The Shoulder Pathologies

Question 1

MOI for anterior dislocation?

Answer 1

Approx 97% of all shoulder dislocations

Violent external rotation in abduction

Question 2

MOI for posterior dislocation?

Answer 2

2-4% of shoulder dislocations

Humeral head forced posteriorly in internal rotation while arm abducted

Result of violent muscle contraction- seizures, electrocution

Question 3

MOI for inferior dislocation?

Answer 3

Less than 1%

Forceful hyper abduction- or direct axial loading on a full abducted arm with elbow extended and pronated

Question 4

Body chart/symptoms for all 3 dislocations?

Answer 4

Anterior- arm abducted and externally rotated. Loss of normal contour of deltoid. Humeral head palpable anteriorly

Posterior- arm held in adduction and internal rotation
Patient unable to externally rotate

Inferior- arm held above and behind head
patient unable to adduct arm

Question 5

What is a SLAP lesion?

Answer 5

Superior labral anterior posterior lesions

Damage to superior aspect of glenoid labrum

Can extend to the long head biceps tendon, glenohumeral ligaments

Question 6

MOI for SLAP?

Answer 6

Common in athletes
Commonly caused by falls/ repetitive overhead motions

May be traumatic or chronic

Question 7

What is SAPs?

Answer 7

Sub-acromial pain syndrome

E.g. supraspinatus tendinopathy, partial tear of rotator cuff, bursitis

Question 8

MOI for SAPs?

Answer 8

Non- traumatic
Usually unilateral

Rotator cuff tear- chronic repetitive/ degenerative, acute
Supraspinatus muscle is most common

Partial thickness tear >50 years, chronic, or related to minor trauma e.g. simple fall on outstretched arm

Question 9

Symptoms of SAPs?

Answer 9

Pain, localised around acromion

Question 10

Aggravating factors for SAPs?

Answer 10

Worsens during or subsequent to lifting the arm

Weak or painful abduction- supraspinatus

Question 11

Age and gender of Adhesive capsulitis?

Answer 11

Higher prevalence in women the men- due to menopause causing a change in hormones

Onset usually 40-59 years

Pathological process resulting in decreased capsular volume

Question 12

MOI for adhesive capsulitis?

Answer 12

Primary adhesive capsulitis- idiopathic (spontaneous)

Secondary- following trauma/surgery

Question 13

Signs and symptoms/body chart of adhesive capsulitis?

Answer 13

Pain, stiffness and dysfunction

Global restriction of movements- lateral rotation is a key movement

Capsular pattern- external rotation, abduction, internal rotation

Often described in 3 stages; pain, stiffness and recovery. Or freezing, frozen and thawing

Question 14

What is the freezing phase?

Answer 14

Pain increases with movement, often worse at night

Progressive loss of motion with increasing pain

Approximately 2-9 months

Question 15

What is the frozen phase?

Answer 15

Pain begins to dimmish

Range of motion further limited

Approximately 4-12 months

Question 16

What is the thawing phase?

Answer 16

Condition begin to gradual resolve

Most patients experience a gradual restoration of motion over next 12-42 months

Question 17

Acromioclavicular joint MOI?

Answer 17

Associated with falls during physical activities such as cycling, skiing

Blunt trauma to the abducted shoulder or landing on an outstretched arm

Question 18

Acromioclavicular joint symptoms?

Answer 18

Swelling
Bruising
Deformity