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MSK Patrick Stenhouse > Shoulder Pathologies > Flashcards

Shoulder Pathologies Flashcards

1
Q

The rotator cuff is formed from which four muscles?

A
  1. Supraspinatus
  2. Infraspinatus
  3. Teres minor
  4. Subscapularis
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2
Q

Where do the following rotator cuff muscles have there insertion site?

  • Supraspinatus
  • Infraspinatus
  • Teres minor
A

Greater tuberosity of humerus

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3
Q

What is the function of supraspinatus?

A

Initiation of abduction

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4
Q

What is the role of teres minor and infraspinatus?

A

External rotation at the shoulder joint

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5
Q

Where does the subscapularis have its insertion site and what is the role of this muscle?

A

Lesser tuberosity of the humerus

Internal rotation at shoulder joint

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6
Q

Collectively, what is the function of the rotator cuff muscles?

A

Pull humeral head into glenoid providing stability

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7
Q

What is impingement syndrome?

A

Pain due to tendons of the rotator cuff muscles due to compression in the subacromial space during movement

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8
Q

What is a painful arc?

A

Pain at between 60-120º on abduction

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9
Q

What are the causes of impingement syndrome?

A
  1. Tendonitis
  2. Subacromial bursitis
  3. AC OA with inferior osteophyte
  4. A hooked acromion
  5. Rotator cuff tear
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10
Q

Where does pain classically radiate in those with painful arc?

A

Deltoid and upper arm

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11
Q

Which clinical test is relevant for painful arc?

A

Hawkins-Kennedy test

(internally rotates the flexed shoulder which should re-create pain)

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12
Q

What are the treatment options for painful arc?

A

Conservative - NSAIDS, analgesia, physio, (up to 3) subacromial injections

Failure to improve with these methods requires subacromial decompression surgery which creates more space in the subacromial space

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13
Q

The classic history or rotator cuff tear involves what?

A

A sudden jerk in patients >40 which produces subsequent pain and weakness

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14
Q

In a rotator cuff tear, which muscle is primarily involved?

A

Supraspinatus

(large tears may also involve the subscapularis and infraspinatus)

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15
Q

What may be seen on examination for rotator cuff tears?

A
  1. Weakness of initiation of abduction (supraspinatus)
  2. Internal rotation weakness (Subscapularis)
  3. External rotation wekaness ( Infraspinatus)
  4. Wasting of supraspinatus
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16
Q

How are rotator cuff tears confirmed?

A

MRI os USS

17
Q

Why is surgery for rotator cuff tears controversial?

A
  1. The tendon is usually diseased and failure of repair is common
  2. Large tears may be irrepairable
  3. The tendon may be retracted too far
18
Q

What is the non-operative management of rotator cuff tears?

A
  1. Physio - strengthens up remaining cuff muscles allowing compensation for weakened supraspinatus
  2. Subacromial injections can aid symptom relief
19
Q

Adhesive capsulitis is characterised by what?

A

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

20
Q

How long does adhesive capsulitis take to resolve?

A

18-24 months

21
Q

What is the first thing a patient developing adhesive capsulitis will complain about?

A

Pain

(this subsides after 2-9 months)

22
Q

After the pain from adhesive capsulitis subsides, what is the next symptoms patients experience?

A

Increasing stiffness

(for 4-12 months)

This gradually thaws over time

23
Q

What is the principal clinical sign of adhesive capsulitis?

A

Loss of external rotation

24
Q

Patients with which conditions are particularly at risk of adhesive capsulitis?

A
  1. Diabetes
  2. Hypercholesterolaemia
  3. Dupuytren’s disease
25
Q

What is the treatment for adhesive capsulitis?

A
  • Physio
  • Analgesics
  • Intra-articular injections
  • After the settling of pain manipulation under anaesthesia can be attempted or surgical capsular release which divides the capsule
26
Q

What is acute calcific tendonitis and how is it characterised?

A

Acute onset of severe shoulder pain characterised by deposition of calcium in the supraspinatus tendon

27
Q

In patients with acute calcific tendonitis, where can the calcium depositis be seen on X-ray?

A

Proximal to the greater tuberosity of the humerus

28
Q

What is the treatment for acute calcific tendonitis?

A

Self limiting

Subacromial steroids and local anaesthesia can control pain

29
Q

What are the two categories of shoulder instability?

A
  1. Traumatic instability
  2. Atraumatic instability
30
Q

With traumatic shoulder instability, dislocation usually occurs __________

A

Anteriorly

31
Q

What is the treatment for traumatic instability?

A

Rest

Physiotherpapy strengthening programme

Recurrent dislocations require a Bankart repair which involve sstabilising the shoulder by reattaching the labrumand capsule to the anterior glenoid

32
Q

Which type of patients can have pain from multidirectional subluxations or dislocations?

A

Patients with generalised ligamentous laxity

(idiopathic, Marfan’s, Ehlers-Danlos)

33
Q

Where is the pain from biceps tendonitis?

A

Anterior shoulder pain

There is pain on resisted biceps contraction

34
Q

Which treatment may be required to relieve symptoms of biceps tendonitis?

A

Surgical division of the tendon

35
Q

Patients with spontaneous tendon rupture as a result of biceps tendonitis often have which clinical sign?

A

Popeye deformity

(due to bunched up biceps muscle)

36
Q

How can tears in the glenoid labrum which are causing pain be identified?

A

MRI arthrogram (contract injected into joint)

37
Q

What is the treatment for tears in the glenoid labrum?

A

Biceps tendonotomy

or

Labral resection or repair

38
Q

What are some other causes of shoulder pain which may or may not be associated with the MSK system?

A
  1. Neck problems can cause referred pain
  2. Angina
  3. Diaphragmatic irritation due to biliary colic, hepatic or subphrenic abscesses)

MSK Patrick Stenhouse (60 decks)

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