Clinical conditions of the shoulder

Question 1

What causes winging o the scapula

Answer 1

Damage o the long thoracic nerve usually caused my trauma

Question 2

What is axillary lymphadenopathy

Answer 2

Enlargement of the axillary lymph nodes

Question 3

What causes axillary lymphadenopathy

Answer 3

• infection of the upper limb which can cause lymphangitis
• infections of the pectoral region and breast
• leukaemia or lymphoma
• metastasis from malignant melanoma in the upper limb

Question 4

Lymph nodes of axillary

APICAL

Answer 4

Anterior

Posterior

Infraclavicular

Central

Apical

Lateral

Question 5

Spinal nerve roots for five major brachial plexus branches

Answer 5

3 musketeers assassinated 4 mice 5 rats and 2 unicorns

Musculocutaneous C5, C6, C7

Axillary C5, C6

Median C6,7,8,T1

Radial C5, 6, 7,8, T1

Ulnar C8 T1

Question 6

Insertion of the muscles a the intertubercular sulcus of the humerus

Answer 6

A lady between 2 majors

Latissimus Dorsi inserts between teres major on the medial lip nod pectoralis major on the lateral lip

Question 7

What neuromuscular structures are at risk in fracture of the surgical neck of the humerus

Answer 7

Axillary nerve

Posterior circumflex artery

Sensation in the regimental made area impaired

Question 8

What will damage to the axillary nerve lead to

Answer 8

Paralysis of the deltoid and teres minor

Therefore difficultly performing abduction of the affected limb

Question 9

Muscles in the anterior compartment of the arm are …..

And are innervated by…..BBC

Answer 9

Musculocutaneous nerve

Biceps bracii
Brachialis
Coracobrachialis

Question 10

What direction does the shoulder dislocate usually and why

Answer 10

Aneroinferiorly because it is weak at its inferior aspect

Anterior because the head of the humerus sits anterior to the glenoid fossa

Question 11

When does anterior dislocation occur

Answer 11

When the individual has their arm positioned in abduction and external rotation

Hand behind head

Question 12

What is a Bankart lesion

Answer 12

The force of the humeral head popping out of the socket often causes part of the glenoid labrum to be torn off.

Question 13

What is a Hill-Sachs lesion

Answer 13

When the humeral head is dislocated anteriorly, the tone of the infraspinatus and teres minor muscles means that the posterior aspect of the humeral head becomes jammed against the anterior lip of the glenoid fossa (see image below). This can cause a dent (indentation fracture) in the posterolateral humeral head

Question 14

When do posterior dislocations occur

Answer 14

Violent muscle contractions

• epileptic seizure
• electrocution
• lightning strike

When arm is flexed across body and post posteriorly

Question 15

How can you look for dislocations in the shoulder

Answer 15

Light bulb sign- the projection of the humeral head becomes more rounded in a posterior dislocation - abnormal

Scapular y shaped view- head of the humerus should be directly within the glenoid fossa

Question 16

Where do clavicle fracture occur mostly

Answer 16

80% in the middle third of the clavicle

Question 17

What can cause a clavicle fracture

Answer 17

Fall onto outstretched hand or onto shoulder

Question 18

What are some indications for surgical fixation in clavicle fracture

Answer 18

• complete displacement
• severe displacement- tenting of skin
• open fracture
• neurovascular compromise
• fracture with imposed uncle
• paring shoulder clavicle fracture with ipsilateral fracture of glenoid neck

Question 19

What is impingement syndrome

Answer 19

Occurs when the supraspinatus tendon impinges on the coracobrachialis-acromial arch leading to irritation and inflammation

Question 20

When do you feel pain in impingement syndrome

Answer 20

When the shoulder is abducted or flexed as the space becomes narrowed

Worsened with shoulder overhead movement

Question 21

What is calcific supraspinatus tendinopathy

Answer 21

Presence of macroscopic deposits of hydroxyapatite in the tendon of supraspinatus

Question 22

What is thought to be the cause of calcific supraspinatus tendinopathy

Answer 22

-regional
hypoxia leads to tenocytes being transformed into chondrocytes and laying down
cartilage in the tendon. Calcium deposits are then formed through a process
resembling endochondral ossification.

Question 23

Adhesive capsulitis

Answer 23

Frozen shoulder

capsule of the glenohumeral joint becomes inflamed and stiff, greatly restricting movement and causing chronic pain

Question 24

Risk factors of frozen shoulder

Answer 24

• Female gender
• Epilepsy with tonic seizures (i.e. sudden muscle contractions)
• Diabetes mellitus (the theory is that glucose molecules bond to the capsular
90
collagen)

• Trauma to the shoulder
• Connective tissue disease

Question 25

Treatment of frozen shoulder

Answer 25

Physiotherapist
Analgesia
Anti-inflammatory meds

Question 26

Treatment of OA of shoulder

Answer 26

activity modification (avoiding activities that precipitate symptoms), analgesia, and anti-inflammatories (NSAIDs). Some patients report a benefit from taking nutritional supplements e.g. glucosamine and chondroitin sulfate.