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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
what is impingement syndrome?
pain originating from t he sub acromial space ………..
26
intrinsic impingement syndrome?
tendon vascularity watershed area tendon degeneration cuff dysfunction
27
extrinsic impingement syndrome?
external pressure due to - type of acromion - coraco acromial ligament - clavicular spur/osteophyte
28
what type of impingment is most likely to occur at which age?
``` <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 ```
29
how is impingement syndrome classified?
Neers classification 1 = inflammation, oedema and haemorrhage (reversible) 2 = …..
30
important aspects of history in impingement?
``` 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) ```
31
features of impingement examination?
``` contour wasting scapula positioning tenderness bursa loss of active ROM? Hawkins Joes test ```
32
X ray signs?
calcification (fluffy dots) in muscles | sclerosis on underside of acromion
33
other shoulder impingement investigations?
US MRI depending on mobility
34
how is impingement treated?
``` rest pain relief physiotherapy cortico-steroid injections in subacromial space (X2 or 3) surgery = last resort ```
35
how long must non operative treatment be used before surgery?
6 months
36
surgical treatment for impingement?
arthroscopic/subacromial decompression
37
how can decompression surgery be used?
….
38
impingement rehab?
``` painful sling for 1-2 weeks early physio and ROM exercise RC strengthening recovery time longer than expected - 3 or 4 months ```
39
classic examination feature of impingement?
painful arc
40
who does cuff tear normally affect?
age 50-60s | most commonly chronic but can be acute trauma
41
how does cuff tear present?
weakness | pain
42
where does cuff tear usually start>
articular surface, not on bursa side
43
examination findings of cuff tear?
muscle wasting = main sign subdeltoid tenderness …..
44
cuff tear investigations? when is each used?
X ray (reduced subacromial space, some sclerosis, rounding of shoulder, humeral head can move upwards) US if good ROM MRI if very stiff
45
treatment of chronic cuff tear?
physio (anterior deltoid strengthening) steroid injections wait and see
46
acute cuff tear treatment?
urgent investigation early physio early reassessment early intervention (good response to surgery)
47
cuff tear surgery?
arthroscopic or open repair of RC
48
cuff repair rehab?
``` 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
who does frozen shoulder affect?
40-50s females | diabetes, lipid and endocrine disease and dupuytrens
50
how does frozen shoulder present?
gradual severe pain | can be bilateral (but not always simultaneous)
51
what is a frozen shoulder?
contracture and thickening of coracohumeral ligament, rotator interval, axillary fold decrease in joint volume NO ADHESION
52
3 phases of frozen shoulder?
freezing frozen thawing self limiting but can take 3-4 years
53
does frozen shoulder always completely resolve?
often have residual pain
54
examination of frozen shoulder?
global restriction......
55
differential diagnoses with frozen shoulder?
locked posterior …...
56
how is frozen shoulder diagnosed and differentiated from other things?
normal radiographs
57
non opeative treatment for frozen shoulder?
``` gentle movements analgesia physio gleno-humeral injections? flouresence? ```
58
operative treatment of frozen shoulder?
manipulation under anaesthetic | arthroscopic capsular release
59
frozen shoulder rehab?
short time in sling | quick physio
60
arthritis presentation?
``` over 60s gradual onset intermittent exacerbations stiffness pain at rest and night functional difficulties ```
61
common arthritis in shoulder?
OA RA post traumatic
62
arthritis examination?
…….
63
arthritis radiograph features?
LOSS
64
non operative treatment of arthritis?
analgesia physio GH steroid injection
65
operative arthritis treatment?
``` shoulder replacement - resurfacing - total shoulder arthroplasty - reverse polarity shoulder replacement rotator cuff arthroplasty ```
66
post arthroplasty rehab?
sling 6 weeks | ……..
67
who does carpal tunnel syndrome affect?
``` >30s females pregnancy hypothryroidism diabetes obesity RA ```
68
what causes CTS?
relative reduction in blood supply | can be intrinsic or extrinsic cause
69
what does the median nerve innervate?
``` LOAF lumbricals IF and MF Opponens Abductor pollicis brevis flexor pollicis brevis ```
70
sensory innervation of median nerve?
thumb | first 2 and a half fingers
71
CTS symptoms?
``` early = pins and needles, pain, clumbsiness later = numbness, weakness ```
72
functional symptoms of CTS?
early morning wakening | ……..
73
CTS signs?
thenar atrophy (if long term) altered sensation weakness of abductor pollicis brevis positive durkins, tinnels and phalens test
74
CTS investigations?
carpal tunnel queastionaire | nerve conduction studies
75
CTS treatment?
mild/moderate = splintage, physio, steroid injections
76
severe CTS treatment? what are the aims of this?
carpal tunnel decompression (division of transverse carpal ligament) - prevents progression and reduce symptoms
77
carpal decompression rehab?
pincer grip returns in 6 weeks | …….
78
who does cubital tunnel syndrome affect?
``` >30s more males post traumatic causes direct pressure (sleeping position) arthritis ```
79
what does the ulnar nerve innervate?
everything else apart from LOAF
80
early symptoms of cubital tunnel syndrome?
ulnar pins and needles | ...
81
late symptoms of cubital tunnel syndrome?
…...
82
signs of cubital tunnel syndrome?
hypothenar wasting
83
cubital tunnel tests?
tinnels modified phalens froments test
84
cubital tunnel investigation?
clinical examination | nerve conduction studies
85
mild/moderate treatment for cubital tunnel?
elbow splinatge physio NSAIDs
86
severe treatment for cubital tunnel?
ulnar nerve decompression

MSK (66 decks)

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