Shoulder and Elbow

Question 1

What is the medical name for frozen shoulder?

Answer 1

Adhesive capsulitis

Question 2

What are the RF for frozen shoulder?

Answer 2

Middle aged
Diabetes
secondary to surgery

Question 3

What is the name of the joint in the shoulder?

Answer 3

glenohumeral joint which is ball and socket

Question 4

What is the pathophysiology of frozen shoulder?

Answer 4

The glenohumeral joint is formed from connective tissue which in adhesive capsulitis becomes inflammaed and fibrosed so there are adhesions which bind the capsule and restrict movement

Question 5

What are the course of sx for frozen shoulder? What is the timeframe?

Answer 5

Stage 1) Pain, worse at night
Stage 2) stiffness affecting movement, particularly EXT rotation
Stage 3) resolves, “thawing”

Each stage last roughly 6 months

Question 6

What are the differentials for frozen shoulder?

Answer 6

Acrioclavicular joint arthirits
Supraspinatus tendinopathy 
Glenohumeral arthirits
Tumour
Infection

If has been trauma:
rotator cuff pathology
dislocation
#

Question 7

How you diagnose supraspinatus tedinopathy?

Answer 7

With the empty can test –> get pt to abduct arm to 90 degrees then internally rotate as if emptying can water. Examiner pushes down on arm and pt resists.

Question 8

How do you diagnose acriomioclavicular joint arthitis?

Answer 8

Tender to palpation, positive scarf test, pain when abduct to 170 degrees +

Question 9

How do you diagnose frozen shoulder?

Answer 9

Clinically
XR to rule out arthirits/ other causes
U/S to see inflammation

Question 10

What is the mx for adhesive capsulitis?

Answer 10

Analgesia
PT
steroids
Injection saline to stretch capsule
Surgery if severe/ resistant

Question 11

What is a rotator cuff injury?

Answer 11

Injury to rotator cuff TENDONS usually due to injury/ overhead activities

Question 12

What are the rotator cuff muscles?

Answer 12

SITS
Supraspinatus
Infraspinatus
Teres minor
Subscapularis

Question 13

What do the different rotator cuff muscles do?

Answer 13

S – Supraspinatus – abducts the arm
I – Infraspinatus – externally rotates the arm
T – Teres minor – externally rotates the arm
S – Subscapularis – internally rotates the arm

Question 14

How does rotator cuff pathology present?

Answer 14

Weakness and pain specific to particular muscle affected

Hard to sleep and get comfy at night

Question 15

What are the Mx for rotator cuff pathology?

Answer 15

Rest
NSAIDs
PT
Surgery if young/ active/ acute/ not recovering

Question 16

What is a shoulder dislocation?

Answer 16

Where the head of the humerus leaves the glenoid cavity of the capula

Question 17

What is subluxation

Answer 17

Partial dislocation where naturally pops back in after

Question 18

How do you distinguish between anterior and posterior dislocations?

Answer 18

Usually by causes:
90% are anterior = extended, posterior and abducted - think of trying to catch heavy rock

posterior - electic shock/ seizure caused - light bulb sign on XR

Question 19

What is a key complication of shoulder dislocation?

Answer 19

Axillary nerve damage: characterised by loss of sensation in regimental badge area over the lateral deltoid; weakness in deltoid and teres minor

Question 20

How do dislocated shoulders present?

Answer 20

Usually quite obvious:
Muscles around shoulder go into spasm;
arm held against body;
deltoid flattened;
head of humerus bulges out

Question 21

How do you assess a shoulder dislocation?

Answer 21

FIRST Assess neurovascular status and for fractures

Question 22

How do you mx a dislocated shoulder?

Answer 22

Entonox, sedate, muscle relaxants - whatever analgesia needed
Sling
Closed reduction
Post-reduction XR