Shoulder and upper limb nerve entrapment Flashcards Preview

Year 2 > Shoulder and upper limb nerve entrapment > Flashcards

Flashcards in Shoulder and upper limb nerve entrapment Deck (60):
1

What is the relevant bony anatomy of the shoulder?

Acromioclavicular joint
Glenohumeral joint

2

What are the relevant muscles of the shoulder?

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

3

What is the rotator interval?

The anatomical space bound by the subscapularis, supraspinatus and corocoid containing the coracohumeral and superior glenohumoral ligament, the biceps tendon and anterior joint capsule

4

There is a ligament spanning from the acromion to the corocoid. T/F

True - acromiocoracoid ligament

5

Where does tendon impingement occur?

Against the acromion or acromiocoracoid ligament

6

What is the rotator cuff?

The combined tendons of the rotator cuff muscles

7

What is more important in shoulder stability - bony anatomy or soft tissue anatomy?

Soft tissue anatomy - bony anatomy does not provide much stability

8

How can pathology of the shoulder bursa be investigated?

Ultrasound

9

How common is shoulder impingement?

Very

10

What are the typical symptoms of shoulder impingement?

Pain on movement (often specific movements)
Night pain (more common with tears)

11

What are the signs of shoulder impingement?

Painful arc
Positive hawkins kennedy test
Positive impingement tests (internal rotation)

12

How common is muscle wasting in shoulder impingement?

Uncommon - usually points to another pathology

13

What are the possible causes of loss of range of movement of the shoulder?

Frozen shoulder
Tear (rotator cuff)
Shoulder impingement (only due to pain)

14

What endocrine condition is frozen shoulder associated with?

Diabetes

15

What is often the main feature which separates shoulder impingement from a rotator cuff tear?

Weakness is present in tears

16

What diagnosis would painful and complete loss of movement at the shoulder point too?

Frozen shoulder

17

What is a painful arc?

Pain on abduction from 50-120 degrees

18

What is a crescendo arc? What does it point towards?

Increasing pain as the shoulder adducts. Acromioclavicular joint pathology

19

What is subacromial bursitis?

Inflammation of the shoulder bursa usually due to or related to impingement

20

What is the bigliani acromial classification? Why is it relevant?

Classification of shoulder morphology (type I - flat, type II - curved, type III - hooked)
Type II and III acromions are associated with higher risk of impingement

21

What is calcific tendonitis?

Build up of calcium within the rotator cuff of unknown cause

22

How does calcific tendonitis present?

Pain
Impingement
Reduced range of movement

23

Who gets calcific tendonitis?

30-60 y/o most commonly

24

How is calcific tendonitis treated?

Joint aspirate --> steroid injection
Self resolving but takes years

25

What is os acromiale?

Non fused epiphysis of the acromion

26

How common is os acromiale?

Very rare

27

How does os acromiale present?

Often asymptomatic
Pain
Impingement

28

How is a rotator cuff tear managed?

Physiotherapy
Surgery

29

How is shoulder arthritis managed?

Conservatively
Surgery high risk with poor results

30

What structure is needed for total shoulder arthroplasty?

Rotator cuff

31

When is a reverse arthroplasty indicated?

When conservative measures have failed and the rotator cuff is rubbish

32

Shoulder instability can be traumatic or atraumatic which is more common?

Traumatic causes

33

What does TUBS stand for?

TUBS relates to shoulder instability

T - traumatic aetiology
U - unidirectional instability
B - bankart lesion
S - surgery needed (bankart repair OR latarjet)

34

Which direction of shoulder dislocation is most common?

Anterior

35

What is at risk in an anterior shoulder dislocation?

Axillary nerve

36

What is a posterior dislocation associated with?

Epileptic seizure
Electric shock
Atraumatic

37

What are hill sachs lesions?

Posterolateral humeral head compression fractures

38

What are hill sachs lesions associated with?

Anterior shoulder dislocation (humeral head becomes wedged beneath glenoid)

39

What is a bankart lesion?

Tear in the anterior inferior glenoid labrum due to anterior shoulder dislocation

40

Do bakart lesions need repaired?

Yes

41

What does AMBRI stand for?

AMBRI is related to shoulder instability

A - atraumatic
M - multidirectional
B - bilateral
R - rehabilitation
I - inferior capsule shift (surgery if conservative fails)

42

What is often positive in atraumatic shoulder instability?

Sulcus sign

43

What conditions are associated with multidirectional shoulder instability?

Ehlers danlos
Marfans

44

What is ehlers danlos syndrome?

A heritable disorder of connective tissue causing joint hypermobility, stretchy and fragile skin

45

What scoring system can be used to diagnose hypermobility syndrome(s)?

Beighton score

46

Which radiographical sign is present with posterior shoulder dislocation?

Light bulb sign

47

Which views should be taken for a suspected posterior shoulder dislocation?

AP
Lateral

48

How is inferior capsule shift managed?

Conservatively
Surgically

49

What is carpal tunnel syndrome?

Compression of the median nerve at the carpal tunnel

50

How does carpal tunnel syndrome present?

Paraesthesia of index, middle and radial ring finger
Thumb weakness
Dull pain
Loss of grip strength
Reduced dexterity
Night disturbance

51

How can carpal tunnel be managed?

Night splints
Surgery
Steroid injections

52

What conditions are associated with carpal tunnel?

Pregnancy
Hypothyroidism
Rheumatoid arthritis
Diabetes
Obesity

53

How is carpal tunnel investigated?

Nerve conduction studies

54

What is the carpal tunnel?

Tunnel by which flexor tendons of the wrist pass inferior to the flexor retinaculum/transverse carpal ligament

55

What is cubital tunnel syndrome?

Compression of the ulnar nerve at the cubital tunnel

56

How does cubital tunnel syndrome present?

Pain/paraesthesia of the elbow
Pain/paraesthesia of the ulnar ring and little finger
Weakness

57

What sign may be present in carpal tunnel syndrome?

Thenar wasting

58

What sign may be present in cubital tunnel syndrome?

Claw-like grip

59

Which three sites might cause compression of the ulnar nerve?

Cubital tunnel
Flexor carpi ulnaris tendon heads
Intermuscular fibrous bands above elbow

60

How is cubital tunnel syndrome treated?

Surgery

Decks in Year 2 Class (72):