Flashcards in Shoulder and upper limb nerve entrapment Deck (60):
What is the relevant bony anatomy of the shoulder?
What are the relevant muscles of the shoulder?
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
There is a ligament spanning from the acromion to the corocoid. T/F
True - acromiocoracoid ligament
Where does tendon impingement occur?
Against the acromion or acromiocoracoid ligament
What is the rotator cuff?
The combined tendons of the rotator cuff muscles
What is more important in shoulder stability - bony anatomy or soft tissue anatomy?
Soft tissue anatomy - bony anatomy does not provide much stability
How can pathology of the shoulder bursa be investigated?
How common is shoulder impingement?
What are the typical symptoms of shoulder impingement?
Pain on movement (often specific movements)
Night pain (more common with tears)
What are the signs of shoulder impingement?
Positive hawkins kennedy test
Positive impingement tests (internal rotation)
How common is muscle wasting in shoulder impingement?
Uncommon - usually points to another pathology
What are the possible causes of loss of range of movement of the shoulder?
Tear (rotator cuff)
Shoulder impingement (only due to pain)
What endocrine condition is frozen shoulder associated with?
What is often the main feature which separates shoulder impingement from a rotator cuff tear?
Weakness is present in tears
What diagnosis would painful and complete loss of movement at the shoulder point too?
What is a painful arc?
Pain on abduction from 50-120 degrees
What is a crescendo arc? What does it point towards?
Increasing pain as the shoulder adducts. Acromioclavicular joint pathology
What is subacromial bursitis?
Inflammation of the shoulder bursa usually due to or related to impingement
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
What is calcific tendonitis?
Build up of calcium within the rotator cuff of unknown cause
How does calcific tendonitis present?
Reduced range of movement
Who gets calcific tendonitis?
30-60 y/o most commonly
How is calcific tendonitis treated?
Joint aspirate --> steroid injection
Self resolving but takes years
What is os acromiale?
Non fused epiphysis of the acromion
How common is os acromiale?
How does os acromiale present?
How is a rotator cuff tear managed?
How is shoulder arthritis managed?
Surgery high risk with poor results
What structure is needed for total shoulder arthroplasty?
When is a reverse arthroplasty indicated?
When conservative measures have failed and the rotator cuff is rubbish
Shoulder instability can be traumatic or atraumatic which is more common?
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)
Which direction of shoulder dislocation is most common?
What is at risk in an anterior shoulder dislocation?
What is a posterior dislocation associated with?
What are hill sachs lesions?
Posterolateral humeral head compression fractures
What are hill sachs lesions associated with?
Anterior shoulder dislocation (humeral head becomes wedged beneath glenoid)
What is a bankart lesion?
Tear in the anterior inferior glenoid labrum due to anterior shoulder dislocation
Do bakart lesions need repaired?
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)
What is often positive in atraumatic shoulder instability?
What conditions are associated with multidirectional shoulder instability?
What is ehlers danlos syndrome?
A heritable disorder of connective tissue causing joint hypermobility, stretchy and fragile skin
What scoring system can be used to diagnose hypermobility syndrome(s)?
Which radiographical sign is present with posterior shoulder dislocation?
Light bulb sign
Which views should be taken for a suspected posterior shoulder dislocation?
How is inferior capsule shift managed?
What is carpal tunnel syndrome?
Compression of the median nerve at the carpal tunnel
How does carpal tunnel syndrome present?
Paraesthesia of index, middle and radial ring finger
Loss of grip strength
How can carpal tunnel be managed?
What conditions are associated with carpal tunnel?
How is carpal tunnel investigated?
Nerve conduction studies
What is the carpal tunnel?
Tunnel by which flexor tendons of the wrist pass inferior to the flexor retinaculum/transverse carpal ligament
What is cubital tunnel syndrome?
Compression of the ulnar nerve at the cubital tunnel
How does cubital tunnel syndrome present?
Pain/paraesthesia of the elbow
Pain/paraesthesia of the ulnar ring and little finger
What sign may be present in carpal tunnel syndrome?
What sign may be present in cubital tunnel syndrome?
Which three sites might cause compression of the ulnar nerve?
Flexor carpi ulnaris tendon heads
Intermuscular fibrous bands above elbow