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MSK > Shoulder & elbow disorders > Flashcards

Shoulder & elbow disorders Flashcards

1
Q

Give 4 differentials of shoulder pain

A

– Subacromial Impingement

– Rotator Cuff Tears

– Dislocation

– Arthritis

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2
Q

What’s the most common cause of shoulder pain?

Define it

A

Subacromial impingement

first stage of rotator cuff disease

Refers to the inflammation and irritation of the rotator cuff tendons as they pass through the subacromial space

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3
Q

Describe the presentation of subacromial impingement

A
  • Insidious onset shoulder pain
  • Exacerbated by overhead activities e.g. washing hair
  • +/- Night pain
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4
Q

how would you examine a patient with subacromial impingement?

A

Painful Arc Test

Neer impingement sign

Hawkins test

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5
Q

In a patient with subacromial impingement, what radiological signs might you see on X-ray?

A
  • +/- Type 3 hooked acromion
  • +/- ACJ osteoarthritis
  • +/- sclerosis/cystic changes in greater tuberosity
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6
Q

Describe the non-operative and operative management for SI

A

Non-operative:

  • Physiotherapy
  • NSAIDs
  • Subacromial corticosteroid injections (first line and mainstay of treatment)

Operative:

  • Arthroscopic subacromial decompression + acromioplasty
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7
Q

List the RFs for rotator cuff tears

A
  • Age (grey hair = rotator cuff tear)
  • Smoking
  • Hypercholesterolemia
  • Thyroid disease
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8
Q

Symptoms of rotator cuff tears?

A

Pain: acute or insidious onset, in deltoid region, worse with overhead activities

+/- night pain

Weakness: loss of active ROM

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9
Q

List the 4 rotator cuff muscles, their function and their tests of function?

A

Supraspinatus- abduction

Infraspinatus and teres minor- externally rotates the arm

subscapularis- internally rotates the arm

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10
Q

perform Jobe’s test

A
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11
Q

where do the rotator cuff muscles insert?

A

All insert in the greater tubercle of the humerus except the subscapularis which inserts on the lesser tubercles of humerus

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12
Q

Imaging for RC muscles?

A

Ultrasound, MRI

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13
Q

Treatment of rotator cuff tear?

non-operative and operative with indications

A

Non-operative: physiotherapy, NSAIDs and subacromial corticosteroid injection

– Operative:
 Rotator Cuff Repair (young, fit)

 Rotator Cuff Debridement (elderly, irreparable tear)

 Tendon Transfer (young, fit, irreparable tear)

Reverse Total Shoulder Arthroplasty (if massive RC tear with advanced arthritis)

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14
Q

why is there a high incidence of shoulder dislocation?

what usually causes it?

most common type of shoulder dislocation?

A

Because the head of the humerus is larger than the shallow glenoid fossa.

typically caused by trauma (e.g., falling on an outstretched arm, rugby tackle

anterior (accounts for 95%)

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15
Q

what are the symptoms and signs of shoulder dislocation when examining a patient?

A

symptoms: severe shoulder pain, inability to move the shoulder

Signs

Empty glenoid fossa: A palpable dent may be present at the point where the head of the humerus is supposed to lie.

The arm is typically in external rotation and slight abduction.

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16
Q

what are the complications of shoulder dislocations?

A

Damage to the axillary nerve:
Numbness over the lateral surface of the shoulder and loss of function of the deltoid muscle

Injury to the brachial plexus, axillary artery/vein

Bankart and Hill sachs lesions

Recurrent shoulder instability (common in <30 yr-old)

Rotator cuff injury (common in >45 yr-old)

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17
Q

Describe this X-ray

A

X-ray of the shoulder joint in AP view

shows an anterior dislocation of the humerus

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18
Q

What is circled in red in this MRI of the shoulder?

A

Bankart lesion - injury of the anterior inferior lip of the glenoid labrum due to traumatic anterior shoulder dislocation

19
Q

treatment of shoulder dislocation?

immediate, conservative, surgical

A

immediate:

  • Immobilization of the joint with a sling
  • Analgesia

Conservative:

  • Closed reduction

surgical:

  • reduction of humeral head and repair of labrum
20
Q

what causes shoulder OA?

A
  • Primary osteoarthritis
  • Secondary arthritis:
    • post-traumatic (fracture or dislocation)
    • inflammatory/crystalline arthritis (Rh Ar, Gout,..)
    • osteonecrosis (AVN)
    • rotator cuff arthropathy (massive RC tear leading to arthritis)
21
Q

symptoms and signs of shoulder OA?

A

Symptoms:

  • Shoulder pain
  • Loss of range of motion: especially external rotation due to anterior capsule contraction
  • Pain at night

Physical exam:

  • Decreased range of movement (ROM)
  • Crepitus
22
Q

What is Goat’s beard on X-ray? when is it seen

A

Osteophytes circumferentially at the humeral head, sign of shoulder OA

23
Q

treatment of Shoulder oA?

non-surgical and surgical

A

Non-operative: NSAIDs, physiotherapy and corticosteroid injections

Operative: Shoulder Replacement

24
Q

List 5 differentials of elbow pain

A

– Osteoarthritis
– Rheumatoid Arthritis
– Tennis Elbow

– Golfer’s Elbow
– Olecranon Bursitis

25
Q

List the stabilising structures of the glenohumeral joint

A

deltoid muscle, rotator cuff muscles, glenoid, glenoid labrum, glenohumeral capsular ligaments

26
Q

List the signs and symptoms of elbow OA and signs on radiological imaging of the joint

A

Symptoms:

  • Progressive painful movement
  • Loss of terminal extension
  • Painful locking or catching of elbow

Signs: reduced range of movement

Radiography: loss of joint space, osteophytes, subchondral sclerosis and cysts.

27
Q

treatment for elbow OA

A

Non-operative: NSAIDs, Cortisone injections

Operative:

 Debridement: removal of osteophytes and capsular release

 Arthroplasty

28
Q

List the signs and symptoms of elbow Rheumatoid Arthritis and signs on radiological imaging of the joint

A

Symptoms: Pain and loss of motion. Hand and wrist involvement usually precedes elbow.

 Examination: fixed flexion deformity and ligamentous incompetence, rheumatoid nodules on elbow.

 Radiography: periarticular erosions and cystic changes

29
Q

what is tennis elbow?

A

overuse injury at the origin of common extensor tendon (specifically extensor carpi radialis brevis) leading to tendinosis and inflammation

30
Q

what are the symptoms and signs of tennis elbow and how would you test for this?

what would you see on radiograph imaging?

A

Symptoms:

  • pain with gripping
  • pain with resisted wrist extension

Examination:

Point tenderness at ECRB origin (lateral epicondyle) outside of the elbow

 Test: resisted extension of long finger exacerbates pain

Imaging: Usually normal or calcifications at extensor origin

31
Q

management of tennis elbow

A

– Non-operative: NSAIDs, physiotherapy, corticosteroid injections. (Effective in 95% - patience is required)

– Operative: release and debridement of ECRB origin.

32
Q

what causes golfer’s elbow (medial epicondylitis)?

A

overuse of flexor-pronator muscles origin (at the medial epicondyle)

33
Q

what are the symptoms and signs of golfer’s elbow and how would you test for this?

what would you see on radiograph imaging?

A

Symptoms: pain with gripping and resisted wrist flexion.

Examination:

  • Point tenderness just distal to medial epicondyle.

Test: pain with resisted forearm pronation and wrist flexion

Radiograph:
– Usually normal or calcifications at flexor origin

34
Q

what is a differential diagnosis of golfer’s elbow and how can we check for this?

A

a torn ulnar collateral ligament

can be ruled out using an MRI

35
Q

management of golfer’s elbow

A

– Non-operative: NSAIDs, physiotherapy, bracing, corticosteroid injections. (Effective in 95% - patience is required)

– Operative: debridement and reattachment of flexor-pronator origin.

36
Q

what causes olecranon bursitis?

A

Trauma, prolonged pressure, infection, rheumatoid arthritis and gout.

37
Q

what is this?

A

olecranon bursitis

38
Q

how does Olecranon bursitis present?

A

Swelling, pain, redness and warmth. Fever and malaise if infective.

39
Q

list the investigations (inc blood tests, mucrobiology and imaging) that you would request if a patient presented with Olecranon Bursitis?

what would you see on imaging?

A

FBC, Uric Acid level and CRP.

aseptic needle aspiration of the bursa - check Gram stain, Culture & Sensitivity. (GOLD STANDARD)

X-ray: radio-opaque foreign bodies, olecranon spur.

40
Q

how would you treat Olecranon Bursitis if it was non-infective, infective and recurrent?

A

non-infective:

  • Ice
  • elevation
  • NSAIDs
  • treat the cause (e.g. gout).

infective: start broad-spectrum antibiotics (covering S aureus) after needle aspiration, oral or IV depending on the severity of infection.
recurrent: wait for the infection to settle, then perform an interval bursectomy

41
Q

Describe the anatomic course of the ulnar nerve at the elbow

A

the ulnar nerve passes posterior to the elbow through the ulnar tunnel (small space between the medial epicondyle and olecranon).

42
Q

List common causes of Cubital Tunnel Syndrome (ulnar nerve entrapment)

A

direct pressure: leaning on elbows

Stretching: prolonged bending of the elbow

elbow arthritis

bony spurs

cysts near elbow

43
Q

what are the signs and symptoms of cubital tunnel syndrome

what special test will you perform?

A

pain and numbness in little finger and ring finger, hypothenar muscle wasting

tinel’s test - tap inside of elbow joint

44
Q

management of cubital tunnel syndrome?

A

NSAIDs, physiotherapy, bracing

cubital tunnel release or medial epincondylectomy

MSK (6 decks)

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