What are the likely causes of fracture in the young vs the old?
Young = high energy injuries
Old = Osteoporotic injuries
What is the most common direction for shoulder dislocation?
Anterior = 90%
Posterior = 9%
Inferior = 1%
What is the treatment for shoulder dislocation?
What is the definition of subacromial impingement?
•Pain and dysfunction resulting from any pathology which decreases the volume of the subacromial space or increases the size of the contents
Can happen when the tendons of the rotator cuff muscles become irritated and inflamed as they pass though the subacromial space. Anything that causes narrowing has the ability to impinge the tendon and cause an inflammatory response. This can be caused by changes in the bone such as subacromial spurs, osteoarthritic spurs and abnormal shape of the acromian. Thickening or calcification of the coracoacromial ligament can also cause impingement.
What are the signs and symptoms of impingement syndrome?
Loss of movement in affected shoulder
What are possible clinical tests for subacromial impingement?
A painful arc of movement may be present during forward elevation of the arm from 60° to 120°.
Passive movement at the shoulder will appear painful when a downwards force is applied at the acromion but the pain will ease once the downwards force is removed
Subacromial impingement tests include the hawkins test and the Neer’s test
What are the therapies available for subacromial impingement?
Subacromial steroid injection
Physiotherapy (anaelgesia is necessary before hand)
Arthroscopic subacromial decompression
What are the causes of capsulitis / frozen shoulder?
Idiopathic or secondary (trauma or periods of immobalisation)
What is the diagnosis of frozen shoulder?
What is capsulitis?
The connective tissue surrounding the glenohumeral joint of the shoulder, becomes inflamed and stiff, greatly restricting motion and causing chronic pain.
What are the clinical features of capsulitis?
Pain - usually worse at night and with cold weather
What are the stages of capsulitis?
Stiffening (as pain reduces the ROM reduces)
Thawing - movement gradually returns
What are the treatments for capsulitis?
Medication - NSAIDS and corticosteroids (systemic or injection)
Manual manipulation of the shoulder under anaethetic to break up the adhesions
Surgery to cut adhesions (capsular release) - usually performed by arthroscopy
What are the two classifications of rotator cuff tears?
What is the treatment for rotator cuff tears?
- Acute rotator cuff tears = early surgery
- Chronic degenerative tears = surgery if symptomatic
What are the classes of shoulder arthritis?
What are the common conditions of the elbow?
- Fractures & dislocations in young
- Tendinopathies in middle age
- Degenerative disease in elderly
- Cubital Tunnel syndrome at any age
What causes tennis elbow or lateral epicondylitis?
It often occurs after strenuous overuse of the muscles and tendons of the forearm, near the elbow joint.
What is the management of tennis elbow?
Rest the muscle
anaelgesics - paracetamol
Physiotherapy in more severe cases
What causes golfers elbow or medial epicondylitis?
Golfer’s elbow is usually caused by overusing the muscles in the forearm that allow you to grip, rotate your arm, and flex your wrist. Repetitive flexing, gripping, or swinging can cause pulls or tiny tears in the tendons.
Would you ever inject steroids for golfers / tennis elbow?
What are the newer treatments for golfers / tennis elbow?
Platelet rich plasma