Common MSK Shoulder Problems

Question 1

Shoulder Impingement Syndrome - Characteristics

Answer 1

Most common.
RC muscle impingement between bony structures.
Pain in abduction, flexion and side lying.

Question 2

Shoulder Impingement Syndrome - Classification (2)

Answer 2

Internal Impingement. Posterosuperior glenoid.
External Impingement (subacromial, supraspinatus tendon): primary vs secondary.

Question 3

Shoulder Impingement Syndrome - External Impingement Classification (2)

Answer 3

Primary: structural obstruction
Secondary: Functional problem:
- Rotator cuff weakness
- Instability
- Scapular dyskinesia
- Biceps pathology

Question 4

Internal Impingement (Glenoid) - MOI, Structures Involved, Pain.

Answer 4

Overhead throwing athletes, repetitive large shoulder ER.
Between Suprasp. and IS tendons and greater tubercle - posterosuperior rim of glenoid.
Posterosuperior pain. Pain at night.

Question 5

Rotator Cuff Pathology - Tendinopathy : Intrinsic vs Extrinsic Mechanisms

Answer 5

Intrinsic mechanism: Secondary, external impingement. Over-use, age, weakness. Degeneration.
Extrinsic mechanism: anatomical variable (acromial shape). Over-use. Internal and external impingement.

Question 6

Rotator Cuff Pathology - Tendinopathy : Clinical Presentation (4)

Answer 6

Pain during overhead activity (throwing). <90° usually pain free.
SS and IS (if involved) tender on palpation.
Painful arc may be present.
Impingement test and apprehension may be present.

Question 7

Rotator Cuff Pathology - Tear : Common Factors

Answer 7

> 60 y, weak external rotators, weak suprasp. and signs of impingement: very likely tear.
Supraspinatus common.
Degenerative or acute.

Question 8

Rotator Cuff Pathology - Tear : Clinical Presentation

Answer 8

Pain radiating to lateral-mid humerus or anterolateral acromion.
Pain in side-lying on shoulder or sleeping with hand overhead.
Pain occurs when reaching above head.

Question 9

Scapular Dyskinesia - Causes (3)

Answer 9

Altered scapular motion and position.
Cause: bone, articular (AC or GH instability), soft tissue (muscle tightness/weakness, post. GH capsule stiffness).

Question 10

Scapular Dyskinesis - Tightness of Soft Tissue

Answer 10

tightness of posterior capsule and pec minor causes increases anterior tilt and protraction.

Question 11

Scapular Dyskinesia - Altered Muscle Performance

Answer 11

Decreased SA strength.
Hyper/early activity of upper trap.
Late activation of mid and lower traps.

Question 12

Scapular Dyskinesis - Clinical Presentation (resting, arm elevation/lowering) (4)

Answer 12

Resting position: excessive protraction, elevation, anterior tilt.
Winging of scapula, inferior medial border prominence.
During arm elevation: early scapula elevation (shrug).
Arm lowering: rapid downward rot.
Scapular-humeral rhythm may be affected.

Question 13

Glenohumeral Instability - Classification regarding Nature (3)

Answer 13

Traumatic
Acquired
Atraumatic

Question 14

Glenohumeral Instability - Traumatic: MOI and Observation

Answer 14

Direct contact (P-A) leading to anterior dislocation of humerus.
Observation: prominent humeral head and space below acromion.
MOI: ER and 90° abd.
Bankart and Hill-Sachs lesions.

Question 15

Glenohumeral Instability - Acquired Instability - Characteristics (4)

Answer 15

Over-use.
Due to hyperangulation, over-head movement.
Subluxation of humeral head (sometimes).
Frequently results in int. or ext. impingement -> RC pathology.

Question 16

Glenohumeral Instability - Acquired Instability - SLAP Injury MOI

Answer 16

Superior labral anterior to posterior injury.
MOI: Excessive traction of biceps tendon:
- Eccentric follow through of of long head after throwing (abd., ER.)
- Peel back mechanism during extreme ER.
4 Types.

Question 17

Glenohumeral Instability - Atraumatic - Cause and Pain

Answer 17

Multidirectional instability.
Result of ligament hyperlaxity or repetitive microtrauma (over-head).
Pain in mid-range and altered muscle activity.

Question 18

Glenohumeral Internal Rotation Deficit (GIRD) - Mechanism

Answer 18

Overhead athletes, repetitive throwing.
Tightening of posterior capsule, leads to increased anterior translation of humeral head.
Decreased subacromial space (related to int. and ext. impingement).

Question 19

Acromioclavicular Sprain - Tyoes (6)

Answer 19

Traumatic, affecting capsule, ligaments, muscles, skin and fascia.
Type 1: sprain of AC ligament
Type 2: torn AC
Type 3: Torn AC and CC
Type 4: Tears + clavicular displacement
Type 5: affecting fascia complex
Type 6: Large displacement of clavicle towards sub-coracoid region.

Question 20

Biceps Tendinopathy - Cause (4) and Pain

Answer 20

Primarily long head.
Result of shoulder instability, impingement, RC pathology or overuse.
Tenderness on bicipital groove, night pain, pain at rest.

Question 21

Adhesive Capsulitis (Frozen Shoulder) - Types (2) and ROM

Answer 21

Joint capsule thickening. Arthrofibrosis.
Idiopathic: spontaneous, >35 y. women.
Secondary: after surgery, immobilization, prolonged inflammation of tendon.
Decreased active and passive ROM: ER > ABD > FLEX > IR.

Question 22

Special Tests - External Subacromial Impingement (5)

Answer 22

Jobe: positive
Neer: poitive anterior
Hawkins: positive
Apprehension: positive anterior
Relocation:
- positive if pain disappears -> secondary impingement.
- Negative if pain stays -> primary impingement.

Question 23

Internal Posterosuperior Glenoid Impingement - Special Tests (5)

Answer 23

Jobe: negative
Neer: positive posterior pain
Hawkins: negative
Apprehension: positive posterior
Relocation: positive if pain eases -> secondary impingement

Question 24

Rotator Cuff Pathology - Special test (1)

Answer 24

Full can test: positive
Primary or secondary impingement

Question 25

Scapular Dyskinesis - Special Tests (2)

Answer 25

Secondary impingement.
Scapula assisted test (SAT): positive
Scapula retraction test (SRT): positive

Question 26

Instability - Special Tests (3)

Answer 26

Secondary impingement
Anterior instability: load+shift test
Posterior instability: post. laxity test
Inferior instability: sulcus sign

Question 27

Biceps SLAP Pathology - Special Tests (3)

Answer 27

O’Brians: positive
Speed’s: positive
Biceps’s load II: positive