Shoulder & Elbow Problems Flashcards
In terms of shoulder problems what is the most likely injury for a 20yr old patient?
Fractures
Instability (i.e. dislocation)
In terms of shoulder problems what is the most likely injury for a 30 or 40 yr old patient?
Traumatic Rotator cuff tears
Capsulitis
In terms of shoulder problems what is the most likely injury for a 50 or 60 yr old patient?
Impingement
AC Joint degeneration
In terms of shoulder problems what is the most likely injury for a 75yr old patient?
Degenerative Rotator Cuff tears
Degenerative Joints
What are the types of Traumatic Shoulder Dislocation and their epidemiology?
90% are anterior
9% are posterior
1% are inferior
How can you treat a shoulder dislocation?
Manipulation
Immobilisation
Physiotherapy
Surgery
Define Subacromial Impingement?
Pain & dysfunction resulting from anything that decreases subacromial space or increases size of its contents
What could cause subacromial impingement?
- Bony outgrowth under the acromion
- Inflammation of supraspinatus tendon
- Subacromial Bursitis
How do we treat a subacromial impingement?
- Subacromial Steroid Injection
- NSAIDS
- Physiotherapy.
- If necessary surgery - Arthroscopic Subacromial Decompression
What is frozen shouldeR?
A chronic fibrosing condition defined by:
- Insidious progressive loss of active and passive shoulder ROM
- Pain
-May be worse at night
All in the absence of any known intrinsic disorder
How do we diagnose frozen shoulder?
- Clinical : progressive pain + stiffness
- Normal radiograph
How do we treat Frozen shoulder?
For early presentation:
o Hydrodilatation- contrast medium, cortisone and local anaestetic are injected into the joint capsule
o Or early physiotherapy and NSAIDS/ steroid injections
Later on: surgery under anaestetic
o Manipulation
o Arthroscopic arthrolysis
Who gets a rotator cuff tear?
Mainly over 40s
- 30s/40s get traumatic tears
- Elderly get degenerative tears
How do we treat a rotator cuff tear?
- Acute= early surgery
- Chronic = only surgery if symptomatic
- Depends on size, age and how long they have had it for
Superior capsular reconstruction
- Surgery used for massive, irreparable rotator cuffs
- Cadaveric skin graft used to reconstruct capsule- not tendon
What types of arthritis affect the shoulder?
Osteoarthritis
Inflammatory Arthritis
Post-traumatic arthritis
List the common elbow problems?
Fractures/dislocations in the young
Tendinopathies in the middle aged
Degeneration in the elderly
Cubital tunnel syndrome can affect anyone
What are the most common elbow tendinopathies?
Golfer’s elbow - tendinopathy of the forearm flexors so pain at the medial epicondyle
Tennis Elbow - Tendinopathy of the forearm extensor so pain at the lateral epicondyle
Both are related to repetative strain from work or sport
How do we treat tennis and golfer’s Elbow?
- ACtivity modification
- PLatelet Rich Plasma (PRP) injection into the tendon
- Physio
- NO STEROID INJECTION
How would you manage a traumatic shoulder dislocation?
- Clinical observation
- Check nerve function and pulses
- X-Ray
- Analgesia e.g. intra-articular local anaestetic, opiod, ENTONOX
What is the common presentation of a traumatic shoulder dislocation?
- Often bulge on head of humerus
- Flattening of the deltoid
- Anterior: Common in contact sports where the shoulder has been fixed into external rotation, extension and abduction
- Posterior: usually presents with reduced external rotation
Classic presentation of a frozen shoulder?
- Initially pain (up to 1 year)
- Followed by stiffness: pain usually settles but range of movement still decreased (6-12 months)
- Followed by thawing: Slowly regains RoM (1-3 years)
What is the presentation of a rotator cuff tear?
- Weakness
- Pain
What imaging would you do for a rotator cuff tear?
- MRI
- US
What is cubital tunnel syndrome
Constriction of the Ulnar nerve due to OA/RA narrowing of the ulnar groove so less room for Ulnar nerve when it passes behind the medial epicondyle. This can lead to nerve neuropathy.
Presentation for CTS
- Reduced sensation: especially in little finger, medial half of ring finger
- Weakness of hand/ clumsiness
Investigation for CTS
- Nerve conduction studies
Treatment for CTS
- Surgical decompression
