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MI1 > Shoulder Injuries > Flashcards

Shoulder Injuries Flashcards

1
Q

What joints are included in the shoulder complex?

A
  • Glenohumeral (G/H)
  • Acromioclavicular (A/C)
  • Sternoclavicular (S/C)
  • Scapulothoracic (S/T)
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2
Q

Where does the long head of biceps attach?

A

Superior aspect of the labrum

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3
Q

What is the function of the GH labrum?

A

Deepens the joint & keeps the humeral head centred on the glenoid

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4
Q

What do rotator cuff related conditions include?

A
  • Impingement
  • Tendon tears
  • Poor control, weakness
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5
Q

What are the types of impingement syndrome of the rotator cuff?

A
  • External (subacromial): Primary, secondary

- Internal (post sup glenoid)

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6
Q

What is primary external impingement syndrome caused by?

A

Things filling up the supraspinatus outlet:

  • Hooked acromion
  • Bony spurs
  • Coracoacromial ligament thickening
  • AC joint OA & osteophytes
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7
Q

What is secondary external impingement syndrome?

A
  • Altered mechanics
  • Inadequate muscular stabilisation of scapula
  • Dyskinesis causing narrowing subacromial space
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8
Q

What is internal impingement syndrome?

A
  • Joint laxity (usually anterior)
  • Dyskinesis
  • Results in tendon being drawn into the joint
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9
Q

What is important to remember about impingements?

A

Not a diagnosis - impingement is caused by something else (usually a combination of factors)

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10
Q

What is an example of dyskinesis in the shoulder?

A

Abnormal/involuntary movement, e.g. hitching the shoulder during flexion etc

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11
Q

How is primary external impingement treated?

A
  • Need to remove the bony spur with acromioplasty
  • Decompression procedure, some of the spur is shaved off
  • Coracoacromial ligament is released/removed if thickened
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12
Q

What are the treatment principles for treating impingements?

A
  • Understand primary cause & treat it

- Understand what is modifiable

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13
Q

What are some of the mechanisms of rotator cuff tears?

A
  • Degenerative tendinopathy (usually supraspinatus)
  • Pre-existing asymptomatic tendinopathy
  • Traumatic tendon rupture e.g. fall, tackle, part of dislocation, huge muscle contraction
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14
Q

What is the most common rotator cuff muscle that is torn traumatically?

A

Subscapularis

  • Blends with anterior capsule
  • Helps keep humeral head centred
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15
Q

What are the non-surgical treatment options for rotator cuff tears?

A
  • Activity modification
  • Intermittent use of sling
  • NSAIDs
  • Steroid injections
  • Correction of biomechanics
  • Strengthening to correct muscle imbalance
  • EPAs
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16
Q

For what percentage of patients does non-surgical management of rotator cuff tears provide relief?

A

Approximately 50%

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17
Q

What type of patients is non-surgical management of rotator cuff tears recommended for?

A

Patients with pain as the main symptom, rather than weakness (functional strength does not improve without surgery)

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18
Q

What are the 2 proven predictors of poor outcomes from non-surgical treatment of rotator cuff tears?

A
  • Long duration of symptoms (>6-12 months)

- Large tears (>3cm)

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19
Q

When does shoulder instability occur?

A
  • After dislocation
  • Weak or uncoordinated rotator cuff
  • Attenuated (thinning/stretched) capsule
  • Labral tears/SLAP lesions
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20
Q

What keeps the humeral head centred?

A

A fine balance of capsular ligaments and cuff tendons

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21
Q

What does the rotator cuff cable help to bind?

A

Supraspinatus and anterior joint capsule

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22
Q

In what direction do G/H dislocations commonly occur?

A

Anteriorly & inferiorly (people usually in a stop sign position)

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23
Q

What are anterior/inferior shoulder dislocations commonly associated with?

A
  • Bankart lesion (labrum rips off glenoid with humeral head +/- bony avulsion)
  • Glenoid rim fracture
  • Hill-Sachs lesion (compression fracture of greater tuberosity of humerus)
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24
Q

What can Hill-Sachs lesions be associated with?

A

Avascular necrosis

25
Q

What are some of the common subjective findings for shoulder dislocations?

A
  • Acute injury, acute pain
  • Prominent acromion, large sulcus under acromion
  • Unable to move shoulder until reduced
  • Heard popping sound
  • Apprehension
26
Q

Why is it important that shoulder dislocations be reduced quickly?

A

Can cause an axillary nerve palsy

  • Nerve is on stretch when shoulder is dislocated
  • Can affect supply to deltoid
27
Q

What are some of the symptoms that remain after successful shoulder reduction?

A
  • Instability (ant/inf)

- Chronic posterior/multiplanar instability

28
Q

What are the mechanisms of injury for glenoid labrum tears?

A
  • Traumatic: secondary to dislocation/sublux

- Repetitive overuse: overhead throwing, inferior traction (swinging from arms e.g. gymnasts)

29
Q

What are the 4 types of SLAP lesions?

A
  1. Attachment to glenoid intact, evidence of degeneration/fraying
  2. Detached superior labrum & long head of biceps
  3. Meniscoid superior labrum torn away, displaced into joint but tendon & rim intact
  4. Superior rim tear extends into biceps tendon, both displaced into the joint
30
Q

What are some of the non-SLAP lesions?

A
  • Vertical glenoid rim lesions
  • Degenerative lesions
  • Flap lesions
31
Q

What subjective findings are associated with glenoid labrum tears/SLAP lesions?

A
  • Poorly localised pain in shoulder
  • Pain with overhead activities
  • Pain with hand behind back movement
  • Popping, catching, grinding, clicking
32
Q

What objective findings are associated with glenoid labrum tears/SLAP lesions?

A
  • Catching mid ROM, blocked ROM or pain at end ROM
  • Pain with resisted biceps test
  • Dynamic labral shear test, crank test, O’Brien’s test
33
Q

How are glenoid labrum tears/SLAP lesions managed?

A
  • Pain reduction (avoid painful positions)
  • Instability underlying lesion (strengthen stabilisers, closed chain & proprioceptive work)
  • Assess & treat hypo/hypermobility
  • Refer for surgical opinion
34
Q

Why are closed chain excesses good for stability?

A

Compress the joint

35
Q

How are SLAP lesions repaired surgically?

A
  • Arthroscopically
  • Anchor inserted into bone containing sutures & 2 wings
  • Once inserted, wings open so sutures are inserted deep into bone & can’t come out
36
Q

What can post surgical management include?

A

Depends on surgeon

  • Sling
  • Pendulum exercises
  • AROM/PROM using pulley
  • Full ROM
  • Throwing
  • Overhead activity
37
Q

What are some of the problems related to stiffness in the shoulder?

A
  • Frozen shoulder
  • Post surgery
  • Post immobilisation
  • Arthropathy (OA/RA)
38
Q

What is frozen shoulder?

A
  • AKA Adhesive capsulitis
  • At least 2 planes of motion restricted (one plane must be external rotation)
  • Folds of capsule stick together (freeze up)
  • Mechanism unknown
39
Q

Who is commonly affected by frozen shoulder?

A

Women around menopause

40
Q

What is frozen shoulder characterised by?

A
  • Begins with severe pain, often for no reason or only mild trauma
  • Pain out of proportion, can’t sleep
  • Usually treated poorly (thought to be psychological etc)
41
Q

What are the phases of frozen shoulder?

A
  • Painful phase (several months)
  • Freezing phase - stiffness becomes more prominent than pain
  • Thawing phase - movement starts to be restored (can take years)
42
Q

How is frozen shoulder managed?

A
  • Surgical: Patient under GA, surgeon forces joint back into range
  • Cortisone injections
  • Physio for loosening stiffness in thawing phase (less pain)
43
Q

What are some of the common shoulder fractures & their mechanisms?

A
  • Clavicle: FOOSH, fall on point of shoulder, direct blow
  • Neck of humerus: FOOSH, OA
  • Shaft of humerus: Torsion injury
  • Supracondylar humerus: Children
  • Greater tuberosity: Compression, shearing off
44
Q

Why do neck of humerus fractures need to be monitored closely?

A

Can cause avascular necrosis

45
Q

How are shoulder fractures managed?

A
  • Clavicle: Sling, figure 8 bandage 2-3/52
  • Neck of humerus: U-slab, sling, plastic splint 4/52
  • Shaft of humerus: Long arm cast 4-6/52
  • Supracondylar: Long arm cast, IF, EF 4/52
46
Q

What are some of the AC joint related problems?

A
  • Sprains
  • Osteolysis
  • OA
47
Q

What is a complication associated with AC joint sprains?

A

Intra-articular disc in joint can be torn, causing pain & cause of OA over time

48
Q

When do AC joint injuries commonly hurt?

A
  • Crossing arms
  • Raising arms above 90 degrees
    (causes compression & rotation at AC joint)
49
Q

What is osteolysis?

A
  • Erosion/softening of distal end of clavicle
  • Can occur spontaneously after AC joint sprain
  • Can occur in people who do lots of overheard weights
50
Q

What is important to remember when looking at AC joint injuries?

A

Always look at the other end of the clavicle at the SC joint

51
Q

Where can referred pain from the shoulder come from?

A
  • Cervical spine
  • Thoracic outlet syndrome
  • Tumours
  • Visceral (gall bladder, liver, diaphragm, ulcers, heart, spleen, lung)
  • Peripheral nerve entrapments (supra/infrascapular nerve, quadrilateral space, long thoracic nerve palsy)
52
Q

What are the main static stabilisers of the shoulder in the functional (abducted) position?

A
  • Anterior band of inferior GH ligament (prevents anterior translation)
  • Posterior band of inferior GH ligament (prevents posterior translation)
  • Glenoid labrum (deepens cavity)
53
Q

What are the clinical features of rotator cuff tendinopathy?

A
  • Pain with overhead activity
  • Ass. symptoms of instability
  • Night pain
  • Reduced abduction/IR
54
Q

What complication can occur with rotator cuff tendinopathy?

A

Calcification (usually in supraspinatus)

55
Q

What is the mechanism of biceps tendinopathy?

A
  • Large volume of weight training (bench press, dips)
56
Q

What is the mechanism of subscapularis muscle tears?

A

Sudden forceful external rotation or extension while in abduction

57
Q

What nerve entrapments can contribute to shoulder pain?

A
  • Suprascapular nerve
  • Long thoracic nerve
  • Axillary nerve
58
Q

What does long thoracic nerve palsy cause?

A

Paralysis of serratus anterior causing winging of the scapula

59
Q

What is thoracic outlet syndrome?

A
  • Compression of the neurovascular structures in the thoracic outlet (esp brachial plexus & subclavian vessels
  • Occurs in overhead sports

MI1 (18 decks)

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