1. Trauma: Shoulder - Impingement

Question 1

What are the two types of impingement?

Answer 1

External and Internal

Question 2

impingement of the rotator cuff overlying the bursal surfaces (superficial surfaces) that are adjacent to the coracoacromial arch

Answer 2

External

Question 3

The coracoacromial arch is made up of

Answer 3

coracoid process, acromion, and coracoacromial ligament

Question 4

What are the Primary External Causes of impingment (Abnormal Coracoacromial Arch)

Answer 4

1. Hooked acromion
2. Subacrimial Osteophyte Formation
3. Subcoracoid Imingement

Question 5

Subacromial osteophyte formation or thickening of the coracoacromial ligament can impinge on what tendon?

Answer 5

Supraspinatus tendon

Question 6

Impingement of the subscapularis between the coracoid process and lesser tuberosity (on axial look for a reduced coracohumeral distance). This can be secondary to congenital configuration, or a configuration developed post traumatically after fracture of the coracoid or lesser tuberosity.

Answer 6

Subcoracoid impingement:

Question 7

typically seen in patients with generalizedjoint laxity

Answer 7

“Multidirectional Glenohumeral Instability”

Question 8

This refers to impingement of the rotator cuff on the undersurface (deep surface) along the glenoid labrum and humeral head.

Answer 8

Internal

Question 9

This is internal impingement that occurs when the arm is in horizontal adduction and internal rotation. In this position, the undersurface o f the biceps and subscapularis tendon may impinge against the anterior superior glenoid rim.

Answer 9

Anterior Superior

Question 10

*Abnormal Coracoacromial Arch — Hook Shaped (B3)
— Osteophytes
—Post Traumatic
—Thickened Ligaments

Answer 10

External Primary

Question 11

‘ Multidirectional Instability
—Labrum Often Normal
—“Increased Glenohumeral Volume” - with injection

Answer 11

External Secondary

Question 12

*Throwers
—F’s with Infraspinatus (and posterior Supra)
—Posterior Superior Labrum Torn
—Cystic Change in Greater Tuberosity

Answer 12

Internal Posterior Superior

Question 13

—Associated with Sub Scapular damage (Maybe the cause rather than the result)
—Anterior Superior Labrum Torn

Answer 13

Internal Anterior Superior

Question 14

If the exam writers just say “Internal
Impingement” - this is the one they are talking about

Answer 14

Internal Posterior Superior

Question 15

most common form

resulting from attrition of the coracoacromial arch.

Answer 15

Subacromial Impingement

Damages Supraspinatus

Question 16

Lesser tuberosity and coracoid do the pinching.

Answer 16

Subcoracoid Impingement

Dmages Subscapularis

(remember the coracoid is anterior - and so is the subscapularis).

Question 17

Athletes who make overhead movements. Greater tuberosity and posterior superior labrum do the pinching.

Answer 17

Posterior Superior “Internal” Imninsement

Damages Infraspinatus (and posterior fibers of the supraspinatus).

Question 18

most common of the four muscles to tear is

Answer 18

the Supraspinatus

Question 19

Most tears in the supraspinatus occur at

Answer 19

The critixal Zone 1-2 cm fromt the tendon footprint

Question 20

the most common location for Calcium Hydroxyapatite (HADD) - or “calcific tendinitis.” in the supraspinatus?

Answer 20

Criical Zone (1-2 cm from the footprint

Question 21

What tear extent warant surgical intervention

Answer 21

A partial tear > 50%

Question 22

How do you know it’s afull thickness tear?

Answer 22

Question 23

An inflammatory condition characterized by a global decrease in motion.

Answer 23

Adhesive Capsulitis “Frozen Shoulder”

Question 24

Adhesive Capsulitis “Frozen Shoulder” commonly affects what structure

Answer 24

Rotator cuff interval

Question 25

Answer 25

Adhesive Capsulitis “Frozen Shoulder”

Grey Smudgy Shit Instead of Clean Fat in the Rotator Cuff Interval

Question 26

Labral tears favors =

Answer 26

Superor marign + anterior to posterior

Question 27

SLAP tear involvement

Answer 27

Insterition = long head biceps

Question 28

SLAP injury mechanism

Answer 28

Over-head movment (classic = swimmer)

Question 29

A SLAP mimic = normal varint = incomplete attachment of the labrum at 12 o’clock’

Answer 29

Sublabral Recess

Question 30

This is an unattached (but present) portion of the labrum - located at the anterior-superior labrum (1 o’clock to 3 o’clock).

Answer 30

Sublabral foramen

As a rule it should NOT extend below the equator (3 o’clock position).

Question 31

absent anterior/superior labrum (1 o’clock to 3 o’clock), along with a thickened middle glenohumeral ligament.

Answer 31

Buford Complex

Question 32

Superficial partial labral injury with cartilage defect

No instability

Answer 32

Glenolabral Articular Disruption

Question 33

Avulsed anterior labrum (only minimally displaced).
Inferior

GH complex still attached to periosteum

Intact Periosteum (lifted up)

Answer 33

Perths

Question 34

Medially displaced labroligamentous complex with absence of the labrum on the glenoid rim. Intactperiosteum. It scars down to glenoid.

Intact Periosteum

Answer 34

Anterior Labral Periosteal Sleeve Avulsion (ALPSA)

Question 35

Torn labrum

Periosteum Disrupted

Answer 35

True Bankart

Question 36

A fracture o f the posterior inferior rim ofthe glenoid.

Answer 36

Reverse Osseous Bankart

Question 37

This is the bizarro version o f the ALPSA, where the posterior labrum and the posterior scapular periosteum (still intact) are stripped from the glenoid resulting in a recess that communicates with the joint space.

Answer 37

POLPSA

Question 38

An extra-articular curvilinear calcification - associated with posterior labral tears (maybe the POLPSA).
It’s related to injury of the posterior band of the inferior glenohumeral ligament.

Answer 38

“Bennett Lesion”

Question 39

An incompletely avulsed / flattened / mashed posterior- inferior labrum.

“glenoid cartilage and posterior labrum relationship is preserved.”

Answer 39

Kim’s Leison

Question 40

anterior shoulder dislocation = Avulsion = Inferior glenohumeral ligament avulsion

Answer 40

HAGL (Humeral avulsion glenohumeral ligament)

Question 41

Answer 41

HAGL (Humeral avulsion glenohumeral ligament).

The “J Sign” occurs when the normal U-shaped inferior glenohumeral recess is retracted away from the humerus, appearing as a J.

Axial MR - Showing the IGHL Tom at its Humeral Attachment

Question 42

The subscapularis attachment =

It sends a few fibers across the bicipital groove to the greater tuberosity =

Answer 42

The subscapularis attaches to the lesser tuberosity. It sends a few fibers across the bicipital groove to the greater tuberosity , which is called the “transverse ligament”

Question 43

Subscapularis Tear =

Answer 43

Medial Dislocation of the Long Head of the Biceps Tendon.

Question 44

Answer 44

Subiuxation of the Biceps Tendon

Occurs with a Tear of the Subscapularis

Question 45

A cyst at the level of the suprascapular notch will affect =

Answer 45

supraspinatus and the infraspinatus

Question 46

A cyst at the level of teh spinoglenoid notch will only affect what?

Answer 46

infraspinatus

Question 47

Answer 47

Cyst in the spinoglenoid notch causing fatty atrophy of the Infraspinatous

Question 48

Compression of the Axillary Nerve in the Quadrilateral Space (usually from fibrotic bands)

Answer 48

Quadrilateral Space Syndrome

Question 49

Answer 49

Quadrilateral Space Syndrome

• Atrophy of Teres Minor

Question 50

This is an idiopathic involvement of the brachial plexus. Think about this when you see muscles affected by pathology in two or more nerve distributions (suprascapular and axillary etc..).

Answer 50

Parsonage-Turner Syndrome