Shoulder orthopaedics and trauma Flashcards Preview

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Flashcards in Shoulder orthopaedics and trauma Deck (38):
1

What is shoulder impingement syndrome?

The tendons of the rotator cuff, mostly supraspinatus, become compressed in the space in the subacromial space, producing pain on movement

2

What are some of the causes of shoulder impingement?

Tendonitis

Subacromial bursitis

Acromioclavicular OA with inferior osteophyte

A hooked acromion

Rotator cuff tear

3

What are the symptoms of shoulder impingement syndrome?

Constant mild pain in shoulder

Pain when lifting objects or raising arms

Loss of movement

4

What signs on examination would indicate a shoulder impingement?

Tenderness below lateral edge of acromion

Painful arc - pain between 80 to 150 degrees of abduction

Positive Hawkins-Kennedy test

 

5

What is a common differential diagnosis for shoulder impingement in older patients?

Acromioclavicular osteoarthritis

6

How can shoulder impingement and acromioclavicular OA be distinguished?

Acromioclavicular OA gives a positive scarf test

7

What are differential diagnoses of shoulder impingement?

Frozen shoulder

Rotator cuff tear

Shoulder instability

 

8

What is the treatment for shoulder impingement?

NSAIDs

Analgesic

Physiotherapy

Subacromial steroid injections

9

How can a shoulder impingement that is not improved successfully with conservative management be treated?

Subacromial decompression surgery

10

What can cause rotator cuff tears?

Impingement

Degeneration of tendons

Vascular problems

Trauma (uncommon)

11

What are the signs and symptoms of a rotator cuff tear?

Muscle weakness

Night pain

Muscle wasting

Positive Jobes test (if supraspinatus affected)

Weakness on rotator cuff muscle tests on examination

12

Which rotator cuff muscle is usually affected by rotator cuff tears?

Supraspinatus

Infraspinatus and subscapularis can also be involved in large tears

13

How can a rotator cuff tear be confirmed?

Ultrasound
MRI

14

What is a frozen shoulder?

Adhesive capsulitis -  the shoulder capsule, the connective tissue surrounding the glenohumeral joint of the shoulder, becomes inflamed and stiff, greatly restricting motion and causing chronic pain

15

How does adhesive capsulitis present?

Progressive pain and stiffness of the shoulder in patients aged 40-60

Pain is often worse at night and in the cold

16

What is the main indicative sign on examination for adhesive capsulitis?

Loss of external rotation

17

What are the risk factors for developing frozen shoulder?

 Diabetes mellitus

Hypercholesterolaemia

Dupuytren's disease

18

What is the main treatment for frozen shoulder?

Analgesics

Physiotherapy

Intra-articular injections

19

How does calcific tendonitis present?

Acute onset shoulder pain

20

What is calcific tendonitis?

Degenerative calcification of the supraspinatus tendon with calcium deposits just proximal to the greater tuberosity

21

How is calcific tendonitis treated?

Subacromial steroid and local anaesthetic injection

22

What does instability of the shoulder involve?

Painful abnormal translational movement or subluxation and/or recurrent dislocation of the shoulder

23

Is a younger patient more likely to suffer reccurent anterior traumatic dislocations than an older patient?

Yes:

80% recurrence in under 20s

20% recurrence in over 30s

24

How can recurrent shoulder dislocations be improved surgically?

 A Bankart repair (open or arthroscopic) can stabilize the shoulder by reattaching the labrum and capsule to the anterior glenoid which was torn off in the first dislocation

25

Which patients might suffer from atraumatic shoulder instability?

Patients with generalized ligamentous laxity (idiopathic, Ehlers‐Danlos, Marfan’s)

26

Which patients suffer from proximal humeral neck fractures?

Those with osteoporosis

27

What is the usual mechanism of a humeral neck fracture?

Osteoporotic bone

Fall onto outstretched hand

Fall directly onto shoulder

28

How does the humeral shaft tend to displace in a fracture of the neck of the humerus?

Medially due to the pull of pectoralis major

Greater and lesser tuberosities may be avusled due to pull of supraspinatus, infraspinatus and teres minor

29

What is the most common pattern of proximal humerus fracture?

Fracture of the surgical neck

30

How are persistently displaced proximal humerus fractures treated?

Internal fixation with plates, screws, wires or intramedullary nails

31

How are head splitting proximal humeral fractures usually treated?

Shoulder replacement unless young patient with good bone quality

32

Which is the more common kind of shoulder dislocation?

Anterior dislocation

33

How do shoulder dislocations occur?

Excessive external rotation force

Fall onto the back of the shoulder

Seizures

 

34

What is a Bankart lesion and how might it occur?

Detachment of the anterior glenoid labrum

May occur as a result of anterior shoulder dislocation

35

What neurovascular structures are at risk in an anterior shoulder dislocation?

The axillary nerve can be stretched as it passes through the quadrilateral space whilst other nerves of the brachial plexus as well as the axillary artery can be stretched or compressed

36

How might an anterior shoulder dislocation be detected on examination?

Loss of symmetry of shoulders

Patient may be supporting injured arm in an abducted position

37

How can axillary nerve damage be detected clinically?

Loss of sensation in regimental badge area

38

What is the mainstay of treatment in shoulder dislocation?

Closed reduction under anaesthetic

Full neurovascular assessment