Shoulder OA Flashcards Preview

My Ortho Upper Limb > Shoulder OA > Flashcards

Flashcards in Shoulder OA Deck (17):
1

Hx

67 yr old retired electrician significant R shoulder pain, began gradually, worse over past 2 yrs, worsened by overhead activity, disturbs sleep after tennis, proximal R humeral fracture after fall from horse 20 yrs ago, managed conservatively. HTN + hypercholesterolaemia.

2

look/ inspect

reduced muscle bulk right deltoid
disuse atrophy

3

feel

tenderness over right glenohumeral joint
crepitus

4

active and passive movement

reduced and painful ROM of R shoulder
particularly lateral rotation R shoulder

5

resisted movement

no pain or weakness

6

special tests

scarf test for AC joint
Empty can test
Apprehension test for instability in ligaments

7

other exam findings

possible OA changes hands
cervical spine exam
neuro exam upper limb

8

DDx

OA R glenohumeral/ shoulder joint
adhesive capsulitis
RA
Gout
Rotator cuff pathology

9

Why is OA likely

Hx pain gradual onset worsened with activity previous fracture

10

Why is adhesive capsulitis/RA/gout unlikely?

Hx frozen shoulder 18 months of pain then stiffness, no hx of RA, no FHx of RA, asymmetrical joint presentation, gout possible due to metabolic risk factors but more common in feet/wrists/ankles
exam frozen shoulder possible, no RA changes in hands, gout tophi

11

Why is rotator cuff pathology unlikely?

no pain or weakness reproduced with resisted movement

12

Investigations GP

bloods [routine + arthritis screen + ESR/CRP/ uric acid]
X-ray shoulder
CT shoulder
MRI shoulder

13

X-ray shoulder

AP, true AP, axillary X-ray R shoulder
subchondral sclerosis
osteophytes at inf aspect of humeral head goat beard
RA erosive pattern

14

CT shoulder

inflammatory arthritis if large bony defects on X-ray

15

MRI shoulder

evaluate rotator cuff tendon

16

initial management GP

analgesia
physio
intra-articular injection of steroid/LA
ortho referral

17

op tx

arthroplasty, arthrodesis