Shoulder and Elbow Problems

Question 1

Describe the epidemiology of shoulder and elbow problems

Answer 1

Teens - fractures and instability
30-40s - rotator cuff and capsulitis
50-60s - impingement and AC joint
70s - degeneration rotator cuff and joint

Question 2

What does upper limb fracture management depend on?

Answer 2

Fracture configuration and patient biology

Question 3

What upper limb fracture is seen in elderly?

Answer 3

Osteoporotic injury

Question 4

What direction of shoulder dislocation is most common?

Answer 4

Anterior - 90%
Posterior - 9%
Inferior - 1%

Question 5

What is the most mobile joint in the body?

Answer 5

Shoulder joint

Question 6

What is the treatment of shoulder dislocation?

Answer 6

Manipulation
Immobilisation
Physiotherapy
Surgery

Question 7

What is subacromial impingement?

Answer 7

Common symptom in middle age of life
Often when abduct their arm - get painful arc then reduces after 120 degrees

Question 8

What is the pathophysiology of subacromial impingement?

Answer 8

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

Question 9

What is the definition of subacromial impingement?

Answer 9

Pain and dysfunction resulting from ant pathology which decreases the volume of subacromial space or increases the size of the contents

Question 10

What is the treatment and management for subacromial impingement?

Answer 10

Subacromial injection - steroid
Physiotherapy
Arthroscopic subacromial decompression - both before don’t improve symptoms

Question 11

What is frozen shoulder?

Answer 11

Adhesive capsulitis - primary (idiopathic) or secondary
Clinical diagnosis with normal radiograph
All movements of the shoulder are restricted

Question 12

What is the treatment for frozen shoulder?

Answer 12

If presented early then hydro dilatation - fluid within joint stretches capsule
Physiotherapy and steroid injections
Late then surgery

Question 13

What is the usual pattern for frozen shoulder?

Answer 13

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

Question 14

What are the 2 circumstances of rotator cuff tear?

Answer 14

Traumatic
Degenerative

Question 15

What is the treatment for rotator cuff tear?

Answer 15

Acute rotator cuff tear - early surgery
Chronic degeneration tears - surgery if symptomatic
Depends on size, age and time

Question 16

When is superior capsular reconstruction done?

Answer 16

An option for massive irreparable rotator cuff tears
Cadaveric skin graft to reconstruct capsule, not tendon

Question 17

What are the types of shoulder arthritis?

Answer 17

Osteoarthritis
Inflammatory arthritis
Post-traumatic arthritis

Question 18

How does shoulder arthritis look on X-ray?

Answer 18

Narrowing of subacromial space and may be rotator cuff problems

Question 19

What is the operation for shoulder arthritis if rotator cuff is okay?

Answer 19

Total shoulder arthroplasty
Better results from resurfacing glenoid

Question 20

What is involved in complex reconstruction of shoulder arthritis?

Answer 20

Custom made implants
Based on 3D reconstruction from CT
Patient specific implants
If glenoid destroyed and deconstruction of bone

Question 21

What are types of elbow problems seen at different ages?

Answer 21

Young - fractures and dislocations
Middle age - tendinopathies
Elderly - degenerative disease
Any age - Carpel Tunnel

Question 22

What is Golfer’s elbow?

Answer 22

Area of pain on inside of forearm
Affects flexors of wrist

Question 23

What is tennis elbow?

Answer 23

Area of pain on outside of forearm
Affects common extensors
Worse when using limb
History of repetitive tasks

Question 24

What is the treatment for Golfer’s or tennis elbow?

Answer 24

Rest, physiotherapy, and simple analgesics
Sometimes steroid injections

Question 25

Where is the ulnar nerve position in relation to elbow?

Answer 25

Posteriorly under the medial epicondyle
Supplies feeling in 1and 1/2 digits