Upper Limb conditions Flashcards
Dislocated shoudler
- visibling might see bruising /swelling - movement is restricted
- 90-95% are anterior (humerus sits in glenoid cavity wc is shallow, and is well supported superior, anterior and posteriorly but weak inferiorly therefore head of humerus dislocates anteroinferioly
- 60% d to subcoracoid location d pull pf muscles disturbs the anterior capsule ad ligament
- 30% subglenoid - frist episode of dislocation when person as hadn’t behind head then pushed arm a little more posterity sodislates anterior
- inferiorly - another way to dilate is blow from posterior
Labral tear aka? and whats is it
- Bankart lesion
- look at the labrum inferioraspect on x rays
- force of the humerus coming out the labrum c glenoid labrum to be torn off, and sometimes a small piece of bone can leave too
what happens also in terms of muscles involved in anterior disolcation
the tone of infraspinaus and teres minor muscle c posterior aspect of humeral head to become jammed against the anterior lip of glenoid fossa c dent known as the ‘indentation fraction’ in postolateral humerus head known as Hill-Sachs Lesion
-50% of those under 40 get anterior shoulder dislocation , 80% with recurrent shoulder dislocations get Hill-Sachs lesion, wc increases risk of secondary osteoarthritis in shoulder joint
posterior dislocations
- less common only (2-4% fo cases)
- occurs with violent muscle contractions d epileptic seizures , electrocution or lightening or when blow to anterior shoulder or flexed across the body elbow and fall/ rotator cuff tears
- p presents with internally rotated arm and adducted,
- on x ray can be missed as it looks likes normal, but the projection of humeral head is a more bulb shape more runded
what bone help s detect shoulder dislocation and what test?
- scapular as you’re supoosed to see a Y view were birufication where glenoid fossa and humerus are in line, you take x ray from end on lateral view ‘scapular y view’
inferior dislocatiosn
- rare (0.5%)
- head humerus inferior to the glenoid , patient presents with forced hand extended over head can’t get hand down
- c due to hyperadbuction
- associated with damages to nerves(60%), rotator cuff tears(80%) and injury to b vessels (3%)
whats the most issue common shoulder dislocation complication
recurrent dislocation wc c damage to stabilising tissues
chances of dislocation and age?
increases60% dependent on age and activity level
how often does damage to axillary nerve occur and artry
artery = 1-2%
n = 10-40% (most recover when shoulder put back into place) less commonly this can also c damage to the cords of brachial plexus
how often do fractures occur in shoulder dislocations
- depends on traumatic mechanism that c the dislocationadn in first time dislocation or nor to if person over 40, if fractured occurs mostly to humerus, (head and greater tubercule) ,clavicle and acromion
rotator cuff muscle tears
- can be associated with shoulder dislocation and is most commonly in older people (80% have them both together)
- tendon tears are common
- supraspinatus tendon one mostly affected where it tears at place of insertion
- c are shoulder displation or age
- related degradation or degenerative
- microtrauma model where d age micro minor injury will c it to tear d v supply and toe d age..then inflammatory cells come to site and oxidative stress leads to tenocyte apoptosis (tendon cell) leading to further degeneration creaticycle known as ‘vicious cycle’ -most are asymotic but experience pain when lean on their elbow and push downwards or when reaching forward
clavicular fractures
- mostly kids and young adult
- 3-5% of all fractures
- 80% are middle of clavicle
- c by fall into affected shoulder or onto outstretched hand
- most treated w/o surgery
- free moving arm
- complete or incomplete displacement
what will happen if …..
-
complications of fracture healing genrally
union =failure to unite
malunion = uniting in suboptimalposition
what are some complications for clavicular fraction
- fracture healing issues
- penumothroaz image to surrounding neuromuscular structures like the suprascpaular nerve
impingement syndrome and whats a special type?
- soft tissue irritation the subacromail space
- supraspinatus tendon impinges creating painful arc between 60-120 degree abduction
- it is with rotator cuff damage or not?
- usually middle age
- MID PAINFUL ARC?cant do work at 90 angle because the tendons are being squashed
- sometimes d bone in the area
calcified Supraspinatus tendiopathy
present of hydroxapaptite in the tendon of supraspinatus (can occur in any rotator cuff muscle tendon but commonly spinatus)
- throes is tenches damaed transform into chondrocytes and lay down cartilafe
- treatment is rest and analgesia and sometimes surgery
adhesive capsulitis (frozen schouder)
- inflamed gelohuemrual joint c it to become stiff exacerbated in cold and at night many risk factors eg.femal, thyroid disease,trauma, daibee -patients complain fo sleep deprivation -treamnt s physio alagesia and anitinlamtomnu 90% of patients regain shoulder function
osteoathetis
people over 50 treatment IsNSAIDSm osteoid injections and sometimes viscosupllentationinjection of hyulanoic acid to increase lubricatiom but can do arthroscopy surgery (key hoe)
less than 35 conditons
- instability so dislocations d trauma and clavicular fractures
over 35
-degenrative and impingement, -tendiopathy -proximal humeral fractures -osteoarthritis -surgical humeral neck - adhesive capsulitis (50s-60s) -acromioclavicular
shoulder joint compec
-gh -sternoc -ac -scapiulothoracic articulations -thoracic spine
why isn’t scapulothroacic articulations a real joint
doesnt contain bursae
1;2 movement and 2:1
-ratio of glenohumeral to scapulothoracic movement during elevation
