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
• NSAIDS
• 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
-May be worse at night
All in the absence of any known intrinsic disorder

Question 11

How do we diagnose frozen shoulder?

Answer 11

• Clinical : progressive pain + stiffness

- Normal radiograph

Question 12

How do we treat Frozen shoulder?

Answer 12

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

Question 13

Who gets a rotator cuff tear?

Answer 13

Mainly over 40s

• 30s/40s get traumatic tears
• Elderly get degenerative tears

Question 14

How do we treat a rotator cuff tear?

Answer 14

• 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

Question 15

What types of arthritis affect the shoulder?

Answer 15

Osteoarthritis
Inflammatory Arthritis
Post-traumatic arthritis

Question 16

List the common elbow problems?

Answer 16

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

Question 17

What are the most common elbow tendinopathies?

Answer 17

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

Question 18

How do we treat tennis and golfer’s Elbow?

Answer 18

• ACtivity modification
• PLatelet Rich Plasma (PRP) injection into the tendon
• Physio
• NO STEROID INJECTION

Question 19

How would you manage a traumatic shoulder dislocation?

Answer 19

• Clinical observation
• Check nerve function and pulses
• X-Ray
• Analgesia e.g. intra-articular local anaestetic, opiod, ENTONOX

Question 20

What is the common presentation of a traumatic shoulder dislocation?

Answer 20

• 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

Question 21

Classic presentation of a frozen shoulder?

Answer 21

• 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)

Question 22

What is the presentation of a rotator cuff tear?

Answer 22

• Weakness

- Pain

Question 23

What imaging would you do for a rotator cuff tear?

Answer 23

• MRI

- US

Question 24

What is cubital tunnel syndrome

Answer 24

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.

Question 25

Presentation for CTS

Answer 25

- Reduced sensation: especially in little finger, medial half of ring finger - Weakness of hand/ clumsiness

Question 26

Investigation for CTS

Answer 26

- Nerve conduction studies

Question 27

Treatment for CTS

Answer 27

- Surgical decompression