Shoulder

Question 1

Where is the most common site of clavicular fractures?

Answer 1

Middle 3rd of clavicle

Question 2

What happens to arm position in a mid-clavicular fracture?

Answer 2

Medial segment elevated (sternocleiodomastoid muscle)
Shoulder drops (trapezius muscle unable to hold lateral segment up)
Arm pulled medially (pect major)

Question 3

What nerves can be damaged in a mid-clavicular fracture?

Answer 3

Suprascapular

Subraclavicular (C3&4)

Question 4

What is a rotator cuff tear?

Answer 4

Tear to one or more of the tendons of the 4 rotator cuff muscles of the shoulder

Impairs; abducting, internally and externally rotating the humerus

Question 5

What causes rotator cuff tears?

Answer 5

Mainly chronic - extended use with other factors

Degenerative micro-trauma model
Age related

Question 6

What is the most common presentation of rotator cuff muscle tears?

Answer 6

Anterolateral shoulder pain radiating down the arm

Weakness of shoulder abduction and movement above horizontal plane

Question 7

What is impingement syndrome?

Answer 7

When supraspinatus tendon impinges on the catacombs-acromial arch leading to irritation and inflammation.

Worsened when shoulder is flexed or abducted resulting in a in weakness and reduced range of motion

Question 8

What causes impingement syndrome?

Answer 8

Anything that narrows the space

Thickening of carococromial ligament
Inflammation of supraspinous tendon
Subcritical osteophytes

Question 9

What is the painful arc?

Answer 9

Caused by impingement syndrome of supraspinatus tendon

During abduction of shoulder between 60 and 120 degrees

Question 10

What is calcified supraspinatus tendinopathy?

Answer 10

Macroscopic deposits of hydroxyapatite in the tendon (mainly supraspinatus)

Question 11

How does supraspinatus tendinopathy present?

Answer 11

Chronic pain aggravated by abducting or flexing arm above shoulder

Mechanical symptoms; snapping/ catching

Question 12

How does calcific tendopathy develop?

Answer 12

Local hypoxia

Tenocytes to chondrocytes that lay down cartilage
Ca deposits formed

Ectopic bone formation

Question 13

What is the most common joint of OA in the shoulder?

Answer 13

Acromioclavicular

Question 14

What is another name for adhesive capsulitis?

Answer 14

Frozen shoulder

Question 15

What is adhesive capsulitis?

Answer 15

Capsule of glenohumeral joint becomes inflamed and stiff greatly restricting movement and causing chronic pain

Question 16

What type of pain is present with adhesive capsulitis?

Answer 16

Constant that is worse at night, with movement and cold weather

Question 17

What are risk factors of adhesive capsulitis?

Answer 17

Female
Diabetes mellitus
Trauma to shoulder
Connective tissue disorders

Question 18

What is the most common direction for a shoulder dislocation?

Answer 18

Anterior

Dislocates anterioinferioly (due to weak inferior aspect)
Pulled anteriorly due to ligament disruption and muscle pull

Question 19

How do anterior shoulder dislocations occour?

Answer 19

Arm abducted and externally rotated and arm forced posteriorly
Direct blown to posterior

Question 20

What is a Bankart lesion/ labra tear?

Answer 20

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

Question 21

What is a Hill-Sachs lesion?

Answer 21

Indentation fracture in the posterolateral humeral head

Caused by the humeral head dislocating anteriorly and the posterior aspect becoming jammed on anterior lip of glenoid fossa

Question 22

What position is the arm held in with an anterior shoulder dislocation?

Answer 22

External rotation

Abduction

Question 23

What position is the arm in with a posterior shoulder dislocation?

Answer 23

Internally rotated
Adducted

Prominent caracoid process

Question 24

What mechanisms cause posterior shoulder dislocations?

Answer 24

Violent muscle contractions (epilepsy/ lightening strike)
Blow to anterior shoulder
Arm flexed across body and pushed posteriorly

Question 25

What mechanism causes inferior shoulder dislocations?

Answer 25

Forceful traction of arm when fully extended over head

Question 26

What is the most common nerve damaged in a shoulder dislocation and why?

Answer 26

Axillary nerve

As it wraps around neck of humerus