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Flashcards in Shoulder Deck (35)
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What is the commonest cause of shoulder pain in people aged 10-30?

Instability ➔ dislocations


What is the commonest cause of shoulder pain in people aged 40-60?

Shoulder impingement syndrome


What is the commonest cause of shoulder pain in people aged 60+?



Define shoulder instability

Inability to maintain the humeral head in the glenoid fossa during function, associated with symptoms e.g. stiffness or pain


Describe the pathophysiology of shoulder instability

  • Structural causes:
    • Damage after major injury
    • Structural deficit predisposing to instability following minor injury
  • Muscle imbalance


Outline the Stanmore classification of shoulder instability


Differentiate shoulder laxity from shoulder instability

  • Laxity:
    • Asymptomatic hypermobile joint
    • Maintains the humeral head in the glenoid fossa
  • Instability:
    • Symptomatic e.g. stiffness or pain
    • Inability to maintain the humeral head in the glenoid fossa


How can shoulder joint instability be assessed?

  • Beighton test: hyper mobility/laxity
  • Apprehension test: assess anterior dislocation on forced external rotation
  • Shoulder relocation test: performed after +ve apprehension test,
    • Apply posterior pressure on humeral head


Outline the treatment options for shoulder instability

  • Analgesia
  • Assessment and acute reduction
  • Encourage early mobilisation
  • I (traumatic): Surgery
  • II (atraumatic) or III (muscle patterning): Rehabilitation ± surgery


Define joint dislocation and subluxation

Dislocation: complete disruption of the joint

Subluxation: partial dislocation followed by relocation


Describe the different types of shoulder dislocations

  • Anterior dislocation (95%):
    • Sports-related (young)
    • Fall on outstretched hand (older)
  • Posterior dislocation (2-4%):
    • Seizures and electric shock
    • Can occur with fall on outstretched hand, or trauma to anterior shoulder
  • Inferior dislocation (0.5%): Traumatic injury pushing arm downwards.


Give three symptoms of shoulder dislocation

  • Severe shoulder pain
  • Limited motion of the shoulder
  • Shoulder bruising or abrasion
  • Swelling


What signs may be seen with shoulder dislocation?

  • Swelling
  • Loss of normal contour of the shoulder
  • Sulcus sign: inferior instability
  • Deltoid muscle wasting: axillary nerve impingement
  • Arterial injury


What is the Lightbulb sign in regards to the shoulder?

  • Abnormal AP radiograph appearance of the humeral head
  • Posterior shoulder dislocation
  • Appears due to internal rotation.


Which nerve is most commonly affected with shoulder dislocations?

Axillary nerve


Provide three injuries associated with a traumatic shoulder dislocation?

  • Bankart lesion (90%):
    • Detachment of glenoid labrum from its antero-inferior surface
  • Hill-Sach lesion (66%):
    • Postero-lateral humeral head compression fracture
    • Humeral head impacts the anterior glenoid
  • SLAP lesion (5-7%):
    • Superior labral tear where the long head of biceps tendon attaches
  • Fracture dislocation
  • Rotator cuff tear: more often in older patients
  • Nerve injury


What is the probability of reoccurrence for shoulder dislocations in <20s


Decreases to 25% for people in their 30s


List three stabilising factors of the shoulder joint

  • Glenoid and glenoid labrum
  • Glenohumeral ligaments
  • Joint capsule
  • Rotator cuff muscles
  • Negative intraarticular pressure
  • Friction


Define shoulder impingement syndrome

  • Supraspinatus tendonitis/subacromial bursitis
  • Occurs on elevation or internally rotation of the humerus
  • At 60-120o of abduction

May cause bicips tendonitis and rupture


What special test is diagnostic of shoulder impingement on examination?


Describe the management options of shoulder impingement syndrome

  • Rest; avoid excessive aggrevation
  • Paracetamol ± NSAIDs or codiene
  • Physiotherapy: recover normal range of motion
  • Steroid injection
  • Operative treatment
    • Subacromial decompression
    • Anterior acromioplasty: may remove calcification in tendon


Define adhesive capsulitis of the shoulder

  • Significantly restricted active and passive movements of the shoulder
    • Characteristic impaired external rotation
  • May be primary (idiopathic) or secondary


Name two associations of secondary adhesive capsulitis

  • Trauma
  • Rotator cuff injury
  • Thyroid dysfunction
  • Diabetes mellitus: 20% will have an episode
  • Cardiovascular disease


Describe the illness course of adhesive capsulitis of the shoulder

Progression through three overlapping phases

  1. Painful: Progressive diffuse shoulder pain lasting weeks-months
  2. Stiffness: Reducing ROM up to 1 year; improving pain
  3. Resolution: Weeks-months of gradually improving ROM


What movement will rule out adhesive capsulitis as a differential diagnosis?

Normal external rotation


Name two differential diagnoses for adhesive capsulitis of the shoulder

  • Polymyalgia rheumatica: acute onset in limb girdle
  • Pancoast tumour: systemic features, hoarse voice
  • Posterior dislocation: seizures and electric shocks


Describe the management for adhesive capsulitis of the shoulder

  • Encourage arm movement; avoid aggravating movements
  • Paracetamol ± NSAIDs or codiene; hot packs
  • Physiotherapy
  • Intra-articular corticosteroid injection
  • Surgery
    • Manipulation under anaesthesia
    • Shoulder arthroscopy


What is Os Acromiale?

What is its significance?

  • Developmental defect: failure to fuse the acromial process
  • Usually asymptomatic
  • May cause secondary shoulder impingement syndrome


What special tests assess rotator cuff integrity?

  • Empty can test: supraspinatus (abduction)
  • Infraspinatus test: infraspinatus (external rotation)
  • Horn blowers test: teres minor (external rotation)
  • Gerber's lift off test: subscapularis (internal rotation)
  • Drop arm test: 2+ tendon tear; esp. supraspinatus


What test can assess for acromioclavicular joint disorder

Scarf test