orthopaedics: shoulder and elbow

Question 1

what makes up the gleno-humeral shoulder joint

Answer 1

scapula, clavicle, proximal humerus, deltoid and rotator cuff muscles

Question 2

what are the rotator cuff muscles

Answer 2

supraspinatus, infraspinatus, teres minor, subscapularis

Question 3

who normally gets shoulder instability and what usually causes it

Answer 3

teens - 30 (young), sport and trauma cause it

Question 4

in traumatic instability where is the humerus displaces

Answer 4

anterior dislocation

Question 5

what are younger people with instability at risk of

Answer 5

more recurrent dislocations and subluxations

Question 6

what happens in atraumatic instability

Answer 6

ligament laxity leading to multidirectional dislocations

Question 7

how do you treat atraumatic dislocations

Answer 7

physio (RC strengthening), surgical bankart repair (reattach labrum and capsule)

Question 8

what is impingement syndrome

Answer 8

rotator cuff tensons are compressed in sub acromial space (under clavicle)

Question 9

what can cause impingement syndrome

Answer 9

tendonitis, subacromial bursitis, acromioclavicular OA with ostephyte, hooked acromion rotator cuff tear

Question 10

what are the symptoms of impingement syndrome

Answer 10

painful arc on abduction, radiates to deltoid and upper arm, tenderness on lateral edge of acromion, positive hawkins-kennedy test

Question 11

how do you treat impingement syndrome conservatively

Answer 11

NSAIDs, analgesia, physio, steroid injection

Question 12

how do you treat impingement syndrome surgically

Answer 12

subacromial decompression surgery

Question 13

who gets rotator cuff tears

Answer 13

50-60 ‘grey hair = cuff tear

Question 14

how do you get rotator cuff tears

Answer 14

acute trauma or chronic attrition from degenerative changes eg sudden jerk on a bus

Question 15

what are symptoms of rotator cuff tears

Answer 15

weakness and pain on abduction, achy pain, difficulty sleeping, painful arc

Question 16

what muscle is usually torn in partial or full thickness rotator cuff tears

Answer 16

supraspinatus, large tears extend to subscapularis and infraspinatus

Question 17

how do you diagnose rotator cuff tears

Answer 17

weakness and pain on abduction, internal rotation, external rotation, USS (gold) and MRI

Question 18

how do you treat rotator cuff tears

Answer 18

surgically: decompression

non-operatively: physio and subacromial injection

Question 19

what is frozen shoulder

Answer 19

adhesive capsulitis where inflammation causes stiffness

Question 20

whos at risk of frozen shoulder

Answer 20

females 40-50, diabetes, hyperlipidaemia, dupuytren’s, OA

Question 21

what are symptoms of frozen shoulder

Answer 21

build up of severe pain lasting 18-24 months, increasing stiffness (thaws over time), LOSS OF EXTERNAL ROTATION

Question 22

how do you manage frozen shoulder non-operatively

Answer 22

physio, analgesia, interarticular injections

Question 23

how do you manage frozen shoulder operatively

Answer 23

MUA, surgical capsular release

Question 24

what is acute calcific tendonitis

Answer 24

acute onset of severe shoulder pain, calcium deposits in supraspinatus tendon

Question 25

how do you treat acute calcific tendonitis

Answer 25

steroid injections

Question 26

what can be a risk factor for shoulder arthritis

Answer 26

OA, inflam arthritis, trauma, sepsis

Question 27

what joints are commonly affected in shoulder arthritis

Answer 27

acromioclavicular joint (often with impingement), glenohumeral joint (cuff tears, instability)

Question 28

what joints and muscles make up the elbow

Answer 28

humero-ulnar, radiocapitallar (radiohumeral), triceps, brachialis, biceps

Question 29

what causes lateral epicondylitis AKA tennis elbow

Answer 29

repetitive strain from repetitive resisted extension at the wrist

Question 30

what happens in lateral epicondylitis

Answer 30

degenerative enthesopathy at extensor (inflam of ligament or tendon at insertion), microtears in common extensor origin

Question 31

what are symptoms of lateral epicondylitis

Answer 31

painful and tender humeral lateral epicondyle (where extensor muscles attach) and pain on resisted wrist extension

Question 32

how do you treat lateral epicondylitis (mild –> severe)

Answer 32

self-limiting, rest, physio, NSAIDs, steroid injection, elbow clasp, USS, surgery

Question 33

how do you get medial epicondylitis AKA golfer’s elbow

Answer 33

repetitive strain at common flexor origin

Question 34

how do you manage medial epicondylitis

Answer 34

self-limiting, physio, rest NSAIDs, injection risky as ulnar nerve

Question 35

what is more common medial or lateral epicondylitis

Answer 35

lateral

Question 36

what can predispose elbow arthritis

Answer 36

OA uncommon unless after trauma

Question 37

what surgery can be done for elbow arthritis after failed conservative management

Answer 37

radio-humeral joint: radial head excision.

radio- ulnar joint: replacement (reduced lifting capacity)