S H O U L D E R

Question 1

what are the rotator cuff muscles of the shoulder

Answer 1

SITS

1. supraspinatous
2. infraspinatous
3. teres minor
4. subscapularis

Question 2

what is adhesive capsulitis

Answer 2

as ‘frozen shoulder’, adhesive capsulitis refers to contraction of the glenohumeral joint capsule to the humeral head, resulting in decreased range of movement and pain.

Question 3

presentation of adhesive capsulitis in 3 stages

Answer 3

Freezing and painful
Frozen and stiff
Thawing (improving ROM)

Question 4

lx and management of adhesive capsulitis

Answer 4

XR, MRI (gold standard). However, diagnosis is usually a clinical one

Management:
Conservative – NSAIDS, PT
Medical – steroid injections
Surgical – operative MUA, arthroscopy

Question 5

what is subacrominal impingement syndrome syndrome

Answer 5

Constellation of a range of conditions, such as calcific tendonitis, subacromial bursitis and rotator cuff tendonitis
Most common shoulder pathology

Question 6

presentation SAIS

Answer 6

progressive pain, worsened by overhead activities.

Question 7

Lx in sais

Answer 7

MRI- gold , xr Again however, diagnosis may be clinical alone. Hawkins and Neer tests can be done to assess

Question 8

testing clinically of rotator cuff muscles

Answer 8

Empty can test (SSp)
Gerber’s lift off (SSc)
External rotation against resistance (IS, TM)

Question 9

rotator cuff investigation and management

Answer 9

Investigations: XR to exclude fracture and then USS, MRI

Management:
Conservative
Arthroscopy if moderate tear
Open surgery if severe tear (but need to consider patient age, activity, MOI

Question 10

sequelae of rotator cuff tear

Answer 10

adhesive capsulitis

enlargement of tear

Question 11

shoulder dislocation is also known as, why prone to happening

Answer 11

glenohumeral dislocation

shoulder joint is highly mobile and therefore inherently less stable

Question 12

MOI of anterior shoulder dislocation

Answer 12

MOI is anterior force applied to the arm when shoulder is abducted and externally rotated

Question 13

presentation of shoulder dislocation

Answer 13

post-traumatic, asymmetry between joints, pain, reduced movement

Question 14

lx required in GH dislocation

Answer 14

Clinically assess the NV status of the limb
XR – ‘trauma series’ of AP, Y-scapula and axial views
USS can be utilised dynamically during reduction
MRI if other injuries suspected, e.g. labral tear

Question 15

describe glenohumeral dislocation anteriorly

Answer 15

Anterior dislocation.

The humeral head is dislocated in an anterior and inferior direction.

Question 16

posterior GH dislocation shows the

Answer 16

Posterior dislocation >

‘Lightbulb’ sign

Question 17

GH Dislocation management

Answer 17

A to E assessment in line with acute/trauma principles
Prompt reduction under conscious sedation with analgesia
MUA (manipulation under anasthesia) if failure of reduction in ED setting
Assess NV status post-reduction
The joint needs to be immobilised for 3 weeks in a sling
PT
Surgical management if complications or recurrence

Reduction > immobilisation > rehabilitation

Question 18

complications of GH dislocation

Answer 18

Bankhart lesion (leads to recurrence)
Hills-Sach defect (resulting in locking of joint)
Rotator cuff tear (older persons)
Greater/lesser tuberosity fracture (older persons)
Humeral neck fracture (high energy trauma)
Adhesive capsulitis
Nerve damage

Question 19

proximal humeral fracture rx factures

Answer 19

– high energy trauma in a young male, low energy fall in an elderly female

Question 20

proximal humeral fracture associated with

Answer 20

Associated with accompanying axillary nerve injury and dislocation

Anatomical fracture is rare but can be complicated by AVN

Question 21

lx and management of proximal humeral fracture

Answer 21

Investigations
XR
CT

Management
Polysling and progressive mobilisation if minimally displaced
Surgical – ORIF, IMN, hemiarthroplasty or total shoulder arthroplasty