Shoulder and Elbow Problems Flashcards
What are the most common shoulder problems in the following populations:
- Teens/20s
- 30s/40s
- 50s/60s
- 70s+
- Teens/20s = fractures and instabilities
- 30s/40s = rotator cuff injuries and capsulitis
- 50s/60s = impingement and acromioclavicular joint problems
- 70s+ = degenerative rotator cuff and joint problems
What are the most common causes of upper limb fractures?
Young population, high energy injuries
Elderly osteoporotic injuries
What factors affect management of upper limb fractures?
Fracture configuration
Patient biology
What joint is most commonly dislocated and why?
The shoulder joint as it is the most mobile joint in the body
What populations do shoulder dislocations occur in?
Most commonly teenagers
Elderly
What proportion of shoulder dislocations are anterior, posterior and inferior?
Anterior- 90%
Posterior- 9%
Inferior- 1%
What extra management steps need to be taken in cases of posterior shoulder dislocations?
Check for epilepsy or electrocution as seizures are the most common cause of posterior dislocations
What are the complications of teenage shoulder dislocation and why?
Recurrent dislocations are almost definite as the labrum is commonly torn in teenage dislocations. This is known as a Bankart tear.
What are the steps in management of shoulder dislocation?
Manipulation of shoulder back into socket
Immobilisation with a sling for a few weeks to reduce pain and inflammation
Physiotherapy
Surgery in some cases
What population is most commonly affected by subacromial impingement?
30s/40s
What pathophysiological process causes frozen shoulder and how does it manifest?
Inflammation of the capsule between the ball and the socket, manifesting as painful restriction of shoulder movement
How is diagnosis of frozen shoulder done?
Clinically- unilateral global restriction of shoulder movement
What investigation can confirm diagnosis of frozen shoulder and what conditions can mimic it clinically?
X-ray
Dislocated shoulder and shoulder arthritis
What pathological processes can cause subacromial impingement and how does this manifest?
Narrowing of the subacromial space due to either a decreased volume of the subacromial space or an increase in the volume of the contents of the subacromial space. This presents as pain that is present when the shoulder is abducted.
How is subacromial impingement managed?
Ultrasound guided injection of subacromial steroid and physiotherapy.
In some cases arthroscopic subacromial decompression surgery can also be used
