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Orthopaedics and Trauma > Shoulder and elbow > Flashcards

Shoulder and elbow Flashcards

1
Q

Presentation of rotator cuff tear

A

Older patient

Weakness

Diffuse lateral shoulder pain

After trauma if younger

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2
Q

Special tests for rotator cuff tears

A

Belly-press or thumb up across back

Supraspinatus test (thumb up)

Thumbs down test (drop can test - impingement, tear, inflammation)

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3
Q

Management of rotator cuff tears

A

Analgesia and physio if longstanding (not reparable in elderly due to poor blood supply)

Small tears –> manage as impingement

Medium tears –> surgical management (esp if acute, trauma)

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4
Q

Pathophysiology of rotator cuff impingement

A

Tendinopathy with disordered collagen, inflammation

Beaking of acromion process with age

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5
Q

Presentation of rotator cuff impingement

A

Painful arc (45-160 degrees)

40s-60s

Only on active movement, passive if acromion pressed

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6
Q

Special tests for rotator cuff impingement

A

Empty can test (thumbs down for supraspinatus)

Hawkins-Kennedy test

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7
Q

Management of impingement syndrome

A

Analgesia, physio, subacromial injections

Calcifying tendinopathy –> aspiration

‘Beaking’ of acromion –> surgical decompression

NSAIDs if calcifuing tendinopathy/AC osteoarthritis

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8
Q

Special test for A-C joint dysfunction

A

Scarf test –> pain over acromioclavicular joint

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9
Q

Management of shoulder arthritis

A

A-C joint: excision

G-H joint: fusion or replacement

For both: analgesia, physio

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10
Q

Radiographic features of osteoarthritis

A

Joint space loss

Osteophytes

Subchondral sclerosis

cyst formation

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11
Q

Presentation of shoulder arthritis

A

Pain, stiffness, loss of movement/function (esp external rotation)

Always consider referred neck pain!

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12
Q

Presentation of frozen shoulder (i.e. adhesive capsulitis)

A

Painful freezing phase: Pain, reduction in ROM (abduction and external rotation), lasts approx 1 year

Frozen phase: Pain subsides, stiffness remains (6-12mo) Active + passive movement affected, worse at night

‘Thawing’ phase: ROM returns, lasts 1-3 years

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13
Q

Investigation of rotator cuff tears

A

LA injection + ultrasonography

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14
Q

Pathophysiology of frozen shoulder

A

Immobilisation, diabetes, thyroid disorders –> fibrosis and thickening of joint capsule restricting movement

Self-limiting condition, hydrodilatation may help (+ physio)

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15
Q

Management of clavicular fractures

A

Collar and cuff sling for 4-6 weeks

Avoid heavy manual labour for 3mo

F/U X-rays at 2w, 6w, 3mo

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16
Q

Presentation of acromio-clavicular joint dislocation

A

Direct blow to shoulder, young contact sports

Tender prominence over A-C joint, pain increased by adduction of shoulder

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17
Q

Presentation of SCJ dislocation

A

Dyspnoea/dysphagia

Mediastinal compression

Upper limb paraesthesia

Follows high-energy trauma, investigated with CT, managed by thoracic surgeons

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18
Q

History suggesting posterior shoulder dislocation

A

Electric shock

High-energy trauma

Epileptic fits

Forcible restraint

Need axillary/oblique views!

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19
Q

Complications of shoulder dislocation

A

Brachial plexus injury

Axillary nerve injury

Rotator cuff tear (MRI/US if fx not returned by 4-6w)

Recurrent dislocation (esp in younger patients, encourage immobilisation for 3-4w)

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20
Q

Presentation of scapulothoracic dissociation

A

Laterally displaced scapula + swelling + bruising

Neurovascular compromise in upper limb

Hx of high-energy trauma

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21
Q

Causes of secondary elbow OA

A

Much more common than primary

Haemoglobinopathies

RA

synovial proliferative disorders (e.g. chondromatosis)

Trauma

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22
Q

Distinguishing medial and lateral epicondylitis

A

Medial = golfer/rower/thrower, affects forearm flexors (wrist pronated and flexed most painful)

Lateral = tennis elbow, overuse of extensors, painful extension (esp middle finger) against resistance

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23
Q

Pathophysiology of epicondylitis

A

Fibroblast + collagen hypertrophy –> inflammation at insertion point

Angiofibroblastic hyperplasia!

24
Q

Management of epicondylitis

A

Analgesia, rest, physiotherapy

90% improvement within 1 yr (self-limiting condition)

25
Q

Presentation of cubital tunnel syndrome

A

Loss of sensation/paraesthesia over ulnar 1/5 fingers

Weakness of ulnar motor function (e.g. splaying fingers)

Pain worse at night and on flexion

26
Q

Pathophysiology of cubital tunnel syndrome

A

RA/OA –> narrowing of ulnar groove –> nerve compression

Valgus cubitus (e.g. following childhood supracondylar fracture) –> traction on ulnar nerve

27
Q

Management of cubital tunnel syndrome

A

Neurophysiology –> confirm ulnar nerve and not C8 pathology

Nighttime splinting

Surgical decompression if symptoms don’t improve

28
Q

Management of distal humerus fracture

A

Above-elbow cast in mild cases

Internal fixation for most

Total arthroplasty in the elderly

29
Q

Commonest complication of distal humerus fracture

A

Elbow stiffness, treated by release of ectopic bone (surgical)

30
Q

Other complications of distal humerus fractures

A

Ulnar nerve injury

Brachial artery injury

Heterotopic ossification

Post-traumatic arthritis

Infection

Compartment syndrome

31
Q

Age group for supra-condylar fractures of the humerus

A

5-7 years old, commonly affect metaphysis (weak point)

32
Q

Complications of supra-condylar fractures

A

Nerve damage (esp anterior interosseous, radial)

Brachial artery damage (esp in completely displaced)

33
Q

Complications of lateral condyle fractures in children

A

If not reduced and fixed, can lead to malunion + lateral arm drift + tardy ulnar nerve palsy (hand weakness, difficulty with fine movements) in adulthood

Also AVN

Higher risk compared to supracondylar fractures

34
Q

Immobilisation period after elbow fractures/fracture-dislocations

A

10-14 days

35
Q

Treatment of frozen shoulder aka adhesive capsulities

A

Physiotherapy, gentle exercises

36
Q

What is a Hill-Sachs lesion

A

Compression fractures of posterolateral humeral head, typically secondary to frequent dislocations

37
Q

Epidemiology of adhesive capsulitis

A

Females in 5th decade

Assoc w/ hypothyroidism, diabetes

38
Q

Differential for impingement syndrome

A

Calcific tendionopathy (40s)

Supraspinatus tendinopathy (30s-50s)

A-C joint OA (weight lifters)

39
Q

Management of shoulder dislocation

A

N-V status assessment

X-ray

Sedation/anaesthesia

Reduction

Post-reduction X-ray + N-V

Broad-arm sling

NSAIDs + rotator cuff physio

40
Q

Main motion lost in adhesive capsulitis

A

External rotation

41
Q

Tendon in lateral epicondylitis (aka tennis elbow)

A

Extensor carpi radialis brevis

42
Q

Tendon in medial epicondylitis (aka golfer’s elbow)

A

Common flexor tendon:

Flexor carpi radialis/ulnaris

Palmaris longus

Pronator teres

Flexor digitorum superficialis

43
Q

Test for anterior interosseous function

A

Motor branch of median nerve

Test with OK sign

44
Q

Commonest complication of elbow surgery

A

Ulnar nerve palsy

45
Q

Clavicle examination findings

A

Middle - prev fracture

Distal - A-C joint subluxation

46
Q

Causes of scapular winging

A

Weakness of serratus anterior e.g. due to long thoracic nerve damage

47
Q

Assessment of internal rotation

A

Thumb movement up back

should reach inferior border of scapula

48
Q

Assessing subscapularis strength

A

Belly press

Lift off from back

49
Q

Testing infraspinatus/teres minor

A

External rotation

50
Q

Testing supraspinatus

A

Thumbs up

30d flexion and abduction

Push up against resistance

51
Q

Jobe’s test (aka Empty can test)

A

Thumbs up

Shoulder abducted

Push up against resistance with thumbs up and then thumbs down

if thumb down weaker/more painful Jobe’s +ve

52
Q

Hawkins test

A

90d flexion and abduction

Internally rotate while adducting shoulder

Positive in impingement syndrome

53
Q

Cross-arm (aka scarf) test

A

Adducting flexed elbow over neck

A-C joint pain is +Ve, may indicate OA

54
Q

Shoulder examination special tests

A

Impingement: Jobe’s, Hawkins

OA: Cross-arm test

Instability: Laxity, sulcus, apprehension

55
Q

What is a Bankart lesion?

A

Avulsion of antero-inferior glenoid labrum during anterior dislocaiton

+/- glenoid fracture (bony Bankart)

Orthopaedics and Trauma (8 decks)

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