Shoulder Injuries

Question 1

Age of onset for rotator cuff injuries

Answer 1

30/40

Question 2

Age of onset for impingement and AC joint

Answer 2

50/60

Question 3

Age of onset for degenerative rotator cuff and joint issues

Answer 3

70s

Question 4

Percentage of dislocations

Answer 4

90% anterior, 9% posterior and 1% inferior

Question 5

Symptoms of traumatic shoulder dislocation

Answer 5

Prominence at the front of the shoulder, inability to move arm and rotate outward, sensation of “Dead arm”

Question 6

Investigation of traumatic shoulder dislocation

Answer 6

X-ray and physical examination

Question 7

Treatment of shoulder dislocation

Answer 7

Reduction

Mild sedation and analgesia

Reduction confirmed on X-ray

Maintanence is via sling or brace

Question 8

Subacromial impingement

Answer 8

pain and dysfunction resulting from any pathology which decreases the volume of the subacromial space or increases the size of the contents.

Question 9

Presentation of subacromial impingement

Answer 9

There is usually pain during elevation and it is located anterior and lateral to the shoulder. There is a painful arc (90-120 degrees with anteflexion or abduction). The pain usually gets worse with overhead activities and there is often weakness and no pain radiating below the elbow. Rolling on the shoulder at night is often very painful also.

Question 10

Treatment of subacromial impingement

Answer 10

subacromial steroid injection, physiotherapy, athroscopic subacromial decompression.

Question 11

Rotator Cuff Tear

Answer 11

When one or more of the rotator cuff tendons tears and detaches from the humerus.

Question 12

Key clinical features of acute rotator cuff tear

Answer 12

Recent trauma

Pain from the shoulder or lateral aspect of the arm

Inability to raise the arm in abduction above shoulder level

Question 13

Investigations of acute rotator cuff tear

Answer 13

Plain radiographs of the glenohumeral joint in two planes should be performed on the day of presentation for patients with “red flag” features.

Question 14

Treatment of acute rotator cuff tear

Answer 14

Early surgical repair is usually recommended to patients with full thickness acute tears causing significant pain or disability. In patients with only a partial thickness tear or individuals not suited to surgical intervention, a course of conservative management would be recommended initially, including the use of adequate analgesia, activity modification, and physiotherapy.

Question 15

Shoulder arthritis can result from

Answer 15

Osteoarthritis
Inflammatory arthritis
Post-traumatic arthritis

Question 16

Osteoarthritis of the shoulder

Answer 16

Global reduction in the range of movement of the gleno-humeral joint but most particularly external rotation. X-rays confirm loss of joint space and osteosclerosis

Question 17

Rheumatoid Arthritis of the shoulder

Answer 17

Destruction of the humeral head, glenoid and rotator cuff.

Question 18

Post traumatic arthitis

Answer 18

Can occur from after rotator cuff injury

Question 19

Osteoarthritis of the Elbow

Answer 19

Secondary is more commo ndue to trauma, synovial proliferative disorders, haemoglobinopathies and RA are recognised insults. There will be stiffness of the elbow and reduced forearm rotation at the proximal radioulnar joint

Question 20

Tennis Elbow

Answer 20

Lateral epicondylitis is an inflammatory process at the forearm extensor origin on the humeral lateral supra-condylar ridge. Tenderness and forced extension of the wrist and digits against resistance increases the discomfort.

Question 21

Golfers elbow

Answer 21

Similar to tennis elbow but affects the common flexor origin on the medial supra-condylar ridge of the humerus