23. Trauma and Orthopedics

Question 1

Epicondylitis:
- State the two types and there colloquial names
- Causes of each incl anatomy

Answer 1

**- 2 types: **
Medial epicondylitis (golfer’s elbow) and Lateral epicondylitis (tennis elbow)
**- Causes: **
Medial (golfers): Repetitive strain on wrist flexion (eg striking the floor in golf) - common flexor tendon overuse on the medial epicondyle of the humerus
Lateral (tennis): Repetitive strain on wrist extension (eg tennis backhand stroke) - common extensor tendon overuse on the lateral epicondyle of the humerus

MUM’S DAD - GOLFER - CENTRE OF THE PARTY - WHAT A FLEXXX… never want to EXTEND the party for the tennis folk.

Question 2

Epicondylitis:
- Presentation of the two types
- Investigations
- Differentials

Answer 2

• Presentation:
  Golfer’s elbow: Tender on medial epicondyle; painful, resisted wrist flexion, finger flexion and forearm pronation
  Tennis elbow: Tender lateral epicondyle, painful resisted wrist and middle finger extension
• Invetigation:
  Clinical diagnosis
• Differentials:
  Bursitis, gout, pseudogout, ulnar neuritis (material side), radio-capitellar osteoarthritis (lateral side)

Question 3

Epicondylitis:
- Management

Answer 3

For both medial and lateral epicondylitis:
- Conservative: Activity modification, analgesia, physiotherapy
- Surgery (rarely indicated): Debridement +/- tendon repair

Question 4

Rotator cuff pathology, list some conditions included in this

Answer 4

So many:
- Rotator cuff tear
- Rotator cuff strain
- Rotator cuff tendinopathy
- Subacrominal bursitis
- Shoulder impingement syndrome
- Calcific tendinitis

ETC…

Question 5

Rotator cuff:
- Name these 4 muscles
- What is a tear and tendinopathy?
- Risk factors
- Presentation?

Answer 5

• An inflammation or tearing of any of the rotator cuff muscles. There are 4: SITS Supraspinatus, Infraspinatus, Teres minor, Subscapularis
• Risk factors: Age, history of trauma
• Presentation: Pain in the top and lateral sides of the shoulder, **worse with movement, restricted movement, **pain may occur at night

Question 6

Rotator cuff impingement: Special tests
- 2 state and explain

Answer 6

• Hawkins test: Shoulder and elbow flexion to 90 degrees, shoulder interal rotation elicits pain (LADY IN PIC BELOW)
• Neers test: Passive shoulder abduction with internal rotation whilst stabilising the scapula with one hand elicits pain

Question 7

Rotator cuff tears Special tests:
- For supraspinatus
- For Infraspinatus and teres minor
- For subscapularis

Answer 7

• Jobe’s test (empty can test) for supraspinatus tears:
  Weakness to resisted elevant with the arm at 90 degrees of abduction, 30 degrees angled forward (in line with the scpular) and internal rotation (thumb pointed down)
• External rotation test for infraspinatus/teres minor tears: Weakness of external rotation with the elbow at 90 degrees and adducted
• Lift-off test for subscapularis tear: Weakness/inability of the patient to life the hand off the back when placed on the lower lumbar spine with the palm facing out.

Question 8

Rotator cuff pathology:
- Investigations
- Management

Answer 8

• Ix: USS or MRI
• • Management:
    Analgesia, corticosteroid injection, physiotherapy
    Consider surgery if the pain is persistent despite conservative treatment. Eg Arthroscopic or open rotator cuff repair. If tear is irreparable, options incl suprascapular nerve ablation, arthroscopic debridement, or arthroplasty (prothesis)