Shoulder conditions

Question 1

type of shoulder condition in <30 year old

Answer 1

instability (sports injury)

Question 2

type of shoulder condition in middle aged people (2)

Answer 2

frozen shoulder

rotator cuff injury

Question 3

type of shoulder condition in elderly people (2)

Answer 3

glenohumeral OA

cuff tear

Question 4

general management of shoulder conditions (3)

Answer 4

short term NSAID
steroid injections
physio

Question 5

another name for impingement syndrome

Answer 5

painful arc

Question 6

what are compressed in impingement syndrome that cause the pain

Answer 6

rotator cuff tendons

Question 7

which degree of movement is there pain in impingement syndrome

Answer 7

60-120 abduction

Question 8

compression of rotator cuff tendons in the subacromial space between 60-120 degrees of abduction

Answer 8

painful arc (impingement syndrome)

Question 9

which age group gets painful arc (impingement syndrome)

Answer 9

30-40s

Question 10

aetiology of painful arc (3)

Answer 10

sports injury
manual worker
tendon degeneration

Question 11

which rotator cuff muscle is typically affected in painful arc (impingement syndrome)

Answer 11

supraspinatus

Question 12

presentation of impingement syndrome (3)

Answer 12

painful arc (60-120 degrees abduction)
shoulder weakness 
pain radiating to deltoid

Question 13

treatment from GP for impingement syndrome (3)

Answer 13

analgesia/NSAID
physio for 3 months
3 steroid injections

Question 14

what are the steroid injections used in the shoulder

Answer 14

depo medrone with lignocaine

Question 15

impingement syndrome

after 6 months if the 3 injections are ineffective what do you do

Answer 15

surgery for decompression

Question 16

investigations for impingement syndrome (to rule out other causes)

Answer 16

xray - calcification, eyebrow sign ultrasound

Question 17

which age group get rotator cuff tears

Answer 17

> 40 year olds

grey hairs = cuff tears

Question 18

most common rotator cuff muscle for rotator cuff tears

Answer 18

supraspinatus

Question 19

pathophysiology of rotator cuff tear

Answer 19

degenerative and a jerk

Question 20

presentation of rotator cuff tear

Answer 20

sudden jerk of arm resulting in immediate pain and weakness

Question 21

treatment of rotator cuff tear (3)

Answer 21

NSAID
physio
injections

Question 22

when might you do a surgery for rotator cuff tear

Answer 22

if young

Question 23

recurrence rate of rotator cuff tears

Answer 23

40% reoccur after 1 year

Question 24

complication of rotator cuff tear

Answer 24

osteoarthritis

Question 25

inflammation of glenohumeral ligaments causing them to thicken and contract

Answer 25

frozen shoulder

Question 26

which age/gender get frozen shoulders

Answer 26

40-60s females (think mum)

Question 27

which chronic condition predisposes you to getting a frozen shoulder

Answer 27

diabetes

Question 28

what are the 3 phases of a frozen shoulder (how it presents)

Answer 28

severe pain for 6 months (FREEZING) pain settles but limited movement (FROZEN) movement returns within 2 years (THAWING)

Question 29

which movement is lost in frozen shoulder

Answer 29

external rotation

Question 30

investigation (necessary for diagnosis) of frozen shoulder

Answer 30

xray - must be normal for diagnosis (to exclude OA and locked posterior dislocation)

Question 31

treatment of frozen shoulder

Answer 31

physio - first line! NSAID/analgesia injections if painful >6 months

Question 32

how long should it take for full resolution of a frozen shoulder (self limiting conditions)

Answer 32

18-24 months

Question 33

calcium deposits in the supraspinatus tendon seen on xray

Answer 33

acute calcific tendonitis

Question 34

most common tendon for shoulder pathology

Answer 34

supraspinatus

Question 35

presentation of acute calcific tendonitis

Answer 35

severe acute onset pain

Question 36

treatment of acute calcific tendonitis

Answer 36

steroid injection for pain | local anaesthetic for pain

Question 37

how is acute calcific tendonitis diagnosed

Answer 37

xray

Question 38

how is acute calcific tendonitis cured

Answer 38

self limiting calcification gets reabsorbed

Question 39

most common type of shoulder dislocation

Answer 39

anterior

Question 40

what is shoulder subluxation

Answer 40

partial dislocation

Question 41

aetiology of posterior shoulder dislocation

Answer 41

seizure | ligamentous laxity conditions (ehlers-danlos syndrome, marfans)

Question 42

aetiology of anterior shoulder dislocation

Answer 42

sports injury

Question 43

cause of badge patch numbness in a shoulder dislocation

Answer 43

axillary nerve damage

Question 44

shoulder dislocation presentation caused by trauma (3)

Answer 44

pain loss of symmetry sometimes badge patch numbness

Question 45

investigations for shoulder dislocation caused by trauma (2)

Answer 45

xray | neurovascular assessment - pulses and nerves before and after surgery (to make sure you dont cause damage!)

Question 46

treatment of shoulder dislocation caused by trauma (4)

Answer 46

calm patient - analgesia, sedation, O2 relocation/manipulation by closed reduction sling for 2-4 weeks physio for strengthening

Question 47

treatment of recurrent shoulder dislocations from trauma

Answer 47

surgery for stabilisation

Question 48

if <20 and have a shoulder dislocation are they more or less likely to have a re-dislocation than someone >30

Answer 48

more 80% re-dislocation for <20s 20% re-dislocation for >20s

Question 49

aetiology of atraumatic shoulder dislocations

Answer 49

ligamentous laxity conditions eg ehlers-danlos, marfans

Question 50

presentation of atraumatic shoulder dislocation

Answer 50

not painful

Question 51

what would you see on xray in atraumatic shoulder dislocation

Answer 51

'light bulb sign' on xray bc humerus is twisted so looks symmetrical front on

Question 52

treatment of atraumatic shoulder dislocation

Answer 52

surgery | physio strengthening

Question 53

what is a bankart lesion when does it occur

Answer 53

when labrum (fibrocartilage) becomes injured and detaches from glenoid fossa after shoulder dislocation

Question 54

what is a hill sachs injury when does it occur

Answer 54

fracture of posterior humeral head after shoulder dislocation

Question 55

shoulder dislocation but pain doesnt settle

Answer 55

rotator cuff tear

Question 56

treatment of acromioclavicular joint dislocation (collar bone to shoulder)

Answer 56

sling and physio | surgery - if >100% dislocation, young athletes, chronic pain

Question 57

which age group get glenohumeral osteoarthritis

Answer 57

>60s

Question 58

presentation of shoulder OA (4)

Answer 58

gradual onset pain at night limited movement crepitus on examination

Question 59

what would you see on xray for someone with shoulder OA

Answer 59

``` LOSS; loss of joint space osteophytes subchondral cysts sclerosis ```

Question 60

treatment of shoulder OA (4)

Answer 60

analgesia physio steroid injections surgery - shoulder replacement, a few different options

Question 61

biceps tendonitis definition where

Answer 61

inflammation of long head of biceps in the bicipital groove of humerus

Question 62

presentation of biceps tendonitis (3)

Answer 62

popeye sign - bunched up triceps anterior shoulder pain worse on shoulder/elbow flexion bruising

Question 63

treatment of biceps tendonitis (2)

Answer 63

rest and physio | surgery (neurovascular risk)

Question 64

complication of biceps tendonitis

Answer 64

tendon rupture

Question 65

who gets biceps tendonitis (4)

Answer 65

athletes that through things swimmers gymnasts heaving lifting occupations

Question 66

how does biceps tendonitis come about

Answer 66

friction between biceps tendon and bicipital groove on humerus = inflammation of tendon