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Orthopaedics > Shoulder and elbow disorders > Flashcards

Shoulder and elbow disorders Flashcards

1
Q

common causes of shoulder pain 4

A

subacromial impingement

rotator cuff tears

dislocation

arthritis

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2
Q

define subacromial impingement

A

the first stage of rotator cuff (RC) disease

most common cause of shoulder pain

inflammation of subacromial bursa due to abutment between greater tuberosuty:
- RC
-acromiom
-coraco-aromial ligament
-acromioclavicular joint

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3
Q

what can subacromial impingement involve 5

A

RC

acromion

RC

coraco-acromial ligament

acromioclavicular joint

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4
Q

state the rotator cuff muscles 4

A

Subscapularis.
Infraspinatus.
Teres minor.
Supraspinatus.

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5
Q

what condiitons are associated with subacromial impingement 3

A

hook shaped acromion

greater tuberosity fracture malunion

shoulder instability

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6
Q

presentation of subacromial impingement 3

A

insidous onset shoulder pain

exacerbated by overhead activities

±night pain

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7
Q

physical exam findings in subacromial impingement 3

A

painful arc test [67]

neer impingement sign [68]
-pain on passive forward flexion >90˚

hawkins test [69]
-Pain on passive forward flexion to 90˚ and internal rotation

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8
Q

radiograph signs in subacromial impingement 3

A

type 3 hooked acromion

ACJ osteoarthitis

sclerosis/cystic changes in greater tuberosity

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9
Q

non-operative treatment of subacromial impingement 3

A

physiotherapy

NSAIDs

subacromial corticosteroid injection
-1st line and mainstay of treatment

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10
Q

operative treatment for subacromial impingement 2

A

arthroscopic subacromial decompression

acromioplasty

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11
Q

risk factors for rotator cuff tears 4

A

age (grey hair=rotator cuff tear)

smoking

hypercholesterolemia

thyroid disease

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12
Q

types of rotator cuff tears 2

A

chronic degenerative tear

acute traumatic avulsion

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13
Q

size of rotator cuff tears 4

A

small 0-1cm

medium 1-3cm

large 3-5cm

massive- 2 or more tendons

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14
Q

syx of rotator cuff tears 4

A

pain
- acute or insidous onset
-in deltoid region
-worse with overhead activities
-±night pain

weakness
-loss of active ROM

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15
Q

for each specific rotator cuff tear muscle state the special test:
-supraspinatous

A

Jobe’s test= empty can test

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16
Q

for each specific rotator cuff tear muscle state the special test
infraspinatous

A

external rotation lag
-patient wont be able to maintain external rotation position

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17
Q

for each specific rotator cuff tear muscle state the special test
teres minor

A

hornblower sign
-can only bring hands to mouth if elbow is in high position

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18
Q

for each specific rotator cuff tear muscle state the special test
subscapularis

A

lift-off test

belly-press test

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19
Q

imaging for rotator cuff tear 2

A

ultrasound scanning

MRI

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20
Q

non-operative treatment for rotator cuff tear 3

A

physio

NSAIds

subacromial steroid injfection

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21
Q

operative treatment for rotator cuff tear and indication for each 4

A

rotator cuff repair
-young, fit

rotator cuff debridement
-elderly
-irreparable tear

tendon transfer
-young, fit
-irreparable tear

reevrse total shoulder arthroplasty
-if massive RC tear with advanced arthritis

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22
Q

classifcatino for shoulder dislocation 3

A

> 95%-anterior (subcoracoid)
and or anterior inferiorn (subglenoid)

4%- posterior

1%-inferior

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23
Q

why is shoulder dislocation the most common dislocation

A

head of humerus larger than shallow glenoid fossa
-this causes higher incidence of shoulder dislocation

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24
Q

what is shoulder dislocation usually from

A

result of trauma
eg falling on outstreched arm, rugby tackle

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25
Q

cause of posterior shoulder dislocation

A

seizure or electric shock

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26
Q

clinical features of shoulder dislocation 4

A

severe shoulder pain

inability to move shoulder

empty glenoid foass
-palpable dent may be present at the point where the head of the humerus is supposed to lie

arm is typically held in external rotation and slight abduction

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27
Q

complications of shoulder dislocation 5

A

damage to axillary nerve

injury to brachail plexus, axillary artery/vein

avulsion fracture of greater or lesser tuberosities

recurrent shoulder instability (common in <30yo)

rotator cuff injruy- common in >45

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28
Q

how does a damaged axillary nerve in a shoulder dislocation present

A

numbness over lateral surface of shoulder and loss of function of deltoid muscle

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29
Q

shoulder dislocation imaging

A

XR

MRI
-indicated to assess soft tissue damage

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30
Q

emergency managemeent of shoulder dislocation 2

A

immobilisation of joint with sling
entonox analgesia

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31
Q

conservative mangaeemnt of shoulder dislocation 1

A

closed reduction

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32
Q

surgical management of shoulder dislocation1

A

reduction of humeral head and reapir of labrum

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33
Q

indications for surgical managemetn of shoulder dislocation 4

A

unsuccessful closed reduction

displaced bankart lesion

recurrent shoulder dislocations

young and active individuals may require early surgery to prevent recurrent dislocation in the future

34
Q

define bankart lesion- related to shoulder dislocation

A

injury of anterior inferior lip of glenoid labrum due to traumatic anterior shoulder dislocation

35
Q

define shoulder osteoarthritis

A

glenohumeral degenerative jiont disease characterised by damage to articular surfaces of humeral head and/or glenoid

36
Q

types of shoulder osteoarthritis 2

A

primary osteoarthitis

secondary arthitis

37
Q

causes of secondary shoulder osteoarthritis 4

A

post-traumatic (fracture or dislocation)

inflammatory/crystalline arthritis (RA, gout)

osteonecrosis (AVN)

rotator cuff arthropathy
-massive RC tear leading to arthritis

38
Q

syx of shoulder osteoarthritis 3

A

shoulder pain

loss of range of motion
-esp external roation due to anterior capsule contraction

pain at night

39
Q

findings on physical exam of shoulder osteoarthritis 2

A

decreaed ROM

crepitus

40
Q

findings on radiograph in shoulder osteoarthritis 5

A

joint space narrowing

subchondral sclerosis

subchondral cysts

osteophytes circumferentially at humeral head (‘goats beard’)

posterior glenoid wear

(just LOSS + post glenoid wear)

41
Q

non-operative treatment for shoulder osteoarthritis 3

A

NSAIDs

physio

steroid injfection

42
Q

operative treatment for shoulder osteoarthritis 1

A

shoulder replacement

43
Q

common causes of elbow pain 5

A

OA

RA

tennis elbow

golfers elbow

olecranon bursitis

44
Q

types of elbow osteoarthitis 2

A

primary

post-traumatic

45
Q

syx of elbow osteoarthitis 4

A

progressive painful movement

loss of terminal extension

painful locking

catching elbow

46
Q

examination of elbow osteoarthitis 1

A

reduced RA

47
Q

radiographs of elbow osteoarthitis 4

A

LOSS

48
Q

management of elbow osteoarthitis 3

A

non-operative
-usual three

operative
-debridement - removal of osteophytes and capsular release
-arthroplasty

49
Q

syx of elbow RA 2

A

pain and loss of moiton

(hand and wrist invoement usually precedes elbow )

50
Q

examaination findings of elbow RA 2

A

fixed flecion deformity

ligamentous incompetence

51
Q

radiograph findings of elbow RA 2

A

periarticular erosions

cystic changes

52
Q

treatment for elbow RA

A

same as OA

53
Q

define tennis elbow

A

overue injury at origin of common extensor tendon leading to tendinosis and inflammation

54
Q

what muscle is overused in tennis elbow

A

extensor carpi radialis brevis (ECRB)

55
Q

syx of tennis elbow 2

A

pain with gripping

pain with resisted wrist extension

56
Q

examamination findings in tennis elbow 2

A

point tenderness at ECRB origin (lateral epicondyle)

test
-resisted extension of long finger exacerbates pain

57
Q

radiographs in tennis elbow

A

usually normal
or
-calcification at extensor origin

58
Q

non-operative treatment for tennis elbow 3

A

usual three

effective in 95% but patience is required

59
Q

operatiev treatment of tennis elbow 1

A

release and debridement of ECRB origin

60
Q

definition of golfers elbow

A

overuse of flexor-pronator origin (medial epicondylitis)

-less common than tennis elbow

61
Q

presenation of golfers elbow 2

A

pain w gripping

pain with resited wrist flexion

62
Q

examination of golfers elbow 2

A

point tenderness just distal to medial epicondyle

test
-pain w resisted forearm pronation and wrist flexsion

63
Q

radiogrpahs of golfers elbow

A

usually normal.
or
calcification at flexor origin

64
Q

when should MRI be used in goflers elbow

A

rule out UCK (ulnar collateral ligament)
-injury in overhead throwers

65
Q

differential diagnosis for golfers elbow

A

torn ulnar collateral ligament

66
Q

non-operative treatment for golfers elbow

A

usual 3 + BRACING

-effective in 95%
-patience required

67
Q

operative treatment for golfers elbow 2

A

debridement

reattachement of flexor-pronator origin

68
Q

operative treatment for golfers elbow 2

A

debridement

reattachement of flexor-pronator origin

69
Q

causes of olecranon bursitis 5

A

trauma

prolonged pressure

infection

RA

gout

70
Q

presentation of olecranon bursitis 6

A

swelling

pain

redness

warmth

if infective:
-fever
-malaise

71
Q

Ix for olecranon bursitis 3

A

FBC

uric acid levels

CRP

72
Q

radiograph findings in olecranon bursitis 2

A

radio-opaque foreign bodies

olecranon spur

73
Q

gold standard for diagnosis of infective olecranon bursitis

A

aseptic needle aspiration of bursa

urgent gram stain, culture and sensitivity

74
Q

treatment of non-infective olecranon bursitis 4

A

ICE

elevation

NSAIDs

treat the cause eg gout, RA

75
Q

treatment for infective olecranon bursitis 1

A

after aspiration start broad-spec ABx

oral or IV depeding on severity of infection

76
Q

treatment for recurrent bursitis

A

once infection settled

-interval bursectomy can be considered

77
Q

define cubital tunnel syndrome

A

compression of ulnar nerve as it passes through the cubital tunnel

78
Q

clinical features of cubital tunnel syndrome 4

A

tingling and numbness of the 4th anf 5th fingers
-starts intermittent and then becomes constant

over time ptx can develop weakness and muscle wasting

pain worse on leaning on affected elbow

Hx of OA or prior trauma in area

79
Q

Ix for cubital tunnel syndrome 2

A

dx usually clinical

selected cases- nerve condution studies

80
Q

Mx of cubital tunnel syndrome 4

A

avoid aggravating activity

physio

steroid injfection

surgey in resistant cases

81
Q

causes of `cubital tunnel syndrome 3

A

arthritis

elbow fractues

sustained postures

Orthopaedics (15 decks)

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