Shoulder and Elbow Problems Flashcards
What typical shoulder injuries do each age group frequently sustain?
- Teens/20s: Fractures and instability
- 30s & 40s: Rotator cuff & capsulitis
- 50s & 60s: Impingement (felt on abduction of the arm) and AC joint
- 70s + : Degenerative rotator cuff and joint
What type of fractures have a similar epidemiology to upper limb fractures?
Hip fractures
How do older and younger upper limb injury scenarios compare?
- Older - elderly osteoporotic injury
* Younger - high energy injuries
How do the outcomes of patients that receive surgical treatment for a displaced proximal humeral fracture along the surgical line compare to those patients who receive non-surgical treatment?
No significant difference (up to 2 years at least)
LOOK AT RECORDING
(shoulder fracture)
What is the most mobile joint in the body?
The shoulder joint
What is the negative effect of the mobility of the shoulder joint?
Lacks stability due to mobility
In what 3 directions does the shoulder dislocate?
- Anteriorly - 90%
- Posteriorly - 9%
- Inferiorly - 1% (electric shock, epilepsy)
What are the treatments for shoulder dislocation (4)?
- Manipulation (under sedation)
- Immobilisation
- Physiotherapy
- Surgery - in manual labour, likely to have reoccurrence, reoccurrence unlikely in elderly
How common are shoulder dislocations in children?
•Rare in children but risk increases into teens
What is subacromial impingement?
Pain and dysfunction resulting from any pathology which decreases the volume of the subacromial space or increases the size of the contents
How is subacromial impingement treated (3)?
- Subacromial Steroid injection
- Physiotherapy
- Arthroscopic subacromial decompression - only 30 %
What is frozen shoulder?
- Also known as adhesive capsulitis - broken down into 2 group
- Pain and stiffness of shoulder
What types of adhesive capsulitis exist?
•Primary (Idiopathic) •Secondary (or post-traumatic) - stiff joint secondary to injury
How is frozen shoulder diagnosed?
- Essentially a clinical diagnosis
- Normal radiograph can show
- MAYBE mri
How is early presentation frozen shoulder treated?
Hydrodilatation - putting large volume of fluid into joint to stretch-out capsule
How are the majority of cases of frozen shoulder treated?
Physiotherapy and steroid injections - hope improvement in 2/3 year
How is late presentation frozen shoulder treated?
Surgery (reduce ligament width)
Is there guaranteed recovery from frozen shoulder?
No, not even after years in some cases
How does frozen shoulder strictly differ from subacromial impingement?
Only abduction is painful in subacromial impingement
What are the two types of rotator cuff tear?
- Traumatic
* Degenerative
What is the treatment for acute rotator cuff tears?
Early surgery
What is the treatment for acute rotator cuff tears?
Early surgery - can present many months after injury and surgery can be very difficult
How is a rotator cuff tear diagnosed?
- Clinical with shoulder examination
* Confirmatory tests - US (more sensitive at picking up whether clean or partial tear), MRI
What is superior capsular reconstruction?
- An option for irreparable rotator cuff tears
* cadaveric skin graft to reconstruct capsule, not tendon
How is a rotator cuff tear diagnosed?
- Clinical with shoulder examination
* Confirmatory tests - US (more sensitive at picking up whether clean or partial tear), MRI
What are the 3 types of shoulder arthritis?
- Osteoarthritis
- Inflammatory arthritis
- Post-traumatic arthritis
What is paramount in prevention of shoulder arthritis?
Rotator cuff integrity
What is the standard surgery for an arthritic shoulder (provided the rotator cuff is okay)?
- Total shoulder arthroplasty
- Used to be hemiarthroplasty but better results from resurfacing the glenoid
- Reverse joint replacement better
What anatomical issues require a complex reconstruction in shoulder arthritis?
Severely arthritic shoulders - glenoid absent or destroyed
How are complex reconstructions carried out?
- Custom made implants
- Based on reconstructions form a CT
- Patient-specific implants
What typical elbow injuries do each age group frequently sustain?
- Young - fractures and dislocations
- Middle-aged - tendinopathies
- Elderly - degenerative disease
- ANY AGE - cubital tunnel syndrome
Where is the area of pain in golfer’s elbow (medial epicondylitis)?
Inside the forearm
Where is the area of pain in tennis elbow (lateral epicondylitis)?
Outside of forearm
What are the treatments for lateral and medial epicondylitis?
- Rest
- Physiotherapy
- Analgesics
- Sometimes steroid injections
- Trials of platelet-rich plasma injections for tendonitis around the elbow
Which nerve is affected in cubital tunnel syndrome?
Ulnar nerve - pain and tingling elbow down to pinkie and ring fingers
