Shoulder Pathology Flashcards
Many fractures and dislocations in the shoulder are the result of falls, commonly a fall on an outstretched hand (FOOSH).
Where do shoulder fractures most commonly occur, location wise, on the shoulder?
- Middle-third clavicle
- Because ligaments firmly attach the medial and lateral ends
What should one be weary of with a fractured clavicle?
- Neurovascular compromise of distal limb
- Rare
- May damage subclavian artery + brachial plexus
What is the treatment for fractured clavicle?
- Conservative → broad arm sling 3 wks + analgesia
- ‘Bump’ forms in healed bone
- Surgical reduction with ORIF only needed if fracture is open or there is neurovascular compromise, as it causes greater disability than conservative treatment
What is a shoulder dislocation?
- Complete loss of contact between articular surfaces of joint
- Shoulder is most commonly dislocated joint
- Sx → pain / loss of fxn / loss of contour
- Can be either anterior (way more common) or posterior
What happens in anterior shoulder dislocation and the main complication?
- Humeral head dislocates anteriorly and then medially to lie underneath the coracoid process
- Main complication is damage to axillary nerve → loss of sensation over deltoid muscle (regimental patch)
- Patient holds arm in abduction + shoulder movement is impossible
Which investigation for shoulder dislocation?
- 2 radiograph views essential
- To confirm direction of dislocation + identify fracture
- Careful examination for fracture of humeral head is important as otherwise fracture-dislocation may be missed
What is the management for shoulder dislocation?
- Analgesia
- Assess neurovascular status of distal limb
- Radiograph
- Early reduction → open or closed
- Reassess neurovascular status
- Confirm reduction with a radiograph
What are features of recurrent shoulder dislocation?
- Repeated anterior dislocation common in young pts
- 90% in those under 20 yrs
- Recurrence linked to soft tissue defect
- Bankart lesion → damage to anterior portion glenoid labrum of capsule
- Hill-Sachs’ lesion → bony deformity of humeral head
- Apprehension test is positive
TUBS
Treatment for shouldre instability depends on the cause.
Surgery is required for which causes of physical damage?
- Traumatic
- Unidirectional instability
- Bankart lesion
- Surgery
Who is acromioclavicular joint subluxation/dislocation common in?
- Rugby players
- Causes pain and step in shoulder
What is the treatment for acromioclavicular joint subluxation/dislocation?
- Sling with strapping over the joint
- Occasionally open reduction with repair of ligament
When the tendon to the long head of biceps is ruptured, there is sudden pain in the upper arm and anterior shoulder, and the patient notices a lump in the upper arm.
How is diagnosis of rupture of tendon to long head of biceps made?
When elbow flexion is resisted, causing a bulging of biceps fibres → the ‘Popeye’ sign
Tx → NSAIDs + steroid injection
Painful arc syndrome affects which range of motion of the shoulder?
- Mid-range of active abduction → 60-120 degrees
- When a tendon structure (nodule) becomes painfully impinged within subarcomial space
- Passive abduction is complete and painless
What are the 5 causes of painful arc syndrome?
- Supraspinatus tendonitis
- Calcifying tendonitis
- Rotator cuff tear
- Subacromial bursitis
- Fracture of greater tuberosity
What are features of and treatment for spuraspinatus tendonitis?
- Acute inflammation of supraspinatus muscle causes acute area of swelling, which becomes painfully squashed underneath the acromion during abduction
- Muscle eventually clears the nodule + pain disappears
Tx → rest / NSAIDs / steroid + LA injection
What are features of frozen shoulder?
- AKA adhesive capsulitis
- Common idiopathic condition
- Painful restriction of EXTERNAL ROTATION
- Reactive inflammation within capsule followed by adhesions, forming between capsule and humeral head
- Pain typically at end of range of movement in all directions
- Diagnosis based on clinical findings
