shoulder injury Flashcards
what is the most common shoudler dislocation?
why are shoulder dislocations common?
complications with shoulder dislocations?
anterior - the humeral head lies anterioinferiorly to glenoid fossa?
genoid fosa is shallow and inferior labrum is weak
reccurance
bankart lesion = tear in labrum
hill sach lesion = indentation fracture of posterolateral humeral head from anterior dislocation
nerve injury, artery injury, RC tear, PT arthiritis
when would a posterior shoulder dislocation happen?
what does the humeral head look like on an X ray?
gow to manage shoulder dislocations?
uncommon - violent muscle contraction e.f. seizure, trauma, electrocution
lightbulb
pain relief, prompt reduction (pop back), test axillary nerve for damage, imaging, physio
what neurovascular structures are at risk in clavicle fractures?
where do most clavicular fractures occur?
mechanism of injury?
what do people present with ?
suprascapular artery and nerve
subclavian artery and vein
brachial plexus
mid section of clavicle
fall onto outstretched arm, direct blow, contact sport, breech delivery
pain, tenting of skin, loss of function
management of clavicular fracture?
what fractures require surgery?
rule out pneumothorax
rule out neurovasular injury
manage conervatively (pain relief, immobilise, physio)
open fractures, severe displacements, nurovascular compromise
what is an RC tear?
what issues does this tear cause?
what 2 types are there?
what are atruamatic caused by?
what is traumatic caused by?
rotator cuff tear - tear in 1 + of the STIS muscles
stability of joint compromised and loss of motion
acute (traumatic) tear and chronic (atrumatic) tear
age degeneration, repetitive overhead use, chronic microtraumas build up and worsened by inflammation
high velocity trauma
what would you see on an acute RC tear?
what would you see on a chronic RC tear?
management?
what is the most common RC tear?
painful and reduced ROM
no pain, compensation movements e.g. shrugging to help abduction, and loss of function
conervative (rest, pain relief)
physio
intra articular injections of pain killers and sterioids to reduce inflammation
young = surgery
supraspinatus
what is calcific supraspinatus tendinopathy?
what causes the pain?
why does it occur?
management?
deposits of hyroxyapatite crystals (clacium phosphate) on the supraspinatus tendon causing pain and is a complication of tendon damage
when phagocytes phagocytose the crystals
tenocyte - chrondrocyte - ossification
tendon stem cell - osteogenic stem cell
acute care = conervative and subacromial steriod/pain injections
long terms = supraspinatus decompression surgery
condition is self limiting
what is shoulder impingement?
when does pain get worse?
what can cause impingement?
what makes you more at risk of getting it?
irritation/inflammtion of tendons that pass the subacromial space
in abduction or flexsion as the subacromial space narrows
anything to narrow the space e.g. inflammtion of supraspinatus tendon, subacromial bursitis, subacromial osteophytes
repetitive lifting/overhead activities
how does shoulder impingement present?
how to manage?
when would you need surgery ?
progressive pain, pain arc (when abduct)
weakness
swelling/inflammation
joint clicking/locking
conservative, physio, subacromial steroid injections, adress underlying cause
may need surgery for bursectomy, acromioplasty and muscle tear repair
what is adhesive capsulitis?
who is more at risk?
what are the 3 stages?
frozen shoulder - chronic fibrosing condition which progessively restricts range of passive and active motion at shoulder
there is thickening of gleohumoral capsule and formation of adhesions
diabetics, females, thyroid disease, breast cancer, connective and CVS disease
freezing, frozen, thawing (when its resolving)
how to manage adhesive capsulitis ?
self limiting - usualy resolves after 18-24 months
physio
pain relief
intraarticular steroid injections
surgery - manipulate joint to loosen ligants and free fibrin strands or arthroscopic capsular release to release fibrin strands
where can shoulder osteoarthiritis occur?
what would you see on X ray??
how to manage ?
acromioclavicular joint, gleonhumoral joint
LOSS (loss of joint space, osteophytes, sclerosis, subchondral cysts)
conervative - modicy daily activities, pain relief, steriod/pain injections
surgery - arthroscopy (debridement), athroplasty (total or hemi)
