orthopaedics: shoulder and elbow Flashcards
what makes up the gleno-humeral shoulder joint
scapula, clavicle, proximal humerus, deltoid and rotator cuff muscles
what are the rotator cuff muscles
supraspinatus, infraspinatus, teres minor, subscapularis
who normally gets shoulder instability and what usually causes it
teens - 30 (young), sport and trauma cause it
in traumatic instability where is the humerus displaces
anterior dislocation
what are younger people with instability at risk of
more recurrent dislocations and subluxations
what happens in atraumatic instability
ligament laxity leading to multidirectional dislocations
how do you treat atraumatic dislocations
physio (RC strengthening), surgical bankart repair (reattach labrum and capsule)
what is impingement syndrome
rotator cuff tensons are compressed in sub acromial space (under clavicle)
what can cause impingement syndrome
tendonitis, subacromial bursitis, acromioclavicular OA with ostephyte, hooked acromion rotator cuff tear
what are the symptoms of impingement syndrome
painful arc on abduction, radiates to deltoid and upper arm, tenderness on lateral edge of acromion, positive hawkins-kennedy test
how do you treat impingement syndrome conservatively
NSAIDs, analgesia, physio, steroid injection
how do you treat impingement syndrome surgically
subacromial decompression surgery
who gets rotator cuff tears
50-60 ‘grey hair = cuff tear
how do you get rotator cuff tears
acute trauma or chronic attrition from degenerative changes eg sudden jerk on a bus
what are symptoms of rotator cuff tears
weakness and pain on abduction, achy pain, difficulty sleeping, painful arc
what muscle is usually torn in partial or full thickness rotator cuff tears
supraspinatus, large tears extend to subscapularis and infraspinatus
how do you diagnose rotator cuff tears
weakness and pain on abduction, internal rotation, external rotation, USS (gold) and MRI
how do you treat rotator cuff tears
surgically: decompression
non-operatively: physio and subacromial injection
what is frozen shoulder
adhesive capsulitis where inflammation causes stiffness
whos at risk of frozen shoulder
females 40-50, diabetes, hyperlipidaemia, dupuytren’s, OA
what are symptoms of frozen shoulder
build up of severe pain lasting 18-24 months, increasing stiffness (thaws over time), LOSS OF EXTERNAL ROTATION
how do you manage frozen shoulder non-operatively
physio, analgesia, interarticular injections
how do you manage frozen shoulder operatively
MUA, surgical capsular release
what is acute calcific tendonitis
acute onset of severe shoulder pain, calcium deposits in supraspinatus tendon
how do you treat acute calcific tendonitis
steroid injections
what can be a risk factor for shoulder arthritis
OA, inflam arthritis, trauma, sepsis
what joints are commonly affected in shoulder arthritis
acromioclavicular joint (often with impingement), glenohumeral joint (cuff tears, instability)
what joints and muscles make up the elbow
humero-ulnar, radiocapitallar (radiohumeral), triceps, brachialis, biceps
what causes lateral epicondylitis AKA tennis elbow
repetitive strain from repetitive resisted extension at the wrist
what happens in lateral epicondylitis
degenerative enthesopathy at extensor (inflam of ligament or tendon at insertion), microtears in common extensor origin
what are symptoms of lateral epicondylitis
painful and tender humeral lateral epicondyle (where extensor muscles attach) and pain on resisted wrist extension
how do you treat lateral epicondylitis (mild –> severe)
self-limiting, rest, physio, NSAIDs, steroid injection, elbow clasp, USS, surgery
how do you get medial epicondylitis AKA golfer’s elbow
repetitive strain at common flexor origin
how do you manage medial epicondylitis
self-limiting, physio, rest NSAIDs, injection risky as ulnar nerve
what is more common medial or lateral epicondylitis
lateral
what can predispose elbow arthritis
OA uncommon unless after trauma
what surgery can be done for elbow arthritis after failed conservative management
radio-humeral joint: radial head excision.
radio- ulnar joint: replacement (reduced lifting capacity)
