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4th year MSK > Shoulder + elbow pathology > Flashcards

Shoulder + elbow pathology Flashcards

1
Q

Why is the shoulder the most commonly dislocated joint?

A

The shoulder is a highly mobile joint which sacrifices stability for an increased range of movement.

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2
Q

What are the different types of shoulder dislocation?

A
  • Anteriorinferior dislocation (anterior) - 95% of shoulder dislocations
  • Posterior dislocation - typically caused by seizures or electrocution
  • Inferior dislocation
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3
Q

Symptoms of a dislocated shoulder

A
  • Pain
  • Reduced mobility
  • Feeling of instability
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4
Q

Dislocated shoulder - on examination

A
  • Often asymmetry with the contralateral side - loss of shoulder contours and an anterior bulge from the head of the humerus
  • Assess the neurovascular status of the arm (pre and post reduction)
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5
Q

Investigations for dislocated shoulder

A
  • Plain radiographs are usually adequate in the acute setting
  • Trauma shoulder series is required, comprising anterior-posterior, Y scapular and axial views
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6
Q

Management of shoulder dislocation

A
  • Appropriate analgesia
  • Reduction, immobilisation and rehabilitation
    • Closed reduction (Hippocratic method)
    • Broad arm sling - typically 2 weeks
    • Physiotherapy
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7
Q

The rotator cuff is composed of 4 muscles:

A
  • Supraspinatus - Abduction
  • Infraspinatus - External rotation
  • Teres minor - External rotation
  • Subscapularis - Internal rotation
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8
Q

Risk factors for rotator cuff tears

A
  • Increasing age
  • Trauma
  • Overuse
  • Repetitive overhead shoulder motions
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9
Q

Symptoms of rotator cuff tear

A
  • Pain over the lateral aspect of the shoulder
  • Inability to abduct the arm above 90 degrees
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10
Q

Rotator cuff tear - on examination:

A
  • Tenderness over the greater tuberosity
  • Supraspinatus and infraspinatus muscle wasting can be seen in massive rotator cuff tears
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11
Q

Investigations for rotator cuff tear

A
  • Urgent plain film radiograph to exclude a fracture
  • Ultrasound to establish the presence of a tear
  • MRI imaging to detect the size, characteristics and location of any tear
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12
Q

Which patients should receive surgical management for a rotator cuff injury?

A
  • Presenting 2 weeks after the injury
  • Remaining symptomatic despite conservative management
  • Large and massive tears
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13
Q

Conservative management of rotator cuff tears

A
  • Analgesia
  • Physiotherapy
  • Corticosteroid injections into the subacromial space
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14
Q

Complications of rotator cuff tear

A

The main complication is adhesive capsulitis, leading to stiffness of the glenohumeral joint.

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15
Q

What is adhesive capsulitis?

A

Adhesive capsulitis is a condition in which the glenohumeral join capsule becomes contracted and adherent to the humeral head.

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16
Q

Symptoms of adhesive capsulitis

A
  • Generalised deep and constant pain of the shoulder
  • Joint stiffness and a reduction in function
17
Q

Adhesive capsulitis - on examination:

A
  • Loss of arm swing
  • Atrophy of the deltoid muscle
  • Generalised tenderness on palpation
  • Limited range of motion
18
Q

Management of adhesive capsulitis

A

Adhesive capsulitis is a self limiting condition, recovery occurs over months to years.

  • Physiotherapy
  • Simple analgesics
19
Q

Pathophysiology of epicondylitis

A

Epicondylitis is an overuse syndrome in the elbow, caused by micro tears in the tendons attaching to the epicondyles of the elbow following repetitive injury.

20
Q

There are two common types of epicondylitis:

A
  • Lateral epicondylitis (“Tennis elbow”)
  • Medial epicondylitis (“Golfer’s elbow”)
21
Q

Clinical features of lateral epicondylitis

A
  • Pain affecting the elbow and radiating down the forearm
    • Typically worsens over weeks to months
    • Most often affects the dominant arm
  • On examination: local tenderness on palpation
  • Full range of movement at elbow and wrist
22
Q

Investigations for lateral epicondylitis

A

Clinical diagnosis

Sometimes USS or MRI

23
Q

Management of lateral epicondylitis

A
  • Analgesia
  • Lifestyle modification
  • Physiotherapy
24
Q

How are elbow dislocations classified?

A
  • Simple
  • Complex (associated with a concomitant fracture)
25
Q

How does a elbow dislocation present?

A
  • Following a high energy fall
  • Elbow will be painful, deformed with associated swelling and decreased function
26
Q

Dislocated elbow examination

A

A complete neurovascular examination of the upper limb is essential

  • A deficit is often found in the territory of the ulnar nerve as neuropraxia of this nerve is common
  • Any concern over the pulse of the limb will warrant a Doppler ultrasound for further assessment
27
Q

Investigations for dislocated elbow

A

Plain film radiograph - both AP and lateral

4th year MSK (10 decks)

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