Shoulder Problems

Question 1

What is the epidemiology of shoulder problems?

Answer 1

Teens/20s; fractures and instability

30s/40s; rotator cuff and capsulitis

50s/60s; impingement and AC joint

70s + ; degenerative rotator cuff and joint

Question 2

Describe upper limb fractures

Answer 2

Similar epidemiology to hip fractures

Young high energy injuries

Elderly osteoporotic injuries

Management depends on fracture configuration and patient biology

Question 3

Describe traumatic shoulder dislocation

Answer 3

Shoulder joint most mobile in body

Stability sacrificed for mobility

Anterior 90%, posterior 9%, inferior 1%

Question 4

How is a shoulder dislocation treated?

Answer 4

Manipulation
Immobilisation
Physiotherapy
Surgery

Question 5

Describe subacromial impingement and its treatment

Answer 5

Inflammation and irritation of rotator cuff tendons as they pass through subacromial space

Pain, weakness and reduced movement of shoulder

Exercises, steroid injections, physiotherapy and arthroscopic subacromial decompression may be used in treatment

Question 6

What is arthroscopy?

Answer 6

A type of keyhole surgery, minimally invasive

Used for joint surgery using arthroscope

Question 7

Describe frozen shoulder

Answer 7

Adhesive capsulitis

Primary (idiopathic) or secondary

A clinical diagnosis, normal radiograph

Pain, stiffness and later thawing

Question 8

How is adhesive capsulitis treated?

Answer 8

Early presentation; hydrodilation

Later; surgery

Question 9

What is the treatment for a rotator cuff tear?

Answer 9

Acute; early surgery

Chronic degenerative; surgery if symptomatic

Depends on size, time and age

Superior capsular reconstruction for massive, irreparable tears

Question 10

Describe superior capsular reconstruction

Answer 10

An option for massive, irreparable rotator cuff tears

Cadaveric skin graft to reconstruct capsule, not tendon

Question 11

What types of arthritis affect the shoulder?

Answer 11

Osteoarthritis
Inflammatory arthritis
Post-traumatic arthritis

Question 12

What are risk factors for rotator cuff injury?

Answer 12

aka impingement syndrome

age >60
Hx repeated overhead movement
Hx superior labral tears
shoulder injury

Question 13

What are symptoms of rotator cuff injury?

Answer 13

shoulder pain
shoulder weakness
loss of active RoM
deltoid pain
night pain
\+ve Neer impingement test

Question 14

What are investigations for rotator cuff injury?

Answer 14

Xray; usually normal
MRI
CT (rarely used)
US

Question 15

What is treatment for rotator cuff injury?

Answer 15

Acute, small tear

• surgical repair if young, active + physio
• corticosteroid injection if sedentary, older ± suprascapular nerve block

Acute medium/large tear
- NSAIDs and rehabilitation

Question 16

Describe adhesive capsulitis

Answer 16

aka frozen shoulder

Chronic fibrosing condition

Usually self-limiting (18-24 months)

Question 17

What are risk factors for adhesive capsulitis?

Answer 17

age 40-70
DM
prior Hx

Question 18

What are symptoms of adhesive capsulitis?

Answer 18

shoulder stiffness
reduced RoM (both active and passive)
positive coracoid pain test
positive shoulder shrug test (not specific)

Question 19

What are investigations for adhesive capsulitis?

Answer 19

plain film radiographs

MRI/CT arthrography; decreased capsular volume, thickened capsule

Question 20

What is treatment for adhesive capsulitis?

Answer 20

1st line
- activity modification + physiotherapy + NSAID/oral corticosteroid

2nd line
- intraarticular corticosteroid injection + activity mod and physio

Hydrodilation
Arthroscopic casular release (in refractory AC)