Flashcards in Shoulder Pathology Deck (17):
Define shoulder dislocation
Complete separation of the glenohumeral joint, may be anterior or posterior
What factors cause shoulder instability?
What neurovascular structures can be commonly involved in shoulder dislocations?
What complications occur with shoulder dislocations?
- Rotator cuff tears
- Hill-Sachs and Bankhart lesions
- Neurovascular injury (axillary nn, aa, median nn, musculocutaneous nn)
There is a 98% probability of a rotator cuff tear being present if the following 3 are present
1) Supraspinatus weakness
2) External rotation weakness
3) Positive impingement sign
What are the 3 types of rotator cuff syndromes?
Subacute tendinitis (painful arc syndrome)
Chronic tendinitis (impingement syndrome)
Rotator cuff tears
What are the 3 basic pathological processes of rotator cuff syndrome?
Trauma and impingement
Which is the most common site of degeneration and fibrocartilaginous metaplasia?
What is the "painful arc"?
Shoulder abduction between 60 and 120 degrees
What is the management of rotator cuff syndrome?
- 1/2 corticosteroid injections into the joint
- Removal of the coracoacromial ligament, anterior part of acromion and the osteophytes
- Can be either via open surgery or arthroplasty
When is surgery indicated for rotator cuff syndrome?
- more than 3 months of ineffective conservative therapy
- persistent recurrence of the syndrome
What are the advantages of arthroscopy vs open surgery?
- Earlier rehabilitation
- Less soft tissue damage
- Better cosmetic appearance
What is the mechanism of developing calcific tendinitis?
Deposition of calcium hydroxyapatite crystals on the supraspinatus tendon, most probably due to fibrocartilaginous metaplasia from local ischemia. This leads to a vascular reaction in an attempt to resorb the calcium causing pain
What is the management of calcific tendinitis?
Pain not so severe:
- slingand NSAIDs
- Corticosteroid injections
- Extracorporeal shockwave treatment
- Drainage with ultrasound guidance (barbotage)
- Surgery (last resort)
What is the purpose of performing an x-ray in adhesive capsulitis and what will it reveal?
Rule out other pathology
X-Ray is normal in adhesive capsulitis
When is operative management indicated in anterior shoulder instability?
1) frequent dislocations with severe pain
2) interference with everyday activities, including sport