Shoulder and elbow disorders Flashcards
common causes of shoulder pain 4
subacromial impingement
rotator cuff tears
dislocation
arthritis
define subacromial impingement
the first stage of rotator cuff (RC) disease
most common cause of shoulder pain
inflammation of subacromial bursa due to abutment between greater tuberosuty:
- RC
-acromiom
-coraco-aromial ligament
-acromioclavicular joint
what can subacromial impingement involve 5
RC
acromion
RC
coraco-acromial ligament
acromioclavicular joint
state the rotator cuff muscles 4
Subscapularis.
Infraspinatus.
Teres minor.
Supraspinatus.
what condiitons are associated with subacromial impingement 3
hook shaped acromion
greater tuberosity fracture malunion
shoulder instability
presentation of subacromial impingement 3
insidous onset shoulder pain
exacerbated by overhead activities
±night pain
physical exam findings in subacromial impingement 3
painful arc test [67]
neer impingement sign [68]
-pain on passive forward flexion >90˚
hawkins test [69]
-Pain on passive forward flexion to 90˚ and internal rotation
radiograph signs in subacromial impingement 3
type 3 hooked acromion
ACJ osteoarthitis
sclerosis/cystic changes in greater tuberosity
non-operative treatment of subacromial impingement 3
physiotherapy
NSAIDs
subacromial corticosteroid injection
-1st line and mainstay of treatment
operative treatment for subacromial impingement 2
arthroscopic subacromial decompression
acromioplasty
risk factors for rotator cuff tears 4
age (grey hair=rotator cuff tear)
smoking
hypercholesterolemia
thyroid disease
types of rotator cuff tears 2
chronic degenerative tear
acute traumatic avulsion
size of rotator cuff tears 4
small 0-1cm
medium 1-3cm
large 3-5cm
massive- 2 or more tendons
syx of rotator cuff tears 4
pain
- acute or insidous onset
-in deltoid region
-worse with overhead activities
-±night pain
weakness
-loss of active ROM
for each specific rotator cuff tear muscle state the special test:
-supraspinatous
Jobe’s test= empty can test
for each specific rotator cuff tear muscle state the special test
infraspinatous
external rotation lag
-patient wont be able to maintain external rotation position
for each specific rotator cuff tear muscle state the special test
teres minor
hornblower sign
-can only bring hands to mouth if elbow is in high position
for each specific rotator cuff tear muscle state the special test
subscapularis
lift-off test
belly-press test
imaging for rotator cuff tear 2
ultrasound scanning
MRI
non-operative treatment for rotator cuff tear 3
physio
NSAIds
subacromial steroid injfection
operative treatment for rotator cuff tear and indication for each 4
rotator cuff repair
-young, fit
rotator cuff debridement
-elderly
-irreparable tear
tendon transfer
-young, fit
-irreparable tear
reevrse total shoulder arthroplasty
-if massive RC tear with advanced arthritis
classifcatino for shoulder dislocation 3
> 95%-anterior (subcoracoid)
and or anterior inferiorn (subglenoid)
4%- posterior
1%-inferior
why is shoulder dislocation the most common dislocation
head of humerus larger than shallow glenoid fossa
-this causes higher incidence of shoulder dislocation
what is shoulder dislocation usually from
result of trauma
eg falling on outstreched arm, rugby tackle
cause of posterior shoulder dislocation
seizure or electric shock
clinical features of shoulder dislocation 4
severe shoulder pain
inability to move shoulder
empty glenoid foass
-palpable dent may be present at the point where the head of the humerus is supposed to lie
arm is typically held in external rotation and slight abduction
complications of shoulder dislocation 5
damage to axillary nerve
injury to brachail plexus, axillary artery/vein
avulsion fracture of greater or lesser tuberosities
recurrent shoulder instability (common in <30yo)
rotator cuff injruy- common in >45
how does a damaged axillary nerve in a shoulder dislocation present
numbness over lateral surface of shoulder and loss of function of deltoid muscle
shoulder dislocation imaging
XR
MRI
-indicated to assess soft tissue damage
emergency managemeent of shoulder dislocation 2
immobilisation of joint with sling
entonox analgesia
conservative mangaeemnt of shoulder dislocation 1
closed reduction
surgical management of shoulder dislocation1
reduction of humeral head and reapir of labrum
indications for surgical managemetn of shoulder dislocation 4
unsuccessful closed reduction
displaced bankart lesion
recurrent shoulder dislocations
young and active individuals may require early surgery to prevent recurrent dislocation in the future
define bankart lesion- related to shoulder dislocation
injury of anterior inferior lip of glenoid labrum due to traumatic anterior shoulder dislocation
define shoulder osteoarthritis
glenohumeral degenerative jiont disease characterised by damage to articular surfaces of humeral head and/or glenoid
types of shoulder osteoarthritis 2
primary osteoarthitis
secondary arthitis
causes of secondary shoulder osteoarthritis 4
post-traumatic (fracture or dislocation)
inflammatory/crystalline arthritis (RA, gout)
osteonecrosis (AVN)
rotator cuff arthropathy
-massive RC tear leading to arthritis
syx of shoulder osteoarthritis 3
shoulder pain
loss of range of motion
-esp external roation due to anterior capsule contraction
pain at night
findings on physical exam of shoulder osteoarthritis 2
decreaed ROM
crepitus
findings on radiograph in shoulder osteoarthritis 5
joint space narrowing
subchondral sclerosis
subchondral cysts
osteophytes circumferentially at humeral head (‘goats beard’)
posterior glenoid wear
(just LOSS + post glenoid wear)
non-operative treatment for shoulder osteoarthritis 3
NSAIDs
physio
steroid injfection
operative treatment for shoulder osteoarthritis 1
shoulder replacement
common causes of elbow pain 5
OA
RA
tennis elbow
golfers elbow
olecranon bursitis
types of elbow osteoarthitis 2
primary
post-traumatic
syx of elbow osteoarthitis 4
progressive painful movement
loss of terminal extension
painful locking
catching elbow
examination of elbow osteoarthitis 1
reduced RA
radiographs of elbow osteoarthitis 4
LOSS
management of elbow osteoarthitis 3
non-operative
-usual three
operative
-debridement - removal of osteophytes and capsular release
-arthroplasty
syx of elbow RA 2
pain and loss of moiton
(hand and wrist invoement usually precedes elbow )
examaination findings of elbow RA 2
fixed flecion deformity
ligamentous incompetence
radiograph findings of elbow RA 2
periarticular erosions
cystic changes
treatment for elbow RA
same as OA
define tennis elbow
overue injury at origin of common extensor tendon leading to tendinosis and inflammation
what muscle is overused in tennis elbow
extensor carpi radialis brevis (ECRB)
syx of tennis elbow 2
pain with gripping
pain with resisted wrist extension
examamination findings in tennis elbow 2
point tenderness at ECRB origin (lateral epicondyle)
test
-resisted extension of long finger exacerbates pain
radiographs in tennis elbow
usually normal
or
-calcification at extensor origin
non-operative treatment for tennis elbow 3
usual three
effective in 95% but patience is required
operatiev treatment of tennis elbow 1
release and debridement of ECRB origin
definition of golfers elbow
overuse of flexor-pronator origin (medial epicondylitis)
-less common than tennis elbow
presenation of golfers elbow 2
pain w gripping
pain with resited wrist flexion
examination of golfers elbow 2
point tenderness just distal to medial epicondyle
test
-pain w resisted forearm pronation and wrist flexsion
radiogrpahs of golfers elbow
usually normal.
or
calcification at flexor origin
when should MRI be used in goflers elbow
rule out UCK (ulnar collateral ligament)
-injury in overhead throwers
differential diagnosis for golfers elbow
torn ulnar collateral ligament
non-operative treatment for golfers elbow
usual 3 + BRACING
-effective in 95%
-patience required
operative treatment for golfers elbow 2
debridement
reattachement of flexor-pronator origin
operative treatment for golfers elbow 2
debridement
reattachement of flexor-pronator origin
causes of olecranon bursitis 5
trauma
prolonged pressure
infection
RA
gout
presentation of olecranon bursitis 6
swelling
pain
redness
warmth
if infective:
-fever
-malaise
Ix for olecranon bursitis 3
FBC
uric acid levels
CRP
radiograph findings in olecranon bursitis 2
radio-opaque foreign bodies
olecranon spur
gold standard for diagnosis of infective olecranon bursitis
aseptic needle aspiration of bursa
urgent gram stain, culture and sensitivity
treatment of non-infective olecranon bursitis 4
ICE
elevation
NSAIDs
treat the cause eg gout, RA
treatment for infective olecranon bursitis 1
after aspiration start broad-spec ABx
oral or IV depeding on severity of infection
treatment for recurrent bursitis
once infection settled
-interval bursectomy can be considered
define cubital tunnel syndrome
compression of ulnar nerve as it passes through the cubital tunnel
clinical features of cubital tunnel syndrome 4
tingling and numbness of the 4th anf 5th fingers
-starts intermittent and then becomes constant
over time ptx can develop weakness and muscle wasting
pain worse on leaning on affected elbow
Hx of OA or prior trauma in area
Ix for cubital tunnel syndrome 2
dx usually clinical
selected cases- nerve condution studies
Mx of cubital tunnel syndrome 4
avoid aggravating activity
physio
steroid injfection
surgey in resistant cases
causes of `cubital tunnel syndrome 3
arthritis
elbow fractues
sustained postures
