Shoulder and elbow problems Flashcards
Main issues seen in teens
Fractures and instability
main issues seen in 30’s and 40’s
Rotator cuff & capsulitis
main issues seen in 50’s and 60’s
Impingement and AC joint
often felt on the abduction of deltoid region
main issues seen in 70’s
Degenerative rotator cuff and joint
Most mobile joint in the body?
shoulder joint
where can the shoulder dislocate (3) - give some examples
anteriorly 90%
posterior 9%, - electric shocks, epileptic fits
inferior 1% - often when people fall over long distances on outstretched arms over head
Where should the labrum attach
anterior part of glenoid
Treatment for dislocations (4)S
Manipulation
Immobilisation
Physiotherapy
Surgery
Subacromial Impingement is pain when…?
pain when they abduct
osteophytes - rotator cuff, bursae that separates comes inflamed
Impingement is defined as?
Pain and dysfunction resulting from any pathology which decreases the volume of the subacromial space or increases the size of the contents
Subacromial Impingement - how can you improve (3)
Subacromial Steroid injection - calms inflammation
Physiotherapy - protract the shoulder joints
Arthroscopic subacromial decompression
Frozen shoulder is often known as
Adhesive Capsulitis?
2 types of Frozen shoulder
Primary (Idiopathic) - starts itself
secondary - post traumatic (dislocation) - secondary to this patient develops a stiff joint
Frozen Shoulder - early presentation
manipulation
hydrodialtion - liquid in to stretch capsule
Frozen shoulder - treatment
– inject steroid
Later - surgery
pattern of frozen shoulder presentation
severe pain
- stiffness when pain diminishes
- thawing of the stiffness and motion returns
Rotator cuff tear - 2 types
Traumatic
Degenerative - rotator cuff often damaged in elderly
Rotator cuff tears - tests
ultrasound - is it complete or partial?
MRI
Treatment of Acute rotator cuff tears ?
early surgery
Treatment of chronic degenerative rotator cuff tears?
surgery if symptomatic
size, time and age
Superior capsular reconstruction is? (2)
a option for massive, irreparable rotator cuff tears
- can use cadaveric skin graft to reconstruct the capsule, not the tendon
Shoulder Arthritis - types we see?
what may the have?
Osteoarthritis
Inflammatory arthritis
Post-traumatic arthritis
- Rotator cuff integrity is paramount
severely arthritic shoulders - whats absent or destroyed?
the glenoid
- custom made implants based on CT reconstructions
Elbow - what can you get? (4)
Fractures & dislocations in young
Tendinopathies in middle age - inflammation of the tendons
Degenerative disease in elderly - rarer in the hip or knee
Cubital Tunnel syndrome at any age
middle age of life - pain on what sides? - what names are given to them
lateral aspect - affects common extensors - Tennis elbow
medial epicondylitis - common flexors of the wrist - Golfer’s elbow
tendonitis is more common In what side of the elbow?
lateral
epicondylitis - what can you inject ?
blood sample - centrifuge off portion of cells that mainly contain platelets -inject around platelets that are inflamed
where does the ulnar nerve come
what does it supply?
what sign?
- posteriorly to the medial epicondyle
- moves down into flexor carpi ulnaris
- feeling in the ulnar 1 and a half digits (wasting, tingly)
- FROMNET’s sign - grasping - thumb flexes
