shoulder and elbow pathologies

Question 1

2 that block external rotation

Answer 1

posterior dislocation

glenohumeral OA

Question 2

which 2 block internal rotation and abduction

Answer 2

impingement

rotator cuff tear

Question 3

summary of impingement

Answer 3

normal movement
painful abduction and IR
Hawkin test

Question 4

adhesive capsulitis summary

Answer 4

can’t move shoulder at all global loss both passive and active

Question 5

summary rotator cuff tear

Answer 5

Jobe’s test
painful abduction, but can be all
loss of above shoulder height
normal passive, weak active

Question 6

test for supraspinatous

Answer 6

jobe test- internal rotation

Question 7

test for infraspinatous and teres minor

Answer 7

hands push out- external rotation

Question 8

subscapularis

Answer 8

gerber’s lift off

belly press test

Question 9

pathologies seen in <30 and test

Answer 9

shoulder dislocation/ instability = apprehension test

Question 10

pathologies seen middle age

Answer 10

impingement
frozen shoulder
traumatic cuff tear

Question 11

pathologies seen in elderly

Answer 11

glenohumeral OA
acromio-clavicular OA
degnerative cuff tear

Question 12

what is impingement

Answer 12

rotator cuff tendon caught between bursa acromion

Question 13

ROfM for impingement pain

Answer 13

abduction and IR becomes painful

Question 14

2 causes of impingement

Answer 14

calcific tendonitis

acromion clavicular joint OA

Question 15

what is calcific tendonitis

Answer 15

depositis of hydroxyapatite crystals into tendon- usually supraspinatous
cause inflammation

Question 16

presentation of calcific tendonitis

Answer 16

chronic pain
intermittent flare ups
pain radiates to deltoid insertion 
stiffness
reduced abduction and internal rotation

Question 17

test for impingement3

Answer 17

hawkin’s test- pain on internal rotation
painful arc
x-ray for osteophytes or calcium depositis

Question 18

management of impingement conservative

Answer 18

conservative

• physio
• analgesia
• steroids
• subacromial injection

Question 19

indication for operative manaement on impingement

Answer 19

conservative failure minimum 4-6 months

subacromial decompression with acromioplasty

Question 20

3 phases of adhesive capsulitis and how long

Answer 20

freeze-3months-painful
frozen-6months- ROM
thawing-12 months

Question 21

most common loss of ROFM 3 from adhesive capsulitis

rem global loss though

Answer 21

ER most then
flexion then
IR

Question 22

presentation frozen

Answer 22

global loss
worse at night
preceding event possible
tender over anterior GHJ

Question 23

causes of frozen shoulder 2

Answer 23

primary: idiopathic
seconddary: risk factors
- DM
- endocrine
- previous surgery
- trauma

Question 24

diagnosis criteria for frozen shoulder

Answer 24

painful shoulder with restricted active and passive motion for at least 1 month duration

Question 25

x-ray of frozen shoulder shows

Answer 25

normal

Question 26

conservative management of frozen shoulder

Answer 26

physio analgesia intra- steroids

Question 27

non-conservative frozen management and indication

Answer 27

1. MUA-crack adhesions | 2. arthroscopic surgical release- if 3-6 months failed

Question 28

types of shoulder dislocation and cause

Answer 28

anterior: FOOSH posterior: subglenoid- epilepsy/ electric subclavicular intrathoracic

Question 29

cause of anterior dislocation

Answer 29

forced abduction, ER and extension

Question 30

causes of shoulder instability traumatic4

Answer 30

1. bakart lesion: avulsion of glenoid labrum from glenoid 2. Glenohumeral ligament avulsion- tear from glenoid 3. hill-sachs lesion impaction # posterior humeral head cause anterior dislocation 4. slack capsule= repetitive stretching of joint capsule

Question 31

causes of shoulder instability atrumatic 2

Answer 31

generalised ligament laxity eg ehlers danlos | hypoplastic glenoid

Question 32

clinical presentation of anterior dislocation

Answer 32

- <25 male following trauma - wilful dislocation/ habitual - ;pain - arm paraesthesia - swelling-palpable humeral head

Question 33

clinical presentation of posterior dislocation

Answer 33

fixed in internal roatation

Question 34

complications of shoulder dislocation 3

Answer 34

1. recurrence risk 80% in young 2. rotator cuff tear/ greater tuberosity fracture older 3. axillay nerve/brachial plexus palsy

Question 35

diagnosis shoulder dislocation

Answer 35

x-ray | apprehension test

Question 36

management dislocation conservative

Answer 36

MUA then physio

Question 37

indications for operative managenment of dislocations

Answer 37

``` hill-sachs <35 play contact sport sig bone injury patient wish posterior dislocate ```

Question 38

operative management for dislocations

Answer 38

- re-construct the glenoid labrum/ tighten ligaments | - for posterior have to take off muscles

Question 39

2 main causes of rotator tear

Answer 39

degernative | trauma

Question 40

rotator cuff tear RofM affected

Answer 40

normal passive, loss active abduction external rotation internal rotation

Question 41

most common tendon to have tear in

Answer 41

suprapsinatous | then teres minor and infrapsinatous

Question 42

2 main dx tool for cuff tear

Answer 42

mri and usss

Question 43

presentation cuff tear

Answer 43

``` muscle wasting >50 history trauma dull ache abduction, ER, IR tender painful/ loss of arc active loss, passive normal ```

Question 44

conservative management for rotator cuff tear

Answer 44

nsaid analgesia steroid physio

Question 45

surgical indication for cuff tear

Answer 45

if conservative fails for elderly or young traumatic

Question 46

surgical option for cuff tear

Answer 46

subacromial decompression reatachment cuff arthroplasty

Question 47

which is the most common shoulder OA

Answer 47

ACJ

Question 48

presentation of GHJ

Answer 48

pain deep shoulder and lateral aspect stiffness crepitus global loss of ROFM

Question 49

x-ray of GHJ shows

Answer 49

high riding humeral head dysfunction of rotator cuff tendon as not opposed to deltoid muscle

Question 50

risk factor for GHJ trauma

Answer 50

previous rotator cuff tear- as centralising effect of cuff muscle is lost= cuff arthropathy

Question 51

ACJ oa presentation

Answer 51

chronic history tender to palpate superior shoulder reduced abduction but normal power

Question 52

risk of shoulder dislocation recurrence ages 19 and 30

Answer 52

>90% at 18 | <50% if over 30

Question 53

axillary distibution of pain in shoulder dislocation name for it

Answer 53

regimental badge