Shoulder and Elbow Problems Flashcards
Describe the epidemiology of shoulder and elbow problems
Teens - fractures and instability
30-40s - rotator cuff and capsulitis
50-60s - impingement and AC joint
70s - degeneration rotator cuff and joint
What does upper limb fracture management depend on?
Fracture configuration and patient biology
What upper limb fracture is seen in elderly?
Osteoporotic injury
What direction of shoulder dislocation is most common?
Anterior - 90%
Posterior - 9%
Inferior - 1%
What is the most mobile joint in the body?
Shoulder joint
What is the treatment of shoulder dislocation?
Manipulation
Immobilisation
Physiotherapy
Surgery
What is subacromial impingement?
Common symptom in middle age of life
Often when abduct their arm - get painful arc then reduces after 120 degrees
What is the pathophysiology of subacromial impingement?
Degeneration of AC joint then produces osteophytes and as arm is abducted the greater tuberosity impinges on rotator cuff between osteophytes on under surface of AC joint
Bursa becomes inflamed so less space and acromioclavicular ligament starts to impinge as well
What is the definition of subacromial impingement?
Pain and dysfunction resulting from ant pathology which decreases the volume of subacromial space or increases the size of the contents
What is the treatment and management for subacromial impingement?
Subacromial injection - steroid
Physiotherapy
Arthroscopic subacromial decompression - both before don’t improve symptoms
What is frozen shoulder?
Adhesive capsulitis - primary (idiopathic) or secondary
Clinical diagnosis with normal radiograph
All movements of the shoulder are restricted
What is the treatment for frozen shoulder?
If presented early then hydro dilatation - fluid within joint stretches capsule
Physiotherapy and steroid injections
Late then surgery
What is the usual pattern for frozen shoulder?
Shoulder is painful and no cause
When pain diminishes then stiffness
As pain gets better then stiffness gets worse
Then thawing of stiffness but doesn’t always return to normal
What are the 2 circumstances of rotator cuff tear?
Traumatic
Degenerative
What is the treatment for rotator cuff tear?
Acute rotator cuff tear - early surgery
Chronic degeneration tears - surgery if symptomatic
Depends on size, age and time
When is superior capsular reconstruction done?
An option for massive irreparable rotator cuff tears
Cadaveric skin graft to reconstruct capsule, not tendon
What are the types of shoulder arthritis?
Osteoarthritis
Inflammatory arthritis
Post-traumatic arthritis
How does shoulder arthritis look on X-ray?
Narrowing of subacromial space and may be rotator cuff problems
What is the operation for shoulder arthritis if rotator cuff is okay?
Total shoulder arthroplasty
Better results from resurfacing glenoid
What is involved in complex reconstruction of shoulder arthritis?
Custom made implants
Based on 3D reconstruction from CT
Patient specific implants
If glenoid destroyed and deconstruction of bone
What are types of elbow problems seen at different ages?
Young - fractures and dislocations
Middle age - tendinopathies
Elderly - degenerative disease
Any age - Carpel Tunnel
What is Golfer’s elbow?
Area of pain on inside of forearm
Affects flexors of wrist
What is tennis elbow?
Area of pain on outside of forearm
Affects common extensors
Worse when using limb
History of repetitive tasks
What is the treatment for Golfer’s or tennis elbow?
Rest, physiotherapy, and simple analgesics
Sometimes steroid injections
Where is the ulnar nerve position in relation to elbow?
Posteriorly under the medial epicondyle
Supplies feeling in 1and 1/2 digits
