Disorders Of The Shoulder

Question 1

What type of shoulder dislocation is most common?

Answer 1

Anterior

Question 2

Presentation on shoulder dislocation

Answer 2

Squaring of shoulder

Question 3

What does a posterior shoulder dislocation look like on an x ray?
Why?

Answer 3

Light bulb sign
Humerus is internally rotated

Question 4

What happens to the humerus in a posterior shoulder dislocation?

Answer 4

Internal rotation

Question 5

Cause of posterior shoulder dislocation

Answer 5

Seizure
Electrocution

‘Electrical reasons - light bulb sign’

Question 6

Where are clavicle fractures mainly located?

Answer 6

Middle third

Question 7

Treatment of clavicle fracture

Answer 7

Plates + screws

Question 8

When is treatment of clavicle fracture needed?

Answer 8

If nerve of muscles are compromised

Question 9

What is the most common rotator cuff tear?

Answer 9

Supraspinous

Question 10

List the rotator cuffs

Answer 10

SITS
Supraspinatus
Infraspinatus
Teres minor
Subscapularis

Question 11

What nerve is most at risk of damaged during anteriorshoulder dislocation?

Answer 11

Axillary nerve

Question 12

Why is anterior shoulder dislocation more common than posterior?

Answer 12

Pull of muscles pull humeral head anteriorly

Question 13

What blood supply is most at risk of damage in shoulder dislocation?

Answer 13

Suprascapular artery and vein

Question 14

Action of supraspinatus

Answer 14

ABduction - first 15°

Question 15

Innervation of supraspinatus

Answer 15

Suprascapular nerve C5-6

Question 16

Action of infraspinatus

Answer 16

External rotation

Question 17

Innervation of infraspinatus

Answer 17

Suprascapular nerve C5-6

Question 18

Action of teres minor

Answer 18

External rotation
ABduction

Question 19

Innervation of teres minor

Answer 19

Axillary nerve C5-6

Question 20

Action of subscapularis

Answer 20

Internal rotation
ADduction

Question 21

Innervation of subscapualris

Answer 21

Nerve to subscapularis C5-6

Question 22

What position would the arm be in if the suprascapular nerve was damaged?

Answer 22

ADucted
Internally rotated

Innervation of infrascapular + supraspinatus

Question 23

Nerve rots of Suprascapular nerve

Answer 23

C5-6

Question 24

Nerve root of axillary nerve

Answer 24

C5-6

Question 25

Causes of impingement syndrome

Answer 25

Tendinitis Bursitis Osteophytes

Question 26

Presentation of impingement syndrome

Answer 26

Painful arc Painful during shoulder ABduction

Question 27

What is impingement syndrome?

Answer 27

Compression of rotator cuff in subacrominal space

Question 28

What happens in calcified supraspinatus tendinopathy?

Answer 28

Calcium deposits in tendon

Question 29

Common age range for calcified supraspinatus tendiopathy

Answer 29

20-40 year olds

Question 30

Risk factor for calcified supraspinatus tendionopathy

Answer 30

Diabetics

Question 31

What is seen on an x ray of a patient with osteoarthritis?

Answer 31

**LOSS** **L**oss of joint space **O**steophytes **S**ubarticular sclerosis **S**ubcondral cysts

Question 32

Risk factors of osteoarthritis

Answer 32

Age Female > male Obesity Trauma to joint > secondary OA

Question 33

What causes primary osteoarthritis?

Answer 33

Wear and tear

Question 34

What causes secondary osteoarthritis?

Answer 34

Trauma to joint > predisposes to OA

Question 35

Treatment of osteoarthritis

Answer 35

NSAIDs Weight loss Physiotherapy Surgery

Question 36

Surgical treatment of severe osteoarthritis in shoulder

Answer 36

Hemiarthroplasty Reverse total shoulder replacement

Question 37

What is a hemiarthroplasty?

Answer 37

Half joint replacement

Question 38

What happens in a reverse total shoulder replacement?

Answer 38

Ball + socket swapped positions

Question 39

What is adhesive capulitis?

Answer 39

Frozen shoulder Shoulder capsule thickens > stiff + tight Less synovial fluid

Question 40

How long does freezing take in adhesive capulitis?

Answer 40

6-9 weeks

Question 41

How long does frozen last for in adhesive capulitis?

Answer 41

4-6 months

Question 42

How long does thawing take in adhesive capulitis?

Answer 42

6 months - 2 years

Question 43

Where is pain located in adhesive capulitis

Answer 43

In all movements

Question 44

Risk factors for adhesive capulitis

Answer 44

Diabetes Hypo/hyperthyroidism Female>male

Question 45

Location of the supraspinatus muscle

Answer 45

Superior to the spine of the scapula

Question 46

Location of the infraspinatus muscle

Answer 46

Inferior to the spine of the scapula Posteriorly

Question 47

Location of the teres minor muscle

Answer 47

Inferior to scapula + infraspinatus

Question 48

Location of supscaularis muscle

Answer 48

Anterior surface of scapula

Question 49

Why does a scapula fracture often not need fixation?

Answer 49

Surrounding muscles hold in place whilst healing occurs

Question 50

What would damage to the axillary nerve cause?

Answer 50

- paralysis of deltoid + teres minor - difficulty performing ABduction <90° - sensation lost in regimental badge area

Question 51

Presentation of biceps tendon rupture

Answer 51

- >50 year olds - hearing a snap - elbow flexion produces a firm lump | due to unopposed contraction of biceps *popeye sign*

Question 52

Why is there not a significant loss of weakness in biceps tendon rupture?

Answer 52

Action of brachialis + Supinators still intact

Question 53

Causes of axillary lymphadenopathy

Answer 53

- Infection of upper limb, pectoral region or breast - leukaemia - lymphoma - metastases

Question 54

Risks associated with axillary lymph node dissection

Answer 54

- interruption of lymphatic drainage > **lymphoedema** - damag to long thoracic nerve > **winged scapula** - damage to thoracodorsal nerve

Question 55

What is winged scapula due to?

Answer 55

- Long thoracic nerve damage - loss of innervation to serratus anterior - medial border of scapula not held against chest wall

Question 56

Causes of winged scapula

Answer 56

- blunt trauma to neck or shoulder - surgical trauma during mastectomy + axillary lymph node clearance