Shoulder and Elbow Problems

Question 1

What typical shoulder injuries do each age group frequently sustain?

Answer 1

• 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

Question 2

What type of fractures have a similar epidemiology to upper limb fractures?

Answer 2

Hip fractures

Question 3

How do older and younger upper limb injury scenarios compare?

Answer 3

• Older - elderly osteoporotic injury

* Younger - high energy injuries

Question 4

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?

Answer 4

No significant difference (up to 2 years at least)

LOOK AT RECORDING
(shoulder fracture)

Question 5

What is the most mobile joint in the body?

Answer 5

The shoulder joint

Question 6

What is the negative effect of the mobility of the shoulder joint?

Answer 6

Lacks stability due to mobility

Question 7

In what 3 directions does the shoulder dislocate?

Answer 7

• Anteriorly - 90%
• Posteriorly - 9%
• Inferiorly - 1% (electric shock, epilepsy)

Question 8

What are the treatments for shoulder dislocation (4)?

Answer 8

• Manipulation (under sedation)
• Immobilisation
• Physiotherapy
• Surgery - in manual labour, likely to have reoccurrence, reoccurrence unlikely in elderly

Question 9

How common are shoulder dislocations in children?

Answer 9

•Rare in children but risk increases into teens

Question 10

What is subacromial impingement?

Answer 10

Pain and dysfunction resulting from any pathology which decreases the volume of the subacromial space or increases the size of the contents

Question 11

How is subacromial impingement treated (3)?

Answer 11

• Subacromial Steroid injection
• Physiotherapy
• Arthroscopic subacromial decompression - only 30 %

Question 12

What is frozen shoulder?

Answer 12

• Also known as adhesive capsulitis - broken down into 2 group
• Pain and stiffness of shoulder

Question 13

What types of adhesive capsulitis exist?

Answer 13

•Primary (Idiopathic) •Secondary (or post-traumatic) - stiff joint secondary to injury

Question 14

How is frozen shoulder diagnosed?

Answer 14

• Essentially a clinical diagnosis
• Normal radiograph can show
• MAYBE mri

Question 15

How is early presentation frozen shoulder treated?

Answer 15

Hydrodilatation - putting large volume of fluid into joint to stretch-out capsule

Question 16

How are the majority of cases of frozen shoulder treated?

Answer 16

Physiotherapy and steroid injections - hope improvement in 2/3 year

Question 17

How is late presentation frozen shoulder treated?

Answer 17

Surgery (reduce ligament width)

Question 18

Is there guaranteed recovery from frozen shoulder?

Answer 18

No, not even after years in some cases

Question 19

How does frozen shoulder strictly differ from subacromial impingement?

Answer 19

Only abduction is painful in subacromial impingement

Question 20

What are the two types of rotator cuff tear?

Answer 20

• Traumatic

* Degenerative

Question 21

What is the treatment for acute rotator cuff tears?

Answer 21

Early surgery

Question 22

What is the treatment for acute rotator cuff tears?

Answer 22

Early surgery - can present many months after injury and surgery can be very difficult

Question 23

How is a rotator cuff tear diagnosed?

Answer 23

• Clinical with shoulder examination

* Confirmatory tests - US (more sensitive at picking up whether clean or partial tear), MRI

Question 24

What is superior capsular reconstruction?

Answer 24

• An option for irreparable rotator cuff tears

* cadaveric skin graft to reconstruct capsule, not tendon

Question 25

How is a rotator cuff tear diagnosed?

Answer 25

• Clinical with shoulder examination

* Confirmatory tests - US (more sensitive at picking up whether clean or partial tear), MRI

Question 26

What are the 3 types of shoulder arthritis?

Answer 26

• Osteoarthritis
• Inflammatory arthritis
• Post-traumatic arthritis

Question 27

What is paramount in prevention of shoulder arthritis?

Answer 27

Rotator cuff integrity

Question 28

What is the standard surgery for an arthritic shoulder (provided the rotator cuff is okay)?

Answer 28

• Total shoulder arthroplasty
• Used to be hemiarthroplasty but better results from resurfacing the glenoid
• Reverse joint replacement better

Question 29

What anatomical issues require a complex reconstruction in shoulder arthritis?

Answer 29

Severely arthritic shoulders - glenoid absent or destroyed

Question 30

How are complex reconstructions carried out?

Answer 30

• Custom made implants
• Based on reconstructions form a CT
• Patient-specific implants

Question 31

What typical elbow injuries do each age group frequently sustain?

Answer 31

• Young - fractures and dislocations
• Middle-aged - tendinopathies
• Elderly - degenerative disease
• ANY AGE - cubital tunnel syndrome

Question 32

Where is the area of pain in golfer’s elbow (medial epicondylitis)?

Answer 32

Inside the forearm

Question 33

Where is the area of pain in tennis elbow (lateral epicondylitis)?

Answer 33

Outside of forearm

Question 34

What are the treatments for lateral and medial epicondylitis?

Answer 34

• Rest
• Physiotherapy
• Analgesics
• Sometimes steroid injections
• Trials of platelet-rich plasma injections for tendonitis around the elbow

Question 35

Which nerve is affected in cubital tunnel syndrome?

Answer 35

Ulnar nerve - pain and tingling elbow down to pinkie and ring fingers