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Injuries and medical problems in sport > UL injuries > Flashcards

UL injuries Flashcards

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1
Q

AC dislocation classification

A
  • Type 1: CC normal, AC sprain
  • Type 2: CC sprain, AC tear

Rest are CC + AC tear, plus:
- Type 3: 25-100% clavicle elevation

  • Type 4: clavicle dislocated posteriorly
  • Type 5: rupture through deltorapezial fascia
  • Type 6: inferior displacement of distal clavicle under conjoined tendon
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2
Q

What is the rotator cuff?

A

4 muscles that support and rotate the GH joint:

  • Supraspinatus
  • Infraspinatus
  • Teres minor
  • Subscapularis
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3
Q

State the functions of each of the rotator cuff muscles

A

Supraspinatus– abduction
Infraspinatus – external rotation
Teres minor – external rotation
Subscapularis – internal rotation

Act to stabilise the humeral head in the glenoid fossa, playing a key role in maintaining overall shoulder stability.

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4
Q

RF for rotator cuff tear

A
  • age
  • trauma
  • overuse
  • repetitive overhead shoulder motions - tennis, swimming, baseball, volleyball
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5
Q

Clinical features of RC injuries

A
  • pain over the lateral aspect of shoulder
  • inability to abduct the arm above 90 degrees.
  • tenderness over the greater tuberosity
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6
Q

3 Tests for rotator cuff injury + muscles tested

A

1) Empty can (Jobe’s) test = supraspinatous
2) Gerber’s lift-off test = subscapularis
3) Posterior cuff test = infraspinatous + teres minor

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7
Q

Describe Jobe’s / the empty can test

A

SUPRASPINATOUS
1) place the shoulder in 90° abduction and 30° of forward flexion and internally rotate fully (as if ‘emptying a can’).

2) Gently push downwards on the arm.
3) weakness on resistance.

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8
Q

Describe Gerber’s lift-off test

A

SUBSCAPULARIS

1) internally rotate arm so the dorsal surface of hand rests on lower back.
2) ask the patient to lift hand away from back against examiner resistance.
3) a positive test is weakness in actively lifting the hand away from back (compare to the contralateral side).

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9
Q

Describe the posterior cuff test

A

INFRASPINATOUS + TERES MINOR

1) arm positioned at patient’s side with elbow flexed to 90°.
2) patient is instructed to externally rotate their arm against resistance.
3) positive test is present if there is weakness on resistance.

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10
Q

Main ddx for rotator cuff injuries

A
  • fracture
  • persistent glenohumeral subluxation
  • brachial plexus injury
  • radiculopathy
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11
Q

Ix rotator cuff tear

A
  • urgent plain X-ray exclude fracture
  • USS for presence and size of tear
  • MRI for size, characteristics, location
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12
Q

Mx rotator cuff injury

A

dependent on the type of tear and functional status of the patient.

CONSERVATIVE

  • little pain/loss of function
  • small tears
  • analgesia + physio
  • <2wks injury
  • corticosteroid injection in subacromial space

SURGICAL

  • Sx despite conservative
  • > 2wks
  • large tears
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13
Q

Main complication from rotator cuff tears

A

Adhesive capsulitis –> stiffness in GH joint

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14
Q

How can rotator cuff injuries by classified?

A

acute (<3 months) or chronic (>3months)

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15
Q
A
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16
Q

Shoulder dislocation incidence

A

account for over half of major joint dislocations which present to emergency departments

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17
Q

Most common shoulder dislocation

A

anteroinferior (usually just termed ‘anterior’)

= 95%

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18
Q

what forces are applied in anterior shoulder dislocation?

A

humerus is extended, abducted, and externally rotated

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19
Q

Label the shoulder joint

A
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20
Q

Causes of posterior dislocation

A
  • typically caused by seizures or electrocution
  • also trauma (a direct blow to the anterior shoulder or force through a flexed adducted arm)

(commonly missed)

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21
Q

clinical features shoulder dislocations

A
  • pain
  • acutely reduced mobility
  • instability
  • asymmetry + loss of shoulder contour (flattened deltoid)
  • anterior bulge from head of humerus
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22
Q

commonly associated boney injuries for shoulder dislocation

A
  • Bony Bankart lesions - fracture of glenoid due to recurrent dislocations
  • Hill-Sachs- impaction injuries on chondral surface of humeral head (80% dislocations)
  • fractures of greater tuberosity/surgical neck of humerus
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23
Q

commonly associated soft tissue injuries for shoulder dislocation

Study These Flashcards
A
  • (Soft) Bankart lesions- avulsions of the anterior labrum and inferior glenohumeral ligament
  • GH ligament avulsion
  • Rotator cuff injuries (v freq ant)
24
Q

What is a SLAP tear? What tendon is commonly involved?

Study These Flashcards
A

Superior Labrum Anterior and Posterior tear

The superior part is where biceps tendon attaches to the labrum- the tear occurs both ant. and post. to biceps tendon

25
SLAP tear versus soft Bankart lesion
Bankart labral tear = commonest in dislocations, occurs inferiorly SLAP = superior, both infront and behind biceps tendon
26
Ix for shoulder dislocations
- Plain radiographs inc trauma shoulder series (Ap, Y-scap, axial) - MRI if labral or rotator cuff injuries are suspected
27
Mx shoulder dislocations
A-E trauma assessment + analgesia REDUCTION, IMMOBILISATION, REHABILITATION: - closed reduction (if failed, manipulation under GA) - assess neurovascular status - Immobilisation with broad arm sling for 2wks - physio for ROM, stregnthening musculature
28
complications of shoulder dislocation
Short term: - labral and cartilaginous injuries - rotator cuff injury Long term: - adhesive capsulitis - nerve damage - chronic pain - limited mobility - stiffness - recurrence
29
Causes of SLAP injuries
ACUTE - fall onto outstretched arm - RTA - Forceful pulling eg catching heavy object - Shoulder dislocation REPETITIVE SHOULDER MOTION - repetitive overhead sports - throwing, weightlifters - can be normal ageing process 'wear and tear'
30
SLAP Sx
Like many common shoulder problems: - locking, popping, catching, or grinding - Pain with lifting objects, especially overhead - Decreased strength + ROM
31
SLAP tear classification
Type 1: fraying of labrum and biceps tendon at glenoid rim Type 2: detachment of labrum and biceps tendon at glenoid rim Type 3: Bucket handle tear of superior labrum Type 4: bucket handle tear of superior labrum with extension into biceps tendon
32
Mx SLAP tear
- initial conservative- NSAID, physio | - arthroscopy
33
Commonest type of clavicular fractures
Type 1 = 75% = middle third is weakest
34
clinical features clavicle fracture
- sudden-onset localised severe pain - focal tenderness, with deformity and mobility at fracture site - may be open injury as clavicle is superior
35
Mx clavicle fracture
- sling till pain free shoulder mobility - open fractures/comminuted = surgical - pin fixation
36
Major complications of clavicle fractures
- Non-union- associated with a distal third clavicular fractures - Neurovascular injury - Puncture injury (haemothorax or pneumothorax). Healing in 4-6 weeks.
37
What is SAIS?
- Subacromial impingement syndrome (SAIS) - inflammation of the rotator cuff tendons as they pass through the subacromial space - resulting in pain, weakness, and reduced ROM - encompasses a range of pathologies
38
What pathologies does SAIS encompass?
- rotator cuff tendinosis - subacromial bursitis - calcific tendinitis All these conditions result in an attrition between the coracoacromial arch and the supraspinatus tendon or subacromial bursa.
39
Most common pathology of the shoulder
Subacromial impingement syndrome (SAIS)
40
Which structures run through the subacromial space?
- rotator cuff tendons - long head of biceps tendon - coraco-acromial ligament surrounded by subacromial bursa
41
Intrinsic mechanisms for SAIS
Involve pathologies of the rotator cuff tendons due to tension (proximal migration of humeral head) - Muscular weakness/imbalance in RC - overuse of shoulder - soft tissue inflammation of tendons + bursa - Degenerative changes of acromion --> tearing rotator cuff
42
extrinsic mechanisms for SAIS
Involve pathologies of the rotator cuff tendons due to external compression: - anatomical variation in shape/gradient acromion - scapular muscular dysfunction - glenohumeral instability --> superior subluxation
43
Sx SAIS
progressive pain in ant. superior shoulder exacerbated by abduction in affected shoulder and relieved by rest weakness and stiffness 2/2 pain
44
2 examination signs for SAiS
Neers impingement test: - arm placed by patient's side - fully internally rotated and passively flexed --> ant.lat. shoulder pain Hawkins test: - shoulder and elbow are flexed to 90deg - pain on passive internal rotation
45
4 ddx SAIS + key Sx for each
- Muscular tear (RC, Biceps LH)- weakness persists with pain relief - Neurological pain (brachial plexus, cervical radiculopathy)- parasthesia + weakness - Frozen shoulder (adhesive capsulitis)- stiffness persists with pain relief - acromioclavicular/glenohumeral arthritis- more generalised, weakness and stiffness
46
Ix for SAIS
- Clinical Dx | - MRI - gold standard
47
What is epichondylitis
chronic symptomatic inflammation of the forearm tendons at the elbow.
48
Briefly describe the attachment of the extensors and flexors of the forearm
EXTENSOR: - lateral epicondyle - common extensor tendon FLEXOR: - medial epicondyle
49
RF lateral epicondylitis
excessive use of extensive forearm muscles | - tennis
50
Sx lat epicondylitis
pain in elbow radiates to forearm - worsens over weeks- months - local tenderness on palpation
51
special tests lat epicondylitis
Cozen's test - elbow flexed to 90 degrees, - extend their wrist against resistance Mill’s Test - lateral epicondyle is palpated by the examiner, whilst also pronating the patient’s forearm, flexing the wrist, and extending the elbow
52
ddx lat epicondylitis
Cervical radiculopathy Elbow osteoarthritis Radial carpal tunnel syndrome
53
Golfers elbow
Medial epicondylitis
54
Most commonly affected tendons in Medial epicondylitis
pronator teres | flexor carpi radialis
55
Cubital tunnel syndrome
Ulnar nerve compression due to excessive leaning on elbow or flexing at the elbow
56
Types of disc problems

Injuries and medical problems in sport (17 decks)

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