Shoulder pathologies

Question 1

Impingement syndrome - definition

Answer 1

Tendons of the rotator cuff become inflammed as they are compressed in the tight subacromial space during movement

Question 2

Impingement syndrome - which rotator cuff muscle is most commonly affected?

Answer 2

Supraspinatous

Question 3

Impingement syndrome - epidemiology

age

Answer 3

Middle aged

Question 4

Impingement syndrome - causes

Answer 4

Rotator cuff tear
Tendonitis
Osteophytes from AC joint
Subacromial bursitis

Question 5

Impingement syndrome - clinical features

Answer 5

Pain originating in the subacromial space which radiates to the deltoid and upper arm
Deep pain
Pain felt when arm is abducted

Question 6

Impingement syndrome - examination

Answer 6

Look:
contour, muscle wasting, deformity, scapula position

Feel:
Tenderness

Move:
Pain on abduction
- this pain subsides once they abduct their arm pst a certain height

Question 7

Impingement syndrome - painful arc angle

Answer 7

60-120 degrees of abduction

as inflammed area of supraspinatus tendon passes through the subacromial space

Question 8

Impingement syndrome - investigations

Answer 8

X-ray
- fluffy dots floating outside (calcium)
US
MRI

Question 9

Impingement syndrome - management

Answer 9

NSAIDs
Analgesia
Physio
Subacromial injection (can administer up to 3)
Severe:
subacromial decompression surgery (wait at least 6 months first)

Question 10

Adhesive capsulitis - definition

Answer 10

Frozen shoulder. Inflammation of the capsule and glenohumeral ligament of the shoulder resulting in tightness due to contraction

Question 11

Adhesive capsulitis - epidemiology

Answer 11

Middle age

Commoner in females

Question 12

Adhesive capsulitis - cause

Answer 12

Can occur after shoulder surgery
Diabetes
High cholesterol

Question 13

Adhesive capsulitis - clinical features

Answer 13

FREEZING
- progressive severe pain, constant pain, pain at night
FROZEN
- pain eventually subsides as stiffness increases
- limitation of movement
THAWING
- stiffness gradually disappears over time and shoulder recovers
- patient gets movement of their arm back

Question 14

Adhesive capsulitis - examination

Answer 14

Restriction of range of movement (unable to externally rotate arm)

Question 15

Adhesive capsulitis - investigations

Answer 15

X-ray

- should be normal

Question 16

Adhesive capsulitis - management

Answer 16

Non operative
- physio, analgesia
- intra-articular glenohumeral injections
Operative
- arthroscopic capsular release

Question 17

Rotator cuff tear - definition

Answer 17

Tears can be partial or full thickness

Lack of muscular stability

Question 18

Rotator cuff tear - causes

Answer 18

Tendon degeneration

Sudden jerk

Question 19

Rotator cuff tear - epidemiology

Answer 19

Over 40 year olds

grey hair, cuff tear

Question 20

Rotator cuff tear - clinical features

Answer 20

Pain

weakness of initiation of abduction (supraspinatous)

Question 21

Rotator cuff tear - examination

Answer 21

LOOK:
- contour, muscle wasting
FEEL:
- tenderness, subdeltoid region 
MOVE: 
- active movement is much less than passive movement

Question 22

Rotator cuff tear - investigations

Answer 22

X-rays

• subacromial space is reduced
• Greater tuberosity of humerus is looked and instead the humerus looks spherical
• Confirm tears on US or MRI

Question 23

Rotator cuff tear - management

Answer 23

Non-operative:
- physio
- subacromial injection 
Operative:
- rotator cuff repair (open or arthroscopic) [failure of surgery is common due to diseased tendon]

Question 24

Acute calcific tendonitis - definition

Answer 24

Calcium in the supraspinatus tendon

Question 25

Acute calcific tendonitis - clinical features

Answer 25

Acute onset of severe shoulder pain

Question 26

Acute calcific tendonitis - investigations

Answer 26

X-ray | - can see calcium deposition just proximal to the greater tuberosity of the humerus

Question 27

Acute calcific tendonitis - management

Answer 27

Subacromial steroid injection

Question 28

Instability - definition

Answer 28

Subluxation/dislocation | Humeral head is no longer sitting in the gleaned fossa

Question 29

Instability - epidemiology | age

Answer 29

Younger people

Question 30

Instability - causes

Answer 30

Mainly traumatic (e.g. sport injury)

Question 31

Instability - clinical features

Answer 31

Pain

Question 32

Instability - examination

Answer 32

``` LOOK: - abnormal shoulder contour - muscle wasting FEEL: - tenderness - muscle spasm MOVE: - range of movement - winged scapula Special tests: - rotator cuff strength - apprehension - relocation - general laxity ```

Question 33

Instability - investigations

Answer 33

X-ray | MRI

Question 34

Instability - management

Answer 34

IV analgesia, O2, IV sedation Reduce shoulder to original position In recurrent dislocations - try a Bankart repair which aims to reattach the labrum and capsule to the anterior glenoid

Question 35

Instability - prognosis

Answer 35

The younger the patient, the higher the risk of recurrent dislocation

Question 36

The dislocation is usually anteriorly/posteriorly?

Answer 36

Anteriorly

Question 37

Causes of anterior dislocation

Answer 37

Trauma

Question 38

Causes of posterior dislocation

Answer 38

Electrocution | Epileptic fit

Question 39

Glenohumeral OA - epidemiology

Answer 39

Elderly

Question 40

GLenohumeral OA - Causes

Answer 40

Cuff tear Instability (recurrent dislocation) Previous surgery

Question 41

Glenohumeral OA - clinical features

Answer 41

Gradual onset Pain at rest and at night Pain at the front of shoulder Stiffness

Question 42

Glenohumeral OA - examination

Answer 42

``` Asymmetry Wasting Limitation external rotation Global restriction in movement Crepitus ```

Question 43

Glenohumeral OA - investigations

Answer 43

X-ray | - LOSS

Question 44

Glenohumeral OA - management

Answer 44

``` Non-operative: - analgesia - physio Operative: - total shoulder replacement - resurfacing ```

Question 45

Associated nerve involvement with anterior dislocation

Answer 45

Axillary nerve