Adult Shoulder Problems

Question 1

what does the gleno-humeral joint contain?

Answer 1

humeral head

scapular glenoid

Question 2

what does the shoulder girdle consist of?

Answer 2

scapula
clavicle
proximal humerus
supporting muscles (deltoid and rotator cuff)

Question 3

role of supraspinatus

Answer 3

initiates abduction

Question 4

role of subscapularis

Answer 4

internal rotation

Question 5

role of infraspinatus

Answer 5

external rotation

Question 6

role of teres minor

Answer 6

external rotation

Question 7

which direction of dislocation is most common in the shoulder?

Answer 7

anterior

Question 8

what causes an anterior shoulder dislocation?

Answer 8

fall with external rotation

Question 9

what structure can be damaged in an anterior shoulder dislocation?

Answer 9

axillary nerve

Question 10

how do you check whether the axillary nerve is damaged?

Answer 10

badge area sensory assessment

Question 11

what conditions do recurrent dislocations happen in?

Answer 11

EDS

Question 12

presentation of shoulder dislocation

Answer 12

deformity
anterior= Bankart lesion
posterior= hill-sachs lesion

Question 13

which shoulder dislocation is rare?

Answer 13

inferior

Question 14

what is a Bankart lesion?

Answer 14

damage to anteroinferior aspect of glenoid labrum

Question 15

what is a Hill-Sachs lesion?

Answer 15

cortical depression of posterolateral humeral head

Question 16

what sign is seen on XR for posterior shoulder dislocation?

Answer 16

light bulb sign

Question 17

what must you palpate after shoulder dislocation?

Answer 17

vascular supply= colour/temperature

neurological= sensation and reflexes

Question 18

management of shoulder dislocation

Answer 18

manipulation
sling
physiotherapy for core strengthening and scapula stabilising
surgery for bankart repair (reattaching labrum and capsule)

Question 19

manipulation methods for shoulder dislocation

Answer 19

Kocher
Hippocratic
Stimson

Question 20

what is Impingement cuff disease?

Answer 20

tendons of the rotator cuff are compressed in subacromial space during movements

Question 21

presentation of cuff impingement

Answer 21

pain in acromion that can radiate to deltoid and upper arm

Question 22

diagnosis of cuff impingement

Answer 22

Hawkin-Kennedy
Scarf and Jobes tests
painful arc 60-120 degrees abduction as supraspinatus passes through space

Question 23

management of cuff impingement

Answer 23

rest
analgesia
physiotherapy
surgical with decompression

Question 24

what can cause a cuff tear?

Answer 24

degeneration

injury

Question 25

which muscle in the rotator cuff is usually torn?

Answer 25

supraspinatus

Question 26

presentation of cuff tear

Answer 26

grey hair (cuff tear) weakness dull achy pain with difficulty sleeping on affected side and reaching overhead

Question 27

diagnosis of cuff tear

Answer 27

1. Gerbet's 2. painful arc 3. USS and MRI

Question 28

management of cuff tear

Answer 28

``` rest analgesia sling physio decompression surgically ```

Question 29

medical name of frozen shoulder

Answer 29

adhesive capsulitis

Question 30

what is adhesive capsulitis?

Answer 30

thickening of ligaments leading to tightening

Question 31

risk factors for adhesive capsulitis

Answer 31

DM hyperlipidaemia Dupytren's endocrine disease

Question 32

presentation of adhesive capsulitis

Answer 32

loss of external rotation progressive pain and stiffness painful arc on abduction 70-120 degrees

Question 33

management of adhesive capsulitis

Answer 33

physio analgesia can have surgery for capsular release

Question 34

what is acute calcific tendonitis

Answer 34

acute onset of shoulder pain due to Ca2+ deposits in supraspinatus tendon

Question 35

management of acute calcific tendoninitis

Answer 35

self-limiting as calcification resorbs

Question 36

what sign does biceps tendinopathy have?

Answer 36

Popeye sign

Question 37

what does tendonitis activate?

Answer 37

matrix metalloproteinases

Question 38

two examples of brachial plexus injuries

Answer 38

1. Erb's palsy | 2. Klumpke's palsy

Question 39

what is Erb's palsy?

Answer 39

injury to C5-6

Question 40

presentation of Erb's palsy

Answer 40

paralysis, weakness and burning in arm

Question 41

diagnosis of Erb's palsy

Answer 41

EMG NCS MRI

Question 42

management of Erb's palsy

Answer 42

physio analgesia surgical nerve graft

Question 43

what is Klumpke's palsy

Answer 43

injury to C8-T1

Question 44

what does Klumpke's palsy affect?

Answer 44

flexors of wrist and fingers (claw hand)