management

Epidemiology

Elderly population

Less common in younger population

Lateral 1/3 Neer Classification

Type I

Fracture lateral to the CC ligaments

- does not extend into the ACJ

- non displaced

- most common 4:1

Definition

Chronic massive rotator cuff defect

- uncovered humeral articular cartilage

- high riding humeral head

- abrasion by undersurface of coracoacromial arch

History

Neer

- introduced term "cuff tear arthropathy"

- included significant rotator cuff diagnosis & arthritis in older patients

- especially women

- synovial fluid contained calcium phosphate crystals + proteases

Aetiology

Definitions

Massive tear 

1.  > 5cm 

- retracted to humerus / glenoid margin

2.  At least 2 complete tendons

- lose SS / IS or SS / SC

Classification

Definition

Instability in at least 2 planes

- postero-inferior

- antero-inferior

- antero-postero-inferior

Epidemiology

Recognised as a common problem 

- often misdiagnosed

Most patients athletic

Definition

A GH dislocation which has been missed for a significant period of time

- time period is arbitary

- > 3-6 weeks

Pathology

Humerus soft and osteoporotic

Significant soft tissue contractures

1.  Anterior / subcoracoid dislocation

Beware

- scarring to NV structures

- RC tears including SSC, especially > 40

Epidemiology

Most common form of shoulder instability

- young males 

- M:F = 2:1

Aetiology

Indirect ER and abduction moment on arm

- disruption of anterior stabilisers

History

Initial injury

- severe pain in shoulder

Anatomy

Synovial joint with hyaline cartilage

Has fibrocartilage intra-articular disc

- complete or incomplete

- usually degeneration by 4th decade

Clavicle may lie superior to acromion in normal population

Acromioclavicular Ligaments

Definition

Injury to ulnar collateral ligament of thumb MCPJ

Aetiology

Initial description

- chronic laxity of British gamekeeper's thumb's 

- no specific trauma

- secondary to breaking pheasant's neck

Acute trauma

- snow ski

- ball games

Valgus / forced abduction

Anatomy

UCL

Rheumatoid Arthritis Diagnostic Criteria

1987 American College of Rheumatology 

Need 4/7 (MAX RANS)

1. Morning Stiffness

2. Arthritis of 3 areas > 6/52

3. Xray changes

4. Rh factor

5. Arthritis of Hand > 6/52

6. Nodules

7. Symmetric Arthritis > 6/52

Epidemiology

Male & Females > 60 years

- X-ray evidence of OA

Symptomatic 

- 25% females

- 15% males

Affected joints

Base thumb

PIPJ / Bouchard's nodes

DIPJ / Heberden's nodes