Shoulder & Elbow Problems

Question 1

In terms of shoulder problems what is the most likely injury for a 20yr old patient?

Answer 1

Fractures

Instability (i.e. dislocation)

Question 2

In terms of shoulder problems what is the most likely injury for a 30 or 40 yr old patient?

Answer 2

Traumatic Rotator cuff tears

Capsulitis

Question 3

In terms of shoulder problems what is the most likely injury for a 50 or 60 yr old patient?

Answer 3

Impingement

AC Joint degeneration

Question 4

In terms of shoulder problems what is the most likely injury for a 75yr old patient?

Answer 4

Degenerative Rotator Cuff tears

Degenerative Joints

Question 5

What are the types of Traumatic Shoulder Dislocation and their epidemiology?

Answer 5

90% are anterior
9% are posterior
1% are inferior

Question 6

How can you treat a shoulder dislocation?

Answer 6

Manipulation
Immobilisation
Physiotherapy
Surgery

Question 7

Define Subacromial Impingement?

Answer 7

Pain & dysfunction resulting from anything that decreases subacromial space or increases size of its contents

Question 8

What could cause subacromial impingement?

Answer 8

Bony outgrowth under the acromion
Inflammation of supraspinatus tendon
Subacromial Bursitis

Question 9

How do we treat a subacromial impingement?

Answer 9

Subacromial Steroid Injection followed by Physiotherapy.

If necessary surgery - Arthroscopic Subacromial Decompression

Question 10

What is frozen shouldeR?

Answer 10

A chronic fibrosing condition defined by:
- Insidious progressive loss of active and passive shoulder ROM
- Pain
All in the absence of any known intrinsic disorder

Question 11

How do we diagnose frozen shoulder?

Answer 11

Based on the clinical presentation of progressive pain followed by progressive stiffness when coupled with a normal X-ray and no other pathology.

Question 12

How do we treat Frozen shoulder?

Answer 12

Early on (in the painful stage) can do steroid injection.
Most cases present later in the stiff stage in which case surgery

Question 13

How long does frozen shoulder last?

Answer 13

typically self-limiting but lasts around 18-24 months

Question 14

Who gets a rotator cuff tear?

Answer 14

30s/40s get traumatic tears

elderly get degenerative tears

Question 15

How do we treat a rotator cuff tear?

Answer 15

an Acute tear needs Early Surgery

A chronic degenerative tear only needs surgery if symptomatic

Question 16

What types of arthritis affect the shoulder?

Answer 16

Osteoarthritis
Inflammatory Arthritis
Post-traumatic arthritis

Question 17

List the common elbow problems?

Answer 17

Fractures/dislocations in the young
Tendinopathies in the middle aged
Degeneration in the elderly
Cubital tunnel syndrome can affect anyone

Question 18

What are the most common elbow tendinopathies?

Answer 18

Golfer’s elbow (medial epicondylitis) - tendinopathy of the forearm flexors so pain at the medial epicondyle

Tennis Elbow (lateral humeral epicondylitis) - Tendinopathy of the forearm extensor so pain at the lateral epicondyle

Both are related to repetative strain from work or sport

Question 19

How do we treat tennis and golfer’s Elbow?

Answer 19

ACtivity modification

PLatelet Rich Plasma (PRP) injection into the tendon followed by Physio

Question 20

What happens in Cubital Tunnel Syndrome/

Answer 20

Compression of the ulnar nerve in the cubital fossa leads to loss of sensation in the little finger and medial half of ring finger