Shoulder & elbow disorders Flashcards
(44 cards)
Give 4 differentials of shoulder pain
– Subacromial Impingement
– Rotator Cuff Tears
– Dislocation
– Arthritis
What’s the most common cause of shoulder pain?
Define it
Subacromial impingement
first stage of rotator cuff disease
Refers to the inflammation and irritation of the rotator cuff tendons as they pass through the subacromial space
Describe the presentation of subacromial impingement
- Insidious onset shoulder pain
- Exacerbated by overhead activities e.g. washing hair
- +/- Night pain
how would you examine a patient with subacromial impingement?
Painful Arc Test
Neer impingement sign
Hawkins test
In a patient with subacromial impingement, what radiological signs might you see on X-ray?
- +/- Type 3 hooked acromion
- +/- ACJ osteoarthritis
- +/- sclerosis/cystic changes in greater tuberosity
Describe the non-operative and operative management for SI
Non-operative:
- Physiotherapy
- NSAIDs
- Subacromial corticosteroid injections (first line and mainstay of treatment)
Operative:
- Arthroscopic subacromial decompression + acromioplasty
List the RFs for rotator cuff tears
- Age (grey hair = rotator cuff tear)
- Smoking
- Hypercholesterolemia
- Thyroid disease
Symptoms of rotator cuff tears?
Pain: acute or insidious onset, in deltoid region, worse with overhead activities
+/- night pain
Weakness: loss of active ROM
List the 4 rotator cuff muscles, their function and their tests of function?
Supraspinatus- abduction
Infraspinatus and teres minor- externally rotates the arm
subscapularis- internally rotates the arm
perform Jobe’s test
where do the rotator cuff muscles insert?
All insert in the greater tubercle of the humerus except the subscapularis which inserts on the lesser tubercles of humerus
Imaging for RC muscles?
Ultrasound, MRI
Treatment of rotator cuff tear?
non-operative and operative with indications
Non-operative: physiotherapy, NSAIDs and subacromial corticosteroid injection
– Operative:
Rotator Cuff Repair (young, fit)
Rotator Cuff Debridement (elderly, irreparable tear)
Tendon Transfer (young, fit, irreparable tear)
Reverse Total Shoulder Arthroplasty (if massive RC tear with advanced arthritis)
why is there a high incidence of shoulder dislocation?
what usually causes it?
most common type of shoulder dislocation?
Because the head of the humerus is larger than the shallow glenoid fossa.
typically caused by trauma (e.g., falling on an outstretched arm, rugby tackle
anterior (accounts for 95%)
what are the symptoms and signs of shoulder dislocation when examining a patient?
symptoms: severe shoulder pain, inability to move the shoulder
Signs
Empty glenoid fossa: A palpable dent may be present at the point where the head of the humerus is supposed to lie.
The arm is typically in external rotation and slight abduction.
what are the complications of shoulder dislocations?
Damage to the axillary nerve:
Numbness over the lateral surface of the shoulder and loss of function of the deltoid muscle
Injury to the brachial plexus, axillary artery/vein
Bankart and Hill sachs lesions
Recurrent shoulder instability (common in <30 yr-old)
Rotator cuff injury (common in >45 yr-old)
Describe this X-ray
X-ray of the shoulder joint in AP view
shows an anterior dislocation of the humerus
What is circled in red in this MRI of the shoulder?
Bankart lesion - injury of the anterior inferior lip of the glenoid labrum due to traumatic anterior shoulder dislocation
treatment of shoulder dislocation?
immediate, conservative, surgical
immediate:
- Immobilization of the joint with a sling
- Analgesia
Conservative:
- Closed reduction
surgical:
- reduction of humeral head and repair of labrum
what causes shoulder OA?
- Primary osteoarthritis
- Secondary arthritis:
- post-traumatic (fracture or dislocation)
- inflammatory/crystalline arthritis (Rh Ar, Gout,..)
- osteonecrosis (AVN)
- rotator cuff arthropathy (massive RC tear leading to arthritis)
symptoms and signs of shoulder OA?
Symptoms:
- Shoulder pain
- Loss of range of motion: especially external rotation due to anterior capsule contraction
- Pain at night
Physical exam:
- Decreased range of movement (ROM)
- Crepitus
What is Goat’s beard on X-ray? when is it seen
Osteophytes circumferentially at the humeral head, sign of shoulder OA
treatment of Shoulder oA?
non-surgical and surgical
Non-operative: NSAIDs, physiotherapy and corticosteroid injections
Operative: Shoulder Replacement
List 5 differentials of elbow pain
– Osteoarthritis
– Rheumatoid Arthritis
– Tennis Elbow
– Golfer’s Elbow
– Olecranon Bursitis
