Shoulder and Elbow Problems Flashcards
What are the most common shoulder problems in teenagers-20s?
Fractures and instability
What are the most common shoulder problems in 30s-40s?
Rotator cuff injuries and capsulitis
What are the most common shoulder problems in 50s-60s?
Impingement and AC joint issues
What are the most common shoulder problems in 70s+?
Degenerative rotator cuff and joint
What are the two associations with upper limb fractures?
Young with high energy injuries
Elderly osteoporotic fractures
What is the most commonly dislocated joint? And why?
Shoulder because the humeral head is substantially larger than the glenoid fossa
In which way does the shoulder tend to dislocate?
Anterior (anterior-inferior)
What causes most shoulder dislocations?
Falling on an outstretched arm
What are the symptoms of shoulder dislocation?
Pain, inability to move shoulder
What are the signs of shoulder dislocation?
Palpable dent (empty glenoid fossa), squared off shoulder
Does a shoulder dislocation require imaging?
Yes to rule out fractures
How do you manage a shoulder dislocation?
Muscle relaxants, analgesia, closed reduction, immobilisation, physio
If complicated (e.g. Bankart lesion) - open reduction and internal fixation may be req.
What are complications of a shoulder dislocation?
Axillary nerve damage, rotator cuff injury
What is a Bankart lesion?
Injury of the anterior glenoid labrum of the shoulder due to anterior shoulder dislocation
What is a subacromial impingement?
Pain and dysfunction from any pathology increasing the volume of the subacromial space/size of its contents
What commonly causes subacromial impingement?
Tendon tissue, esp. supraspinatous or soft tissue that is trapped in the joint
What symptoms are commonly caused by subacromial impingement?
Pain on movement (esp. overhead activities), nocturnal pain (esp. when lying on shoulder), painful arc
What is painful arc?
Pain related restriction of movement and strength with abduction of arm between 60 and 120 degrees)
How do you treat subacromial impingement?
Subacromial steroid injection, physiotherapy, arthroscopic subacromial depression
What is adhesive capsulitis?
Aka frozen shoulder
Inflammation and fibrosis of the joint capsule leading to contracture of the joint
How do you diagnose adhesive capsulitis?
Clinically
What symptoms are typical of adhesive capsulitis?
Severe restriction and limitation of both active and passive RoM in all plates (esp. external rotation), dull shoulder pain
What will you find on XRay with adhesive capsulitis?
Nothing
What is the management of adhesive capsulitis?
Physiotherapy and NSAIDs
If early presentation, steroid injections can help bring down swelling
Late presentation - surgery
How long does it usually taken for adhesive capsulitis to go away?
1.5-2 years
What are the two types of rotator cuff injury?
Traumatic - acute injury, in athlete, acute severe pain and loss of strength
Degenerative - older adults, chronic pain, loss of strength less pronounced
In rotator cuff injury what tendon appears to be most commonly affected?
Supraspinatus
What are the signs of rotator cuff injury?
Superior displacement of the humeral head on XRay
How do you manage rotator cuff injuries?
Acute tear - early surgery
Chronic degenerative - symptomatic - surgery, but treatment mostly conservative
What are the types of arthritis that can affect the shoulder?
OA, inflammatory arthritis, post-traumatic arthritis
What is the most common way to dislocate your elbow?
Fall on outstretched hand
What is the most common type of elbow dislocation?
Posterior
What are the signs and symptoms of an elbow dislocation?
Pain, swelling, inability to flex/extend Ekbow deformity (olecranon more prominent posteriorly), limb length discrepancy)
What imaging should you do for elbow dislocation?
XRay - confirm dislocation, rule out fractures
How do you manage elbow dislocation?
Simple - analgesia, closed reduction, immobilisation
More complex - open reduction, internal fixation
What causes insertional tendinopathies?
Repetitive strain and subsequent poor healing
What is tennis elbow?
Overuse injury of hand and finger extensors that originate in the lateral humeral epicondyle (i.e. from repetitive/excessive pronation/supination and extension of wrist)
What are the clinical features of tennis elbow?
Pain and tenderness over lateral epicondyle and extensor muscles, thickening of tendons
What is golfer’s elbow?
Overload injury of the hand and finger flexor tendons that originate in the medial humeral epicondyle(from repeated wrist flexion and pronation)
What are the clinical features of Golfer’s elbow?
Pain over medial epicondyle and along flexor muscles, thickening of tendons
What is cubital tunnel syndrome?
Compression of the ulnar nerve at the elbow
What is the aetiology of cubital tunnel syndrome?
Leaning on elbow/prolonged elbow flexion, athletic activities
What are the clinical features of cubital tunnel syndrome?
Sensory loss over hypothenar eminence and medial 1 1/2 fingers
+ve tinel test
What is tinel test?
Paraesthesiae reproduced in ulnar portion of hand by tapping medial epicondyle of humerus
