Shoulder + Elbow Flashcards
What is the main difference re aim of treatment in upper limb vs lower limb arthritis?
Lower limb range of movement isn’t important – enough to get up and down stairs, you just want it to be pain free. Function, movement and control are more important in the upper limb. Patients with upper limb arthritis are looking for range of movement as well as pain relief.
Sternoclavicular joint arhtirtis Common or rare? How does patient typically present? Management? Can replacement be done?
This is very rare; it presents with swelling/pain.
Usually patient with no particular history – insidious onset of swelling,
Management
- Physio
- Injection
- Excision (rare) – only if someone really isn’t coping
The joint is very stable; we don’t do replacement.
Acromioclavicular joint arthritis Common or rare? What does it often overlap with? What might it be caused by? Management?
This is very common.
It often overlaps with impingement.
May be due to trauma – often have someone who used to play rugby etc.
Management
- Injection – usually diagnostic
- Excision – although there is a capsule, that isn’t the most important stabilizer of the joint; the coracoclavicular ligaments are the main stabilizers so you can excise and still have a fairly stable joint
Glenohumeral joint arthritis
List come causes
Symptoms?
May be due to (not totally understood) - Cuff tear - Instability – recurrent dislocation or subluxation can lead to arthritis - Previous surgery - Idiopathic* - most common Symptoms - Pain – in rotation - Crepitus (grinding) - Loss of movement especially external
List some complications + disadvantages of shoulder replacement
Infection
Instability – like the hip, but not quite so bad
Stiffness – subscapularis is damaged during the surgery; loss of external rotation
Nerve damage – axillary nerve wraps around the back of the head of the humerus – division of the capsule risks damage to this
Loosening
90% OK at 10 years vs 98% for hips
In terms of forces, which direction do the rotator cuff muscles pull the humerus in?
Which direction does the deltoid move the humerus in?
Rotator cuff - downward and medial
Deltoid pulls head upwards
Give some disadvantages of reverse geometry shoulder replacement
New- no long term studies
Complication rate high (30-50%!)
Deltoid may “fatigue” around 7 years
If fails, what then? -> fusion, excision
What are the two joints at the elbow?
Ulnohumeral
Radiocapitellar
What two things does RA cause in the elbow joint?
Erosion
Instability
Is osteoarthritis of the elbow typically primary or secondary?
Primary OA of the shoulder is uncommon. The elbow is often involved in rheumatoid arthritis and OA can occur after trauma (intra-articular fractures).
Osteoarthritis of the elbow
Who is the typical patient?
What is the biggest problem for the patient?
What simple operation can be very useful?
Where are the osteophytes removed from?
What is then done?
Middle aged men who have a heavy manual job
Not pain - range of movement -> caused by osteophyte impingement
Simply removing the osteophytes can do real good
Remove osteophytes from the olecranon fossa, then make a hole. This leads to a much greater range of movement.
What is special about the surgical management of radocapitellar OA?
Arthritic change at the radio-capitaller joint which has failed non-operative management can be treated with surgical excision of the radial head, which affords good pain relief with minimal functional limitation. Radial head is only a secondary stabilizer (so not vital).
What are some disadvantages of elbow replacement?
Limited lifespan
Not good for young/active people – works best elderly rheumatoids
Limited to 5kg/1kg repeatedly – or you are at risk of it
What are some differences between RA and OA in the wrist re:
- Joint involvement?
- Dustribution?
- X-ray appearance?
- Common joints which are involved?
Osteoarthritis - Monoarticular - Localised - Osteophytes/sclerosis - Early jt space narrowing - Base of thumb, PIP + DIPjts Rheumatoid - Polyarticular - Systemic - Erosions - Later joint space narrowing - Synovitis - Tendon rupture - MCPjt - Carpus
Scapholunate advanced collapse
What sign is seen on x-ray?
What causes this?
What is the big issue with this injury?
Terry Thomas sign - scaphoid-lunate ligament has been torn, leading to a hole seen on x-ray.
Often seen as a sprain and written of -> “gets better” -> pain is back after a few years and patient has developed OA, which may eventually need total wrist arthrodesis.
