shoulder and elbow

Question 1

epidemiology

Answer 1

young high energy
old osteoporotic

Question 2

shoulder pathologies

Answer 2

subacromial impingement
dislocation
frozen shoulder
rotator cuff tear
shoulder arthritis

Question 3

subacromial impingment what is

Answer 3

pain and dysfunction resulting from any pathology which decreases volume of subacromial space or increases size of the contents

Question 4

treatment subacromial impingement

Answer 4

steroid injection
physio
athroscopic subacromial decompression

Question 5

frozen shoulder

Answer 5

adhesive capsulitis
primary or secondary (post traumatic/surgery/immobilisation)
inflammation and fibrosis in the joint capsule lead to adhesions (scar tissue) which tightens the joint
lasts 1-3 years before resolving

Question 6

frozen shoulder (adhesive capsulitis) presentation

Answer 6

shoulder pain and stiffness
pain then stiffness then thawing phase
asymmetric usually
loss of ROM and function
most commonly middle aged

Question 7

differentials to frozen shoulder

Answer 7

supraspinatus tendinopathy
AM joint arthritis
GH joint arthritis
septic arthritis
inflammatory arthritis
malignancy

Question 8

diagnosis of adhesive capsulitis

Answer 8

clinical diagnosis
exclusion
imaging investigations not usually required
xrays are normal but can show differential

Question 9

management

Answer 9

NSAIDs
physio
intraarticular steroid injection if early presentation

if later presentation surgical manipulation under anaesthesia
athroscopy to cut adhesions and release shoulder

Question 10

rotator cuff tear

Answer 10

injury to tendons of rotator cuff muscles. can be partial or full
due to injury or degenerative changes with age
overhead activities

Question 11

presentation of rotator cuff tear

Answer 11

acute onset of symptoms after an acute injury, or with a gradual onset of symptoms
Shoulder pain
Weakness and pain with specific movements relating to the site of the tear (e.g., abduction with a supraspinatus tear)
discomfort at night

Question 12

investigations for rotator cuff tear

Answer 12

MRI and US
Xray for excluding bony pathology

Question 13

management of rotator cuff tear

Answer 13

degenerative rotator cuff tears -conservatively. surgery if symptomatic
Active or young patients, acute or full-thickness tears - surgery (arthroscopic rotator cuff repair)
surgery when physio fails

superior capsular reconstruction for massive irreparable rotator cuff tears. cadaveric skin graft to reconstruct capsule

rest and adapted activities
analgesia
physiotherapy

Question 14

shoulder arthritis can be and how treated

Answer 14

osteoarthritis
inflammatory
post traumatic

custom made implants
resurfaced glenoid

Question 15

golfers elbow

Answer 15

medial epicondylitis
inside of forearm pain
due to repetitive tasks

Question 16

tennis elbow

Answer 16

lateral epicondylitis
outside of forearm pain
due to repetitive tasks