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shoulder pathology Flashcards

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1
Q

Biceps Tendinitis and Tenosynovitis s/s? (2)

A
  • pain over anterolateral shoulder that radiates down
  • inflammation of the long head of the biceps tendon (tendinitis) within the bicipital groove and tendon sheath (tenodynovitis)
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2
Q

what is Acute Tendinitis?

A

rotator cuff tendons become inflamed or irritated

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3
Q

acute tensinitis AKA?

A

common with athletes AKA:

  • swimmers shoulder
  • pitchers shoulder
  • tennis shoulder
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4
Q

acute tendinitis symptoms?

A
  • pain triggered by arm movement
  • swelling in front of shoulder
  • stiffness
  • clicking sound with arm movement
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5
Q
A

tendonitis

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6
Q

what is chronic tendinitis?

A
  • long term inflammation and degeneration of tissue in one or more of the tendons in the shoulder
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7
Q

chronic tendinitis is more likely to occure due to?

A
  • repetitive motions over time which puts stress on the tendons
  • calcifications may form and restrict movement within the shoulder
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8
Q

chronic tendinitis symptoms?

A
  • pain and discomfort
  • pain worsened during use, at night, or in the morning
  • stiffness
  • loss of strength
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9
Q

injury rate of shoulder related injuries depends on? (3)

A
  • shallowness of glenoid fossa
  • laxity of ligaments
  • strength of muscles
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10
Q

Common Shoulder Problems (8)?

A 
Instability
Impingement
Rotator cuff tears
AC joint sprains and degeneration
Adhesive capsulitis
Labral tears
Biceps tendinopathy
Clavicle fractures
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11
Q

3 categories of shoulder instability?

A
  • shoulder subluxation
  • shoulder dislocation
  • shoulder separation
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12
Q

what is shoulder subluxation?

A
  • incomplete or partial dislocaiton
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13
Q

what is shoulder dislocation?

A
  • complete dislocation of the GH joint

- most common anteriorly and inferiorly

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14
Q

what is shoulder separation?

A
  • complete dislocation of the AC joint
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15
Q

most common glenohumeral instability?

A

anteriorinferior instability

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16
Q

glenohumeral instability is caused by?

A
  • overstretching of the middle and inferior glenohumeral ligaments
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17
Q

6 categories of glenohumeral instability?

A 
Traumatic
Atraumatic
Unidirectional
Multi-directional
Unilateral
Bilateral
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18
Q

what is subacromial impingement syndrome?

A
  • entrapment or impingement of the structures in the subacromial space
  • between the CA arch and greater tuberosity
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19
Q

Subacromial space contains?

A
  • rotator cuff tendons
  • long head of biceps tendon
  • subacromial bursa
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20
Q

3 stages of impingement syndrome?

A 
1. <25 years old, overuse injury
    edema
2. 25-40 years old,
    fibrosis, bursal thickening
3. >50 years old
    partial or ft tear or rupture
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21
Q

what is Rotator Cuff Interval?

A
  • hypoechoic area surrounding the cross-sectioned long head of the biceps tendon
  • varies in size and may not be apparent in some individuals
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22
Q

Rotator Cuff Interval could be mistaken for?

A

rotator cuff tear

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23
Q

Musculotendinous Junction on U/S?

A

shows varying echogenicity of the interdigitating hyperechoic tendinous fibers and hypoechoic muscle fibers, an appearance that mimics tendinosis or a rotator cuff tear.

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24
Q

Supraspinatus-Infraspinatus Interface?

A
  • thinning of the rotator cuff at the supraspinatus-infraspinatus interface is a normal finding and should not be mistaken for a partial-thickness tear
  • seen in patients with rheumatoid arthritis
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25
Supraspinatus-Infraspinatus Interface
26
Most commonly torn rotator cuff muscle is the?
supraspinatus
27
ROTATOR CUFF TEARS/FAILURE?
- usually torn from chronic subacromial impingement | - may be traumatic tear
28
a complete tear is a result of?
repeated movements or sudden injury
29
what is a complete tear?
- tears all the way through to the tendon or it can rip the tendon off of the bone
30
complete tear symptoms?
- clicking or popping when you move your arm - pain when you move your arm or lie on it - weakness sin arm
31
complete tear diagnosis and treatment?
diagnosis: MRI, X-ray, U/S treatment: physical therapy or surgery
32
complete tear
33
Full Thickness Rotator Cuff Tears - Criteria? complete non visualization of the cuff
1. complete non visulaization of the cuff | - bare shoulder or massive tear
34
Full Thickness Rotator Cuff Tears - Criteria? localized or focal nonvisualization of cuff?
Localized or focal nonvisualization of cuff Occur in anterolateral critical zone Deltoid Herniation sign -defined pieces of cuff seperated by herniation of deltoid muscle into tear
35
what is the deltoid herniation sign?
defined pieces of cuff seperated by herniation of deltoid muscle into tear
36
Critical Zone of the rotator cuff?
area of relative avascularity on the supraspinatus muscle tendon near its insertion (tenoperiosteal junction) on the greater tubercle of the humerus.
37
Full Thickness Rotator Cuff Tears - Criteria? discontinuity of the cuff?
Smaller tear associated with fluid collection from SA-SD bursa Double cortex sign-bright reflective line at the surface of cartilage overlying the humeral head in the presence of focal overlying fluid 
38
Full Thickness Rotator Cuff Tears - Criteria? abnormal cuff echogenicity
Focal area of increased or decreased echogenicity | Least reliable
39
full thickness rotaor cuff tears allow communication of the?
glenohumeral and the SA-SD bursa, partial thickness tears do not
40
Partial- and full-thickness rotator cuff tears are visualized as?
hypoechoic lesions or mixed hyper-and hypoechoic lesions most frequently located in the critical zone of the supraspinatus tendon and should be verified in two orthogonal directions.
41
what is a partial tear?
- one of the muscles that forms the rotator cuff is damaged | - happens over time while repeating same arm motion
42
most common sports for partial tears (2)?
tennis and baseball
43
partial tear symptoms?
- difficulty lifting arm - weakness in shoulder - trouble doing things you normally do
44
patrial tear treatment?
physical therapy
45
Partial Thickness Rotator Cuff Tears - Types (3)?
1. intrasubstance (m/c) 2. articular surface 3. bursal surface
46
Partial Thickness Rotator Cuff Tears - articular surface?
- rim rent= early supraspinatus tear within the critical zone - associated with focal cortical irregularity of the humerus
47
partial thickness tear- intrasubstance tear
48
partial thickness articualr tear
49
partial thickness bursal tear
50
Minor Criteria for Tears (3)?
1. intra or extra articular fluid collections 2. abdormal contour of subdeltoid bursa 3. elevation of humeral head
51
intra or extra articular fluid collections found where?
subacromial-subdeltoid bursa
52
abnormal contour of subdeltoid bursa?
- concavity- medium or large tear | - thickness normal SA-SD bursa measures 2mm or less
53
thickness normal SA-SD bursa measures?
2mm or less
54
elevation of humeral head?
- massive tear | - compare with normal side
55
what is associated with "popeye sign"?
biceps tendon rupture
56
what is Popeye Deformity ? who does it affect
- Bicep tendon (usually the long head) tears causing the muscle to bunch up and form a ball of muscle in the upper arm - The tear usually occurs suddenly - Mostly affects people over 50 yrs
57
popeye sign
58
Calcific Tendinitis?
Calcium crystal deposit within the substance of the supraspinatus(critical zone) or biceps tendons
59
calcific tendinitis
60
Subluxation/ Dislocation of Biceps Tendon occurs where?
over medial wall of bicipital groove
61
Subluxation/ Dislocation of Biceps Tendon
62
Effusion?
Abnormal accumulation of fluid in or around a joint
63
effusion symptoms? (4)
Swelling - mild to severe Pain - suttle throb to sharp pain Stiffness - limit range of motion or entirely immobilize the joint Redness/warmth - associated with inflammation
64
effusion causes? (2)
septic | aseptic
65
septic causes or effusion?
- caused by infection - Most commonly caused by bacteria - Symptoms are rapid and painful - Infection may be caused by systemic infection through bloodstream or through a wound or medical procedure
66
septic causes or effusion risk factors?
- older age - diabetes - HIV - intravenous drug use - joint replacement
67
aseptic causes or effusion?
- not caused by infection - sports injury - car accident - serious fall
68
aseptic effusion is commonly associated with?
- bursitis | - tendosynocitis
69
effusion
70
Teardrop Sign?
– effusion – teardrop shaped thickening of the bursa distal to lateral edge of greater tuberosity
71
burisitis?
- inflammation | - hypervascularity with colour doppler
72
Transverse ultrasound image of the rotator cuff depicting acute subacromial-subdeltoid bursitis
73
Frozen Shoulder?
- adhesive capsulitis - shoulder capsule thickens and becomes tight - Stiff bands of tissue — called adhesions — develop less synovial fluid in the joint
74
frozen shoulder
75
Labral Tear causes?
pain and a catching sensation with movement of the shoulder
76
labral tear causes?
probably the result of an injury to the shoulder, such as falling on an outstretched hand
77
what might damage the labrum over time?
- excess motion of the humerus moving around on the glenoid | - An unstable shoulder may also cause injury to the labrum, if it repeatedly dislocates out of the glenoid.
78
Labral Cyst?
 - pockets of joint fluid that develop outside of the joint under tears of the labrum - also known as ganglia (or a ganglion)
79
labral cyst AKA glanglia
80
Avulsion Fracture?
greater and lesser tuberosity at insertion of rc tendons
81
Hill-Sachs Deformity?
depression fracture of posterior humeral head secondary to recurrent anterior dislocation
82
Geyser sign?
(effusion at the acromioclavicular joint) in a patient with total rotator cuff rupture

MSK (8 decks)

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