bony bankart lesion
why is the empty can test (ECT) used to test for impingement?
arms abducted and thumbs pointing downwards= internal rotation of humerus- greater tubercle brought under acromion, compressing supraspinatus tendon.
what is Hawkin's test?
impingment test in which elbow is flexed repeatedly as arm is adducted, downward flexion elicits more pain as arm internally rotated, and adducting arm increases sensitivity.
another name for frozen shoulder?
what is the cross arm test (scarf test) ?
arm adducted acoss chest, and then moved across toshoulder
pain felt over AC joint= +ve test= +ve in OA- narrows coracoacromial space
another name for frozen shoulder?
how is instability of shoulder joint tested for?
anterior and posterior drawer tests
posterior apprehension test
how can subacromial bursitis be tested for?
painful arc test
what does the supraspinatus run through?
a tunnel formed by the spine of the scapula, the acromion and the coracoacromial ligament
what provides some separation of supraspinatus from the acromion?
commonest cause of shoulder pain?
cervical spondylosis- nerve root irritation in neck is referred to shoulder
why might severe shoulder pain occur in dialysed ptnts?
subacromial impingement on amyloid deposits
what surgery may be performed for impingement syndrome?
decompression of subacromial space- e.g. excision of osteophytes, AC joint arthroplasty and excision of CA ligament
presentation of rotator cuff tear?
ptnt unable to initiate arm abduction
painful arc of movement
what happens anatomically in frozen shoulder?
shoulder movements are grossly restricted due to contraction and thickening of the joint capsule
often all movements severely reduced, but in milder cases, rotation espec. internal is mainly affected
presentation of frozen shoulder?
severe pain,may disturb sleep
frequently a history of minor trauma, producing some tearing of degenerating shoulder cuff
may be initiated by period of arm immobilisation
mainstay of frozen shoulder tment?
graduated shoulder exercises
hydrocortisone injections may be helpful
can also do arthroscopic surgery with a capsular release
presentation of calcific supraspinatus tendinitis, in which inflammatory changes occur in subdeltoid bursa?
sudden, severe incapacitating pain
shoulder acutely tender, often swollen and warm to touch
how are symptoms of calcifying supraspinatus tendinitis relieved?
removal of material by asiration, curettage or shock wave therapy
or local injections of hydrocortisone
commonest infection occurring near shoulder in England?
what is an exostosis?
new bone formation on surface of bone because of excess calcium forming
causes of deltoid wasting?
axillary nerve damage
what might an increase in external rotation in extension indicate?
tear of subscapularis
what is the Hawkins-Kennedy impingement sign?
shoulder and elbow are both flexed to 90 degrees, and shoulder gently internally rotated until ptnt complains of pain or scapula felt to move
tment for ACJ dislocation?
why might ACJs be prominent?
ACJ OA- osteophytic thickening
where is pain from the shoulder felt?
anterolaterally, and at insertion of deltoid (AL aspect of humerus), sometimes radiates down arm
if on top of shoulder, suggest ACJ dysfunction or C spine disorder
why might a ptnt's arm be persistently internally rotated?
shoulder posterior dislocation
where is the supraspinatus tendon located?
just below anterior edge of acromion
what does pain in mid abduction range suggest?
rotator cuff tear
or supraspinatus tendinitis ( acute or chronic-impingement?)
what does pain at end of abduction indicate?
what is the 'critical zone' in terms of rotator cuff degeneration?
the relatively avascular region near the insertion of supraspinatus tendon into the greater tuberosity of the humerus
this is the common site of cuff degeneration
another name for subacute tendinitis?
painful arc syndrome
history of pain in subacute tendinitis?
anterior shoulder pain after vigorous or unaccustomed activity e.g. competitive swimming or wkend house decorating
shoulder tender along anterior acromion
history of pain in chronic tendinitis (impingement)?
recurrent attacks of subacute tendinitis
pain worse at night, unable to lie on affected side
if course crepitation or palpable snapping when shoulder passively rotated, may be partial tear or marked fibrosis
signs of impingement on plain X-ray?
cyst formation on greater tuberosity
or overgrowth of anter. edge of acromion, thinning of acromion and upward displacement of humeral head
conservative tment of rotator cuff syndrome?
eliminate aggravating activity
avoid impingement position
short NSAID course
can be given 1-2 injections of corticosteroids into SA sace if prev methods fail, then ptnt must persevere with protective modifictions of shoulder activity for at least 6 mnths
what must be detached if open shoulder surgery for impingement rather than arthroscopic?
deltoid muscle, delaying rehabilitation
indication for surgical tment of impingement?
non-subsidence of symptoms after conserv tment for 3 mnths, or if recur persistently after each tment period
features of acromioplasty?
remove CA ligament
A part of acromion
and osteophytes at ACJ
performed for impingement and during repair of RC tears
advantages of arthroscopy over open repair of RC?
less soft tissue damage
better cosmetic appearance
why does pain occur with acute calcific tendinitis?
vascular reacton around calcium hydroxyapatite crystals deposited in SS tendon, producing swelling and tension in tendon
tment of acute calcific tendinitis?
arm rested in sling and short course of NSAIDs
or corticosteroid injection into SA space if more painful
can use shockwave therapy to disintegrate crystals
why are X-rays used in diagnosing frozen shoulder?
exclude other causes of pain and stiffness
what is seen on examination of ptnt with frozen shoulder?
may be slight muscle wasting
movements always limited, and shoulder may be very stiff
how is frozen shoulder different to post-traumatic stiffness?
FS- pain and stiffness progressively worsens, but in post-traumatic stiffness, stiffness is maximal at start and gradually lessens
conservative tment of frozen shoulder?
physio and steroid injects no proven benefit
charcteristic history of ptnt presenting with torn long head of biceps?
while lifting a heavy object, they feel something snap
shoulder aches and brusing appears over front of arm
prominent lump when elbow flexed actively
what is a SLAP lesion?
fall on outstretched arm can damage superior part of glenoid labrum anteriorly and posteriorly
usually fall history followed by shoulder pain
symtpoms settle, then persistent painful click on abducting arm above shoulder height, + loss of power when using arm in that position
may be unable to throw
can do MRI arthrography or arthroscopic exam., and treat by re-attachment or debridement
what does A.dislocation of shoulder often follow?
acute injury in which arm is forced into abduction, ER and extension
if recurr dislocation, labrum and casule often detached from A rim of glenoid= bankhart lesion
how is the apprehension test for A.subluxation or dislocation performed?
abduct, ER and extend ptnt's shoulder while pushing on humeral head
ptnt will forcible resist movement if feel joint is going to dislocate
P dislocation tested for by drawing arm forward and across ptnt's body- adduction and IR