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Flashcards in Shoulder Pathology Deck (17):
1

Define shoulder dislocation

Complete separation of the glenohumeral joint, may be anterior or posterior

2

What factors cause shoulder instability?

-Shallow glenoid
-Loose capsule
-Ligamentous laxity

3

What neurovascular structures can be commonly involved in shoulder dislocations?

Neurological
-Axillary nerve
-Musculocutaneous nerve
-Median nerve

Vascular
-Axillary artery

4

What complications occur with shoulder dislocations?

- Rotator cuff tears
- Hill-Sachs and Bankhart lesions
- Neurovascular injury (axillary nn, aa, median nn, musculocutaneous nn)
-Recurrent dislocations

5

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

6

What are the 3 types of rotator cuff syndromes?

Subacute tendinitis (painful arc syndrome)
Chronic tendinitis (impingement syndrome)
Rotator cuff tears

7

What are the 3 basic pathological processes of rotator cuff syndrome?

Degeneration
Trauma and impingement
Vascular reaction

8

Which is the most common site of degeneration and fibrocartilaginous metaplasia?

Supraspinatus

9

What is the "painful arc"?

Shoulder abduction between 60 and 120 degrees

10

What is the management of rotator cuff syndrome?

Conservative:
- NSAIDs
- Physiotherapy
- 1/2 corticosteroid injections into the joint

Surgical:
- Removal of the coracoacromial ligament, anterior part of acromion and the osteophytes
- Can be either via open surgery or arthroplasty

11

When is surgery indicated for rotator cuff syndrome?

- more than 3 months of ineffective conservative therapy
- persistent recurrence of the syndrome

12

What are the advantages of arthroscopy vs open surgery?

- Earlier rehabilitation
- Less soft tissue damage
- Better cosmetic appearance

13

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

14

What is the management of calcific tendinitis?

Pain not so severe:
- slingand NSAIDs

Severe pain:
- Corticosteroid injections
- Extracorporeal shockwave treatment
- Drainage with ultrasound guidance (barbotage)
- Surgery (last resort)

15

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

16

When is operative management indicated in anterior shoulder instability?

1) frequent dislocations with severe pain
2) interference with everyday activities, including sport

17

What are the 6 complications of supracondylar fractures?

Immediate
Ulnar/median nerve injury
Compartment syndrome
Brachial artery injury

Late
Stiffness
Varus deformity