Shoulder and Elbow Problems

Question 1

What are the most common shoulder and elbow problems for each age group? (teens & 20s/30s and 40s/50s and 60s/70+)

Answer 1

• Teens/20s
  
  • Fractures and instability
• 30s and 40s
  
  • Rotary cuff and capsulitis
• 50s and 60s
  
  • Impingement and AC joint
• 70s and +
  
  • Degenerative rotary cuff and joint

Question 2

What are upper limb fractures usually due to in younger and older patients?

Answer 2

Younger - high velocity injuries

Older - osteoporotic injuries

Question 3

What is the most mobile joint in the body, and what does this sacrifice?

Answer 3

Shoulder, sacrificing stability

Question 4

What are the 3 directions of shoulder dislocation?

Answer 4

• Anterior 90%
• Posterior 9%
• Inferior 1%

Question 5

What direction of shoulder dislocation is most common?

Answer 5

Anterior (90%)

Question 6

What is the treatment for shoulder dislocation?

Answer 6

• Manipulation
• Immobilisation
• Physiotherapy
• Surgery

Question 7

What is the presentation of subacromial impingement?

Answer 7

Often pain when abduct arm, due to degeneration in acromial joint

Question 8

What is impingement?

Answer 8

Pain and dysfunction due to pathology which decreases volume of subacromial space of increases the size of contents

Question 9

What is the treatment for subacromial impingement?

Answer 9

• Subacromial steroid injection
• Physiotherapy
• Arthroscopic subacromial decompression

Question 10

What is frozen shoulder also known as?

Answer 10

Known as adhesive capsulitis:

• Primary (idiopathic) or secondary

Question 11

What are the clinical features of frozen shoulder?

Answer 11

All movements painful or restricted (stiff)

Question 12

How is frozen shoulder diagnosed?

Answer 12

Is a clinical diagnosis with normal radiograph

Question 13

What is the treatment for frozen shoulder?

Answer 13

• Early presentation
  
  • Hydrodilatation
• Late presentation
  
  • Surgery

Question 14

How is rotary cuff tear diagnosed?

Answer 14

Diagnosis is clinical, using tests can tell which part is damaged

Confirmatory tests are US or MRI scan

Question 15

What is the treatment for rotary cuff tear?

Answer 15

Treatment:

• If acute then early surgery
• If chronic and degenerative then surgery is symptomatic
• Depends on size, time and age

Superior capsular reconstruction is an option for massive, irreparable rotator cuff tears:

• Cadaveric skin graft is used to reconstruct capsule, not a tendon

Question 16

What is the cause of rotary cuff tear in younger and older patients?

Answer 16

Younger - traumatic

Older - degenerative

Question 17

What are the different kinds of shoulder arthritis?

Answer 17

• Osteoarthritis
• Inflammatory arthritis
• Post-traumatic arthritis

Question 18

What is the treatment of shoulder arthritis?

Answer 18

• Joint replacement
• Reverse shoulder prosthesis (concave and convex reversed) often used when rotator cuff muscles damaged as better bio-mechanics

Question 19

What are the most common elbow pathologies for each age group (young/middle aged/elderly)?

Answer 19

• Young
  
  • Fractures and dislocation
• Middle age
  
  • Tendinopathies
• Elderly
  
  • Degenerative disease
• Cubital tunnel syndrome at any age

Question 20

What is epicondylitis?

Answer 20

A painful inflammation of tendons surrounding an epicondyle

Question 21

What are the 2 kinds of epicondylitis?

Answer 21

• Golfers elbow is medial side of joint
  
  • Affects flexors
• Tennis elbow is lateral side of joint
  
  • Affects extensors

Question 22

Golfer’s elbow effects what group of muscles?

Answer 22

Flexors

Question 23

Tennis elbow affects what group of muscles?

Answer 23

Extensors