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MSK > Shoulder Problems > Flashcards

Shoulder Problems Flashcards

1
Q

give 4 shoulder problems

A 
instability
cuff disease
- impingement
- cuff tear
frozen shoulder
arthritis
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2
Q

at what age is each problem most likely?

A 
instability = 20-30
impingement = 30-40s
frozen shoulder = 40-50s
cuff tears = 50-60s
arthritis = >60
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3
Q

how many joints are in the shoulder girdle?

A

4

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4
Q

how many muscles attach to the scapula?

A

17

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5
Q

coracohumeral ligament is thickened in what disease?

A

frozen shoulder

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6
Q

what are the 4 important extrinsic muscles?

A

deltoid
trapezium
pectoralis major
latissimus dorsi

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7
Q

what are the intrinsic muscles?

A

rotator cuff muscles

  • supraspinatous
  • infraspinatous
  • teres minor
  • subscapularis
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8
Q

who does shoulder instability usually affect?

A

teenage - 30s
young sporty people
usually traumatic

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9
Q

where does the shoulder usually dislocate?

A

anteriorly

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10
Q

what can indicate whether anterior or posterior dslocation?

A

subtle dislocation = posterior

gross = anterior

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11
Q

what is more likely to cause a posterior dislocation?

A

epileptic fit
alcohol?
electrocution

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12
Q

first thing you do in an acute shoulder dislocation due to trauma?

A

analgesia

then reduce the joint

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13
Q

how does a more chronic instability of the shoulder present?

A

atraumatic
not painful
no support

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14
Q

important aspects of history in shoulder dislocation?

A

mechanism of injury
ease of dislocation
has it happened before

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15
Q

what is seen on examination of shoulder instability?

A 
abnormal shoulder contour
muscle wasting
tenderness
spasm
good ROM
scapular winging/dyskinesia
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16
Q

give 2 conditions associated with hyperlaxity?

A

marfans

ehlers danlos syndrome

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17
Q

how is a shoulder reduced by manipulation?

A

Kocher method
can give IV analgesia, O2 or IV sedation
Hippocratic method (large muscly people)
Stimson method (multiple dislocations)

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18
Q

post reduction treatment?

A

2-3 weeks sling for pain relief
analgesia
gradual early mobilisation
physiotherapy

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19
Q

investigations for shoulder dislocations?

A 
imaging (X rays etc)
MRI angiogram (if multiple dislocations have occurred)
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20
Q

give for injuries associated with shoulder instability

A

Labral lesion (Bankart) = most important
fracture humeral head (Hill Sachs)
Fracture of glenoid (Bony bankart)
Rotator cuff tear

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21
Q

what do all shoulder dislocations get?

A

physio (RC and core strengthening, scapula stability)

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22
Q

what causes an increased risk of recurrence of dislocation?

A

younger age at first dislocation

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23
Q

surgical treatment?

A

arthroscopic/open stabilisation

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24
Q

instability rehab?

A 
6 weeks sling
8-10 weeks no driving
12 weeks no heavy lifting
No contact sports for 12 weeks
training and non-contact sports after 6 weeks
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25
Q

what is impingement syndrome?

A

pain originating from t he sub acromial space ………..

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26
Q

intrinsic impingement syndrome?

A

tendon vascularity
watershed area
tendon degeneration
cuff dysfunction

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27
Q

extrinsic impingement syndrome?

A

external pressure due to

  • type of acromion
  • coraco acromial ligament
  • clavicular spur/osteophyte
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28
Q

what type of impingment is most likely to occur at which age?

A 
<30s = RC tendonitis/subacromial bursitis
calcific tendonitis = 30-40s
tendinosis/partial tears RC = 40-50s
cuff tear = 50-60s
cuff arthropathy (due to really bad cuff tear) = 70s
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29
Q

how is impingement syndrome classified?

A

Neers classification
1 = inflammation, oedema and haemorrhage (reversible)
2 = …..

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30
Q

important aspects of history in impingement?

A 
age
hand dominance
occupation
pain (SOCRATES)
reach and stretch ability
painful arc
neurology (pins and needles etc)
neck pain (can be related to shoulder cause)
analgesia, physio, injections (any previous treatment)
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31
Q

features of impingement examination?

A 
contour
wasting
scapula positioning
tenderness bursa
loss of active ROM?
Hawkins Joes test
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32
Q

X ray signs?

A

calcification (fluffy dots) in muscles

sclerosis on underside of acromion

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33
Q

other shoulder impingement investigations?

A

US
MRI
depending on mobility

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34
Q

how is impingement treated?

A 
rest
pain relief
physiotherapy
cortico-steroid injections in subacromial space (X2 or 3)
surgery = last resort
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35
Q

how long must non operative treatment be used before surgery?

A

6 months

36
Q

surgical treatment for impingement?

A

arthroscopic/subacromial decompression

37
Q

how can decompression surgery be used?

A

….

38
Q

impingement rehab?

A 
painful
sling for 1-2 weeks
early physio and ROM exercise
RC strengthening
recovery time longer than expected - 3 or 4 months
39
Q

classic examination feature of impingement?

A

painful arc

40
Q

who does cuff tear normally affect?

A

age 50-60s

most commonly chronic but can be acute trauma

41
Q

how does cuff tear present?

A

weakness

pain

42
Q

where does cuff tear usually start>

A

articular surface, not on bursa side

43
Q

examination findings of cuff tear?

A

muscle wasting = main sign
subdeltoid tenderness
…..

44
Q

cuff tear investigations? when is each used?

A

X ray (reduced subacromial space, some sclerosis, rounding of shoulder, humeral head can move upwards)
US if good ROM
MRI if very stiff

45
Q

treatment of chronic cuff tear?

A

physio (anterior deltoid strengthening)
steroid injections
wait and see

46
Q

acute cuff tear treatment?

A

urgent investigation
early physio
early reassessment
early intervention (good response to surgery)

47
Q

cuff tear surgery?

A

arthroscopic or open repair of RC

48
Q

cuff repair rehab?

A 
sling 6 weeks
no driving 8-10 weeks
12 weeks no heavy lifting
prolonged physio
6-9 months recovery
2-40% recurrence rate at 1 year
49
Q

who does frozen shoulder affect?

A

40-50s females

diabetes, lipid and endocrine disease and dupuytrens

50
Q

how does frozen shoulder present?

A

gradual severe pain

can be bilateral (but not always simultaneous)

51
Q

what is a frozen shoulder?

A

contracture and thickening of coracohumeral ligament, rotator interval, axillary fold
decrease in joint volume
NO ADHESION

52
Q

3 phases of frozen shoulder?

A

freezing
frozen
thawing
self limiting but can take 3-4 years

53
Q

does frozen shoulder always completely resolve?

A

often have residual pain

54
Q

examination of frozen shoulder?

A

global restriction……

55
Q

differential diagnoses with frozen shoulder?

A

locked posterior ……

56
Q

how is frozen shoulder diagnosed and differentiated from other things?

A

normal radiographs

57
Q

non opeative treatment for frozen shoulder?

A 
gentle movements
analgesia
physio
gleno-humeral injections?
flouresence?
58
Q

operative treatment of frozen shoulder?

A

manipulation under anaesthetic

arthroscopic capsular release

59
Q

frozen shoulder rehab?

A

short time in sling

quick physio

60
Q

arthritis presentation?

A 
over 60s
gradual onset
intermittent exacerbations
stiffness
pain at rest and night
functional difficulties
61
Q

common arthritis in shoulder?

A

OA
RA
post traumatic

62
Q

arthritis examination?

A

…….

63
Q

arthritis radiograph features?

A

LOSS

64
Q

non operative treatment of arthritis?

A

analgesia
physio
GH steroid injection

65
Q

operative arthritis treatment?

A 
shoulder replacement
- resurfacing
- total shoulder arthroplasty
- reverse polarity shoulder replacement
rotator cuff arthroplasty
66
Q

post arthroplasty rehab?

A

sling 6 weeks

……..

67
Q

who does carpal tunnel syndrome affect?

A 
>30s
females
pregnancy hypothryroidism
diabetes
obesity
RA
68
Q

what causes CTS?

A

relative reduction in blood supply

can be intrinsic or extrinsic cause

69
Q

what does the median nerve innervate?

A 
LOAF
lumbricals IF and MF
Opponens
Abductor pollicis brevis
flexor pollicis brevis
70
Q

sensory innervation of median nerve?

A

thumb

first 2 and a half fingers

71
Q

CTS symptoms?

A 
early = pins and needles, pain, clumbsiness
later = numbness, weakness
72
Q

functional symptoms of CTS?

A

early morning wakening

……..

73
Q

CTS signs?

A

thenar atrophy (if long term)
altered sensation
weakness of abductor pollicis brevis
positive durkins, tinnels and phalens test

74
Q

CTS investigations?

A

carpal tunnel queastionaire

nerve conduction studies

75
Q

CTS treatment?

A

mild/moderate = splintage, physio, steroid injections

76
Q

severe CTS treatment? what are the aims of this?

A

carpal tunnel decompression (division of transverse carpal ligament)
- prevents progression and reduce symptoms

77
Q

carpal decompression rehab?

A

pincer grip returns in 6 weeks

…….

78
Q

who does cubital tunnel syndrome affect?

A 
>30s
more males
post traumatic causes
direct pressure (sleeping position)
arthritis
79
Q

what does the ulnar nerve innervate?

A

everything else apart from LOAF

80
Q

early symptoms of cubital tunnel syndrome?

A

ulnar pins and needles

…

81
Q

late symptoms of cubital tunnel syndrome?

A

……

82
Q

signs of cubital tunnel syndrome?

A

hypothenar wasting

83
Q

cubital tunnel tests?

A

tinnels
modified phalens
froments test

84
Q

cubital tunnel investigation?

A

clinical examination

nerve conduction studies

85
Q

mild/moderate treatment for cubital tunnel?

A

elbow splinatge
physio
NSAIDs

86
Q

severe treatment for cubital tunnel?

A

ulnar nerve decompression

MSK (66 decks)

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