shoulder

Definition

Mid-substance calcification of the rotator cuff

- part of a metaplasia secondary to hypoxia

Aetiology

2 groups of patients

Classification

Primary

Due to scapulothoracic articulation disorder

1.  Neurological Origin

A.  Spinal Accessory Nerve / Trapezius palsy

B.  Long Thoracic Nerve /  Serratus Anterior palsy

C.  Dorsal Scapular Nerve / Rhomboids palsy (rare)

2.  Osseous Origin

AP Shoulder

Technique

- in plane of thorax

- oblique of GHJ

AP in plane of scapula

Grashey

- angle 45^o lateral

- allows estimation of glenohumeral space

Anatomy

Terminal branch of the posterior cord

- lateral to radial nerve

- behind axillary artery

- runs over inferolateral border of SSC

- enters quadrangular space

Quadrangular space

- SSC superiorly anterior

- T major inferior

- T minor superiorly posterior

- long head triceps and humerus

Divides into anterior and posterior branches

Epidemiology

Rare 

- 2% of acute dislocations

Often missed

- < 1/ 52 25%

- < 6/52 25%

- < 6/12 25%

- > 6/12 25%

Aetiology

Definition

Instability in at least 2 planes

- postero-inferior

- antero-inferior

- antero-postero-inferior

Epidemiology

Recognised as a common problem 

- often misdiagnosed

Most patients athletic

Definition

A GH dislocation which has been missed for a significant period of time

- time period is arbitary

- > 3-6 weeks

Pathology

Humerus soft and osteoporotic

Significant soft tissue contractures

1.  Anterior / subcoracoid dislocation

Beware

- scarring to NV structures

- RC tears including SSC, especially > 40

Epidemiology

Most common form of shoulder instability

- young males 

- M:F = 2:1

Aetiology

Indirect ER and abduction moment on arm

- disruption of anterior stabilisers

History

Initial injury

- severe pain in shoulder

Definition 

Idiopathic inflammatory condition

- characterised by progressive shoulder pain & stiffness

- due to contracture of capsuloligamentous structures

- spontaneously resolves 

Epidemiology

2% incidence

- 40 - 60 years

- Women 2:1

Sedentary workers

- Non-dominant limb

Bilateral in 10 - 40%

Aetiology

Epidemiology

Much less common than hip OA

- usually presents late

Aetiology

Similar causes as hip (AS IT GRIPS 3C)

Alcohol / Steroid / Trauma / Idiopathic

Gauchers

RA / RTx

Sickle Cell