Conditions of the Shoulder

Question 1

What are the two classifications of shoulder injury?

Answer 1

• articular: extra- or intra-articular
• stabilizer: joint stability (static; via the glenohumeral ligaments) and joint control (dynamic; via rotator cuff muscles)

Question 2

What is impingement syndrome? How do patients present? What clinical test should be performed?

Answer 2

• when the subacromial bursa and supraspinatus tendon become compressed between the humeral head, acromion, and coraco-acromial ligament
• pain with forward elevation of arm
• Hawkins-Kennedy test (high sensitivity, low specificity; so a negative test makes impingement unlikely)

Question 3

Which patients experience anterior shoulder instability? Which clinical test should be performed?

Answer 3

• common in swimmers and pitchers

- apprehension test AKA anterior-release test (high sensitivity, good specificity)

Question 4

Which clinical test should be performed when suspecting a rotator cuff tear?

Answer 4

• empty-can test (very low sensitivity, 100% specificity; so positive tests are essentially diagnostic, but uncommon)
• drop arm test (very low sensitivity, 100% predictive value; so inability to perform the test highly suggests a tear, but the patient may still be able to perform the test normally)

Question 5

What are the normal ranges of motion of the shoulder?

Answer 5

• internal rotation: 70 degrees
• external rotation: 60 degrees
• flexion: 180 degrees
• extension: 60 degrees
• abduction: 180 degrees
• adduction: 30 degrees

Question 6

Scapulohumeral Rhythm

Answer 6

• during flexion or abduction, the 1st 120 degrees are glenohumeral and the final 60 degrees are scapulothoracic (this is when you’ll see an upward rotation/tilt in the scapula)

Question 7

What is the mechanism for sternoclavicular injuries? Acromioclavicular injuries?

Answer 7

• sternoclavicular: direct contact

- acromioclavicular: direct trauma to tip of elbow, top of shoulder, clavicle, or FOOSH (fall on outstretched hand)

Question 8

What is the main mechanism for glenohumeral sprains? Glenohumeral dislocations?

Answer 8

• sprains: forceful abduction and rotation

- dislocations: direct trauma via FOOSH (laxity; better prognosis) and indirect trauma (instability; poorer prognosis)

Question 9

What are the three types of glenohumeral dislocations? Which is the most common?

Answer 9

• anterior glenohumeral (most common); Bankart lesion, Hills-Sachs lesion
• posterior glenohumeral; reverse Hills-Sachs lesion
• inferior glenohumeral (very uncommon)

Question 10

What is the main mechanism for proximal or shaft fracture of humerus? For epiphyseal humerus fractures?

Answer 10

• proximal or shaft: direct blow or FOOSH

- epiphyseal: direct blow or indirect loading (this fracture is common in young athletes)

Question 11

What causes a biceps rupture? How will the patient present?

Answer 11

• results from a powerful biceps contraction; usually occurs at origin of muscle at bicipital groove
• patient will hear a snap followed by intense pain; protruding “popeye” bulge in upper arm; extreme weakness with elbow flexion and supination

Question 12

A painful abduction/flexion arc from 70 degrees to 120 degrees indicated what condition?

Answer 12

• a rotator cuff impingement

Question 13

Which rotator cuff tendon is most likely to be involved in rotator cuff tendinopathy?

Answer 13

• the supraspinatus muscle’s tendon

Question 14

What is “frozen shoulder”?

Answer 14

• a contracted and thickened joint capsule with little synovial fluid leading to pain in all directions with both active and passive movement