Shoulder and Elbow Problems

Question 1

Which shoulder problems are most common in teens/20’s?

Answer 1

Fractures
Instability

Question 2

Which shoulder problems are most common in 30/40s?

Answer 2

Rotator cuff and capsulitis

Question 3

Which shoulder problems are most common in 50/60s?

Answer 3

Impingement
AC joint issues

Question 4

Which shoulder problems are most common in 70+?

Answer 4

Degenerative rotator cuff and joint

Question 5

Why do shoulder dislocate easily?

Answer 5

Most mobile joint in the body

Question 6

In which three directions may the shoulder dislocate?

Answer 6

Anteriorly- most common, 90%
Posterior- 9%
Inferior- 1%

Question 7

Treatment for shoulder discolation?

Answer 7

Manipulation- often under sedation
Immobilisation
Physiotherapy
Sometimes surgery, those who are younger and very active may benefit from surgery after having a shoulder dislocation

Question 8

In subacromial impingement, in which movement is their pain?

Answer 8

Abduction of shoulder- initial; abduction is okay but the greater the abduction, the more pain felt

Question 9

Definition of impingement?

Answer 9

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

Question 10

How can subacromial impingement be improved?

Answer 10

Subacromial steroid injection
Physiotherapy
Arthroscopic subacromial decompression

Question 11

What is another name for frozen shoulder?

Answer 11

Adhesive capsulitis

Question 12

What are the two types of frozen shoulder?

Answer 12

Primary idiopathic (just starts itself)
Secondary (post-trauma e.g. post dislocation)

Question 13

What would a radiograph of someone with frozen shoulder/adhesive capsulitis show?

Answer 13

Normal radiograph

->diagnosis is made clinically

Question 14

If frozen shoulder/adhesive capsulitis presents early, what can be done?

Answer 14

Hydrodilation, a form of manipulation
Steroid injections
Physio

Question 15

If frozen shoulder/adhesive capsulitis presents later, what can be done?

Answer 15

Surgery

Question 16

What is the classical pattern of symptoms which helps to make the diagnosis of frozen shoulder?

Answer 16

Start off with severe pain
As pain diminishes, stiffness increases
Gradually, there is a thawing of the stiffness and movement returns

Question 17

What differentiates subacromial impingement to frozen shoulder?

Answer 17

In subacromial impingement, it’s only abduction that is painful
In frozen shoulder, all movements are restricted e.g. flexion, extension, rotation

Question 18

What are the two causes of a rotator cuff tear?

Answer 18

Trauma
Degenerative

Question 19

Diagnosis of rotator cuff tears are usually clinical but what are some confirmatory tests?

Answer 19

MRI
Ultrasound

->MRI gives details about muscle quality around the cuff

Question 20

Treatment of acute rotator cuff tears?

Answer 20

Early surgery

Question 21

Treatment of chronic degenerative rotator cuff tears?

Answer 21

Surgery if symptomatic

Question 22

What is an option for massive, irreparable rotator cuff tears?

Answer 22

Superior capsular reconstruction

->cadaveric skin graft to reconstruct the capsule, not the tendon

Question 23

What are the types of arthritis?

Answer 23

Osteoarthritis
Inflammatory arthritis
Post-traumatic arthritis

Question 24

In severe arthritis of the shoulder, often the glenoid in absent or destroyed. What can be done?

Answer 24

Custom made implants

->these are more common now when bone stock is low

Question 25

In younger patients, which elbow injuries are more common?

Answer 25

Fractures and dislocations

Question 26

In middle aged patients, which elbow injuries are more common?

Answer 26

Tendinopathies

Question 27

In older patients, which elbow injuries are more common?

Answer 27

Degenerative disease

Question 28

Which elbow related condition occurs at any age?

Answer 28

Cubital Tunnel syndrome

Question 29

Which side gets pain in golfer’s elbow?

Answer 29

Medial

->flexors attach to medial epicondyle

Question 30

Which side gets pain in tennis elbow?

Answer 30

Lateral

->extensors attach to lateral epicondyle, think of tennis players extending arms to serve

Question 31

What commonly causes golfer’s/tennis elbow?

Answer 31

Repetitive tasks

->actually fairly uncommon for sportsmen to get either

Question 32

What are the treatments for tennis/golfer’s elbow?

Answer 32

Rest
Physiotherapy
Simple analgesics
Sometimes steroid injections