Shoulder and Elbow Problems Flashcards
Which shoulder problems are most common in teens/20’s?
Fractures
Instability
Which shoulder problems are most common in 30/40s?
Rotator cuff and capsulitis
Which shoulder problems are most common in 50/60s?
Impingement
AC joint issues
Which shoulder problems are most common in 70+?
Degenerative rotator cuff and joint
Why do shoulder dislocate easily?
Most mobile joint in the body
In which three directions may the shoulder dislocate?
Anteriorly- most common, 90%
Posterior- 9%
Inferior- 1%
Treatment for shoulder discolation?
Manipulation- often under sedation
Immobilisation
Physiotherapy
Sometimes surgery, those who are younger and very active may benefit from surgery after having a shoulder dislocation
In subacromial impingement, in which movement is their pain?
Abduction of shoulder- initial; abduction is okay but the greater the abduction, the more pain felt
Definition of impingement?
Pain and dysfunction resulting from any pathology which decreases the volume of the subacromial space or increases the size of the contents
How can subacromial impingement be improved?
Subacromial steroid injection
Physiotherapy
Arthroscopic subacromial decompression
What is another name for frozen shoulder?
Adhesive capsulitis
What are the two types of frozen shoulder?
Primary idiopathic (just starts itself)
Secondary (post-trauma e.g. post dislocation)
What would a radiograph of someone with frozen shoulder/adhesive capsulitis show?
Normal radiograph
->diagnosis is made clinically
If frozen shoulder/adhesive capsulitis presents early, what can be done?
Hydrodilation, a form of manipulation
Steroid injections
Physio
If frozen shoulder/adhesive capsulitis presents later, what can be done?
Surgery
What is the classical pattern of symptoms which helps to make the diagnosis of frozen shoulder?
Start off with severe pain
As pain diminishes, stiffness increases
Gradually, there is a thawing of the stiffness and movement returns
What differentiates subacromial impingement to frozen shoulder?
In subacromial impingement, it’s only abduction that is painful
In frozen shoulder, all movements are restricted e.g. flexion, extension, rotation
What are the two causes of a rotator cuff tear?
Trauma
Degenerative
Diagnosis of rotator cuff tears are usually clinical but what are some confirmatory tests?
MRI
Ultrasound
->MRI gives details about muscle quality around the cuff
Treatment of acute rotator cuff tears?
Early surgery
Treatment of chronic degenerative rotator cuff tears?
Surgery if symptomatic
What is an option for massive, irreparable rotator cuff tears?
Superior capsular reconstruction
->cadaveric skin graft to reconstruct the capsule, not the tendon
What are the types of arthritis?
Osteoarthritis
Inflammatory arthritis
Post-traumatic arthritis
In severe arthritis of the shoulder, often the glenoid in absent or destroyed. What can be done?
Custom made implants
->these are more common now when bone stock is low
In younger patients, which elbow injuries are more common?
Fractures and dislocations
In middle aged patients, which elbow injuries are more common?
Tendinopathies
In older patients, which elbow injuries are more common?
Degenerative disease
Which elbow related condition occurs at any age?
Cubital Tunnel syndrome
Which side gets pain in golfer’s elbow?
Medial
->flexors attach to medial epicondyle
Which side gets pain in tennis elbow?
Lateral
->extensors attach to lateral epicondyle, think of tennis players extending arms to serve
What commonly causes golfer’s/tennis elbow?
Repetitive tasks
->actually fairly uncommon for sportsmen to get either
What are the treatments for tennis/golfer’s elbow?
Rest
Physiotherapy
Simple analgesics
Sometimes steroid injections
