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Flashcards in Shoulder & Arm Deck (13):
1

What is a Bankart lesion?

Injury of antero(inferior) glenoid labrum due to anterior shoulder dislocation ---> pocket in ant. glenoid forms that the humeral head dislocates into

2

What is a Hills-Sachs lesion?

Cortical depression in posterolateral head of humerus due to anterior shoulder dislocaton ---> humeral head impacts against anteroinferior glenoid rim

3

What is the origin, insertion, and function of supraspinatus?

Origin = medial 2/3 of supraspinous fossa
Insertion = superior facet of greater tubercle

Function = abduction (0-15 degrees)

Suprascapular nerve (C5, C6)

4

What is the origin, insertion, and function of infraspinatus?

Origin = medial 2/3 of infraspinous fossa
Insertion = middle facet of pos. surface of greater tubercle

Function = external rotation

Suprascapular nerve (C5, C6)

5

What is the origin, insertion, and function of subscapularis?

Origin = medial 2/3 of subscapular fossa
Insertion = lesser tubercle

Function = internal rotation

Upper and lower subscapular nerves (C5, C6)

6

What is the origin, insertion, and function of teres minor?

Origin = upper 2/3 of pos. scapula, immediately adjacent to lateral border
Insertion = inferior facet of pos. surface of greater tubercle

Function = external rotation

Axillary nerve (C5, C6)

7

What is the look component of the shoulder exam?

FRONT:
- alignment and posture
- symmetry
- wasting: deltoid, pectorals
- lumps, scars, bruising, sinuses, swellings
- scapula

BACK:
- scapula
- wasting: supraspinatus, infraspinatus
- movements of scapulothoracic joint

Axilla: lymphadenopathy, large joint effusions

Arm position: rotation

Bony prominences: ACJ and SCJ

8

What is the feel component of the shoulder exam?

Skin: palpate general area for temp. and effusions

Muscle: supraspinatus, infraspinatus, deltoid

Tendons: flex biceps and feel tendon, push arm back and feel just ant. for supraspinatus tendon

Bony landmarks: run hand from SCJ along clavicle to ACJ ---> greater and lesser tuberosities and around glenohumeral joint ---> spine of scapula and around inf. scapula back to ACJ

9

What is the move component of the shoulder exam?

Flexion (180 degrees)

Extension (65 degrees)

Abduction (180 degrees):
- active: high arc pain (ACJ e.g. arthritis), middle arc pain (rotator cuff e.g. tendinitis, cuff tear)
- passive: pain (mechanical) or no pain (muscular)

Adduction (50 degrees)

External rotation (70 degrees)
- loss of external rotation = frozen shoulder

Internal rotation
- try to touch inf. scapula with fingers behind back (normal is base of scapula)

10

What are the special tests of the shoulder?

Serratus anterior = patient pushes up against wall ---> winging of scapula

Deltoid = abduct against resistance at 90 degrees

Supraspinatus = resisted empty can test

Teres minor/infraspinatus = resisted external rotation

Subscapularis = lift-off test

Neers impingement test = stabilise scapula with one hand, internally rotate straight arm and passively flex other arm ---> pain indicates impingement

Hawkin's test = flex arm to 90 degrees, pronate hand, and flex elbow to 90 degrees, then passively internally rotate shoulder ---> pain indicates impingement

Crank shoulder apprehension test = high five position, pull back elbow and push proximal humerus forward ---> patient shows fear of instability in shoulder dislocation/subluxation disorders

Scarf ACJ test = patient places hand on opposite shoulder ---> pain in ACJ pathology

11

Give some examples of intrinsic causes of shoulder pain.

Rotator cuff disorders:
- rotator cuff tears = traumatic or atraumatic, drop arm test, painful arc, Hx of repetitive/heavy movements
- subacromial pain
- calcific tendinitis: self-limiting, 30yrs-60yrs

Glenohumeral disorders:
- adhesive capsulitis (frozen shoulder): diabetes, prolonged immobilisation
- arthritis

Acromioclavicular disorders:
- trauma
- osteoarthritis
- restriction of passive horizontal movement of arm across the body when elbow extended

Biceps tendinitis

Infection

Shoulder instability +/- associated hypermobility disorders

12

Give some examples of extrinsic causes of shoulder pain.

Referred pain e.g. neck, MI, diaphragm

Polymyalgia rheumatica

Malignancy e.g. apical lung tumours, metastases

13

What are some red flags signs in a shoulder exam?

- Hx of malignancy, S&S consistent with neoplasia
- overlying skin erythema (tumour/infection)
- systemic S&S (polymyalgia rheumatica, giant cell arteritis)
- fever (tumour/infection)
- Hx of trauma/recent convulsions/electric shock (?unreduced dislocation)
- change in shoulder contour with loss of rotation (dislocation)
- sensory motor deficit (neurological lesion)