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Disorders and Diseases of the Shoulder and Elbow
Barton Lecture
21
Anatomy
Professional
01/21/2011

Additional Anatomy Flashcards

 


 

Cards

Term




Gleno-humeral joint muscles

Definition

»Stabilizers (rotator cuff)
Supraspinatus (abduction)
Infraspinatus (external rotation)
Subscapularis (internal rotation)
Teres minor (external rotation)
»Motion
Deltoid (abduction, flexion, extension)
Pectoralis major (adductor, internal rotator
Latissimus dorsi (abduction , internal rotation)
»Other muscles
Biceps brachii (supination/flexion of elbow)
Triceps brachii (extension of arm and forearm)

Term




Shoulder Radiographs

Definition

AP shoulder
»Routine
»True
Y-scapula lateral
Axillary lateral

Term

 

 

 

AC joint

Definition

Result from fall on shoulder
Classified based on degree of separation of clavicle relative to acromion
Treatment
»Type I & II – sling for comfort
»Type III – controversial (surg vs non-surg)
»Type IV, V, VI - surgical

Term




Arthritis of Shoulder

Definition

Destruction of joint cartilage with loss of joint space
»Usually > 50 years of age
»Numerous causes
OA
RA
Trauma
Rotator cuff pathology

Term




Arthritis of Shoulder Treatment

Definition

Treatment
»Non-operative
NSAIDS
Heat/ice
Stretching
Corticosteriod injection
»Operative
Total Joint Replacement

Term




Fracture of the Clavicle

Definition

Among most common bony injuries
Rarely needs surgery
May damage over-riding skin, great vessels, lung or brachial plexus

Term




Fracture of the Proximal Humerus

Definition

Most in older age population with osteoporosis
80% minimally displaced
Look for bone pathology
»Cysts
»Tumor 
Physical Findings
»Severe pain
»Swelling
»Discoloration around upper arm & shoulder
»Possible brachial plexus injury
»Check pulses (axillary artery injury)

 

Term




Fracture of the Scapula

Definition

Results from high-energy trauma
90% of patients with scapula fractures will have associated injuries (often life threatening)
»Lung
»Spinal cord
»Head
Physical Findings
»Easily missed as associated injuries are focused on
»Pain about the back of shoulder
»Skin abrasions & swelling
»Tenderness of palpation

 

Term




Fracture of the Scapula Diagnostics

Definition

Diagnostics
»AP shoulder radiograph
»AP chest radiograph
»CT scan
»Axillary view – look at acromion

Treatment
»Non-operative
Sling
Early range of motion (ROM)
»Glenoid (> 2MM displaced) surgical management
»Scapular body fractures – ? hospitalization for pulmonary contusions

Term




Frozen Shoulder

Definition

Insidious onset and decreased active and passive range of motion
Cause unknown
»Most likely an inflammatory process

Diagnositics
»Radiographs of Shoulder
»r/o tumor
»MRI if not improved in 3 months
»Arthrography – decreased volume

Term




Frozen Shoulder Physical Findings

Definition

Physical Findings
»Pain & loss of motion
»Female/non-dominant arm/40-65 years
»Associated medical conditions
Insulin dependent diabetes
Hypothyroidism
Recent neurosurgical procedure
Parkinson’s
Recent myocardial infarction

Term

 

 

 

Frozen Shoulder Treatment

Definition

Treatment
»NSAIDs
»Physical therapy – home exercise program
»Examination under anesthesia if not improved in 12 weeks
»Associated with IDDM – arthroscopic surgical release
»2 – 2.5 year recovery period

Term




Glenohumeral Instability

Definition

Inability to keep humeral head centered in the glenoid socket
»No bony stability
»Remember anatomy
Reduced – humeral head located on glenoid
Subluxed – head partially off glenoid
Dislocated – head completely off glenoid

»

Term




Glenohumeral Instability (Types of Instability)

Definition

»TUBS
Traumatic
Unilateral
Bankart lesions (tear in glenoid labrum)
Surgery
(patients >40 years may have rotator cuff tear)
»AMBRI
Atraumatic
Multi-directional
Bilateral
Rehabilitation
Inferior capsule repair

Term




Glenohumeral Instability Physical Findings and Treatment

Definition

Physical Findings
»Apprehension sign – abduction/external rotation
Pain
Apprehension
»Sulcus sign
Indentation between acromion & humeral head when arm pulled down
»Laxity exam
»Sensation – deltoid area for axillary N. injury

Treatment
»Acute dislocations
Reduction
Immobilization then Physical therapy
Think about associated fractures and rotator cuff tears
»Atraumatic
Physical therapy
If voluntary (ie party trick) – psychiatric evaluation

Term




Impingement Syndrome

Definition

Impingement of acromion, coracoacrionail ligament, acromioclavicular joint & coracoid process of the underlying bursa, biceps tendon and rotator cuff
Treatment
»NSAIDS
»Physical therapy
»Steroid injection
»Surgical arthroscopy

Term




Rotator Cuff Tear

Definition

Four muscles form a cover around the head of the humerus
Tears primarily in supraspinatus tendon
»Injury
»Poor blood supply
»Subacromial impingement
»Usually > 40 years of age

Term




Rotator Cuff Tear Physical Findings and Treatment

Definition

Physical Findings
»Pain, especially at night
»Weakness, catching, grating
»Atrophy of supra & infraspinatus
»Passive ROM – full
»Active ROM – barely hike the shoulder
Treatment
»NSAIDS
»Physical therapy
»Corticosteroids (controversial)
»Surgery

Term




Rupture of the Biceps Tendon

Definition

Tear of the proximal tendon
> 40 years of age
Long standing impingement
Often associated with rotator cuff tear

 

Term

 

 

 

Rupture of Biceps Tendon Physical Findings and Treatment

Definition

Physical Findings
»Sudden sharp pain
»Bulge in lower arm (“Popeye”)
»Weakness of elbow flexion and supination

Treatment
»Non-operative treatment for most
»Physical therapy for strength
»Younger patients – surgical repair

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