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
