Shoulder and Elbow Disorders Flashcards
Explain features of supraspinatus tendonitis (subacromial impingement/painful arc)
Rotator cuff injury which is the most common cause of shoulder pain.
Presentation: insidious onset shoulder pain, exacerbated by overhead activities, +/- painful arc. On examination there is painful arc test, positive neer impingement sign and positive hawkins-kennedy sign.
Ix - Radiographs
Rx - First line is physio, NSAIDs and subacromial steroids. Can do surgery to decompress.
Name the different rotator cuff muscles
SITS
Supraspinatus - abducts the arm,
Infraspinatus - externally rotates,
Teres minor - externally rotates,
Subscapularis - internally rotates.
Presentation, investigations and management of rotator cuff tears
Presentation - shoulder pain, weakness and pain with specific movements relating to the site of tear. May have night pain.
Ix - Ultrasound or MRI scan.
Rx - Conservative management (rest, analgesia and physio) if degenerative rotator cuff tear. Traumatic tears in young patients are more likely to be repaired with surgery.
What is Adhesive capsulitis and its pathophysiology?
It is inflammation and fibrosis which causes adhesions in the glenohumeral joint.
It most commonly occurs to people in middle age with diabetes being a big risk factor.
What is the presentation and differential diagnosis of adhesive capsulitis?
Typical presentation with three phases:
1. Painful phase - often first symptoms which is worst at night.
2. Stiff phase - Shoulder stiffness (external rotation is most affect. Both active and passive movement is affected)
3. Thawing phase - gradual improvement in stiffness and return to normal.
Differential diagnosis - Supraspinatus tendinopathy, AC joint arthritis, glenohumeral joint arthritis. Other important ones to rule out are septic arthritis, inflammatory arthritis and malignancy.
Investigations and management of adhesive capsulitis?
Ix - Clinical diagnosis once excluded other causes.
Rx - Continue using the arm, analgesia, physio, steroid injections, hydrodilation. In severe or resistant cases then surgery can be performed
Describe features of shoulder osteoarthritis
Presentation - shoulder pain, loss of ROM and night pain. On examination there is reduced ROM and crepitus.
Ix - AP and axillary lateral x-rays.
Rx - Non-operative (topical NSAIDs, physio and steroid injections) and operative (shoulder replacement)
Describe features of elbow osteoarthritis
Presentation - painful movement, loss of extension, painful locking or catching of elbow. On examination there is reduced ROM.
Treatment - Non-operative (topical NSAIDs, steroid injections) or operative
Features of olecranon bursitis?
Presentation: Typically affects middle aged men. Swollen, warm, tender and fluctuant elbow. Important to note any signs of infection (fever and malaise).
Ix - aspiration of fluid, FBC, uric acid levels and CRP.
Rx - rest, ice, compression, analgesia, protect elbow, steroid injections and if infected then start flucloxacillin.
Explain the presentation and management of lateral epicondylitis
Also known as tennis elbow.
Presentation: pain over lateral epicondyle, pain worse on wrist extension against resistance or supination of forearm with elbow extended.
Ix - Mill’s test and Cozen’s test
Rx - Analgesia, steroid injection, physio and avoid muscle overload.
Explain the presentation and management of medial epicondylitis
Also known as Golfer’s elbow.
Presentation: Pain over medial epicondylitis, pain aggravated by wrist flexion and pronation, may have numbness/tingling in 4th and 5th finger.
Rx - Analgesia, steroid injection, physio and avoid muscle overload.
Explain features of a pulled elbow
Subluxation of the radial head - most upper limb injury in children under age 6.
Signs - pain and limited supination and extension of the elbow.
Rx - analgesia and passively supination of the elbow joint whilst elbow is flexed to 90 degrees.
Risk factors, presentation and investigations of Bicep’s rupture?
Risk factors - Heavy overhead activities, shoulder overuse or injuries which may stress biceps injury, smoking and steroids.
Presentation - Sudden pop or tear at shoulder or ACF followed by pain and bruising. ‘Popeye deformity’ in rupture of proximal tendon and weakness.
Ix - Examination, biceps squeeze test (if intact will cause supination). Ultrasound is first line imaging. For long head of biceps rupture no further imaging is needed. For distal biceps tendon rupture then get urgent MRI
Clinical features of shoulder dislocation?
Severe shoulder pain,
Inability to move shoulder,
Empty glenoid fossa.
Arm is typically held in external rotation and slight abduction.
Complications of shoulder dislocation?
Damage to axillary nerve,
Injury to brachial plexus, axillary vein/artery,
Avulsion fracture of tuberosities,
Recurrent shoulder instability,
Rotator cuff injury
