Shoulder and Elbow Flashcards
Elbow pain - common causes
Osteoarthritis Rheumatoid arthritis Gout Tennis elbow Golfer's elbow
Difference between Tennis elbow and Golfer’s elbow
Tennis elbow - overuse injury involving eccentric overload at the origin of the extensor tendon
- pain over the lateral epicondyle
Golfer’s elbow - overuse syndrome of flexor-plantar mass origin
- pain over medial epicondyle
Olecranon bursitis - clinical features
Localised swelling Local tenderness Pain Full range of motion Erythematous Fever Warm to touch
Olecranon bursitis - cause
Inflammation of the bursa overlying the olecranon of the ulnar
Lumps/swellings of elbow
Olecranon bursitis Rheumatoid nodules Gout Septic Arthritis Osteophytes
Shoulder pain - causes
Osteoarthritis Rotator cuff tear Tendinitis Frozen shoulder Thoracic outlet syndrome Bursitis
Osteoarthritis - radiological findings
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts
Shoulder osteoarthritis - non-operative management
Physical therapy
NSAIDs - for pain and inflammation
Intra-articular injections e.g. corticosteroids
DMARDs - RA
Shoulder osteoarthritis - operative management
Total shoulder arthroplasty - more common, requires an intact rotator cuff
Hemiarthroplasty - performed in younger patients, or those with a torn rotator cuff
Arthroscopic debridement
Shoulder instability - clinical features
Anterior - arm held abducted and externally rotated - loss of normal contour of the deltoid - prominent acromion - palpable humeral head anteriorly - pain Posterior - arm abducted and internally rotated - posterior prominence of the head of the humerus - pain
Shoulder instability - radiological features
Anterior - AP film
- humeral head appears to have moved inferior and medial
Posterior - axillary, lateral view required
- light bulb appearance on AP film
- loss of the normal half-moon overlap sign
Shoulder instability - static shoulder stabilisers
Scapulohumeral ligaments - superior glenohumeral ligaments - coracohumeral ligament - middle glenohumeral ligaments - anterio-inferior glenohumeral ligament Posterior capsule
Shoulder instability - dyanamic shoulder stabilisers
Rotator cuff muscles (primary role) - supraspinatus, infraspinatus, subscapularis and teres minor Rotator interval Long-head of biceps Periscapular muscles
Shoulder instability - complications
Damage to axillary nerve - numbness and sensory loss to lateral shoulder and inability to abduct the arm
Injury to the brachial plexus, axillary artery and axillary vein
Avulsion fractures of tubercles
Recurrent shoulder instability
Rotator cuff injury
Adhesive capsulitis - description
a. k.a. frozen shoulder
- pain and loss of motion in the shoulder with no other cause
Adhesive capsulitis - clinical features
Dull pain Stiffness (self-limiting) Painful arc Decreased range of movement (especially external rotation) - both active and passive - affects the glenohumeral joint
Adhesive capsulitis - stages
Stage 1 (freezing stage) - minimal synovitis - pain - decreased range of movement Stage 2 (frozen stage) - proliferative synovitis with contraction of the capsule and adhesions of axillary recess Stage 3 (thawing stage) - contracted capsule - follows the end of the inflammation
Adhesive capsulitis - management
Non-operative
- NSAIDs, physical therapy and intra-articular steroid injections
- usually successful within 3-6 months
Operative
- manipulation under anaesthesia (indicated when drug treatments and NSAIDs fail)
- arthroscopic surgical release (indicated only once extensive therapy has failed)
Subacromial impingement - clinical features
Pain
- insidious onset
- exacerbated by overhead activities
- night pain, especially when lying on affected side
Movement restriction - depends on the muscle involvement
Painful arc between 60 and 120 degrees
Subacromial impingement - complications
Can easily progress to rotator cuff tendonitis or rotator cuff tear
Subacromial impingement - treatment
Non-operative - avoid overhead movements - NSAIDs - physical therapy - glucocorticoid injections Operative management - arthroscopic decompression - open acromioplasty if acromion narrows
Rotator cuff - anatomy
Supraspinatus - superior to spine of scapula - innervated by suprascapular nerve Infraspinatus - inferior to spine of scapular - innervated by suprascapular nerve Teres minor - inferior to subscapularis and infraspinatus - innervated by axillary nerve Subscapularis - immediately deep to the scapula - innervated by upper and lower subscapular nerve
Rotator cuff tear - clinical features
Pain
- deltoid pain
- exacerbated by overhead movements
- acute = sudden onset pain and weakness
Weakness
- loss of active range of movement
- normal or increased passive range of movement
Rotator cuff tear - treatment
Degenerative rupture (in elderly or inactive patients)
- NSAIDs and physical therapy
- glucocorticoid injections
Traumatic rupture (in active patients)
- surgical treatment
- rotator cuff repair (mini-open or arthroscopic)
- subacromial decompression and rotator cuff debridement
Massive tear
- reverse total shoulder arthroplasty
