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OSCE > Shoulder > Flashcards

Shoulder Flashcards

1
Q

Internal rotation of arm

A

Posterior shoulder dislocation

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2
Q

Serratus anterior pathology

A

Ask patient to push against wall

Scapular winging

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3
Q

jobes test is testing for

A

Supraspinatus

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4
Q

Jobe’s test

A

Patient internally rotates arm whilst in 45 degree abduction and 30 degree forward flexion with an extended elbow
Attempts to further abduct against resistance on the elbow results in pain

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5
Q

Belly-press test and Gerber’s test

A

Test for subscapularis

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6
Q

Belly press test

A

Patient presses on their abdomen

Positive if elbow drops posteriorly as there is pain on internal rotation of the shoulder

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7
Q

Gerber’s test

A

Patient holds hand behind their back with palm facing outwards
Push on patient’s hand while they resist movement
Positive if unable to lift hand away from back

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8
Q

Infrasponatus and Teres minor

A

Flex elbow to 90 degrees and externally rotate against resistance

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9
Q

Rotator cuff tear

A

Drop arm sign

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10
Q

Rotator cuff tear movement

A

Patient lowers arm slowly from 160 degree abduction

Positive if patient can’t control the arm, and it drops quickly to the side

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11
Q

Treatment of rotator cuff tear

A

Analgesia and physio

Tears may need surgical repair

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12
Q

Winging

A

Long thoracic nerve

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13
Q

Pain on 0-20 of abduction

A

Full thickness tear (rupture) of the supraspinatus tendon 0-20

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14
Q

Pain on 20-40 abduction

A

Auxiliary nerve damage

Deltoid not working

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15
Q

Pain on abduction 40-60

A

Adhesive capsulitis

Frozen shoulder

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16
Q

Pain on 60-120 abduction arc

A

Subacromial painful arc

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17
Q

Pain on 120-180 abduction

A

Acromioclavicular painful arc

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18
Q

Painful arc test

A

60-120 abduction

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19
Q

Painful arc test results

A

Pain exacerbated by thumb pointing down (empty can sign)

Pain better with thumb pointing up (full can)

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20
Q

Painful arc between 160-180

A

Acromioclavicular joint pathology e.g. OA

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21
Q

neer’s test

A

Passive flexion of the shoulder with a pronated arm, whilst scapula is stabilised

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22
Q

hawkin’s test

A

Shoulder and elbow both flexed to 90 degrees
Pain on passive internal rotation as the rotator cuff rubs on the undersurface of the acromion- external rotation may relieve pain

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23
Q

Treatment of subacromial impingement syndrome

A

Analgesia
Physio
Steroid injection
Surgery (arthroscopic acromioplasty) if this fails

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24
Q

Biceps tendinopathy

A

Speeds test

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25
Q

Speeds test

A

Ask patient to place arm out in front of them with elbow flexed at 30 degrees and palm facing up
Push down on patients palm while they resist movement
Positive if pain felt at bicipital groove

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26
Q

treatment of biceps tendinopathy

A

Analgesia (+/- steroid injection but risks tendon repture)

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27
Q

Acromioclavicular joint pathology

A

Scarf test

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28
Q

Scarf test

A

Ask patient to place hand over opposite shoulder as if putting on a scarf
Push lightly at the elbow to force abduction
Positive if pain at ACJ

29
Q

Shoulder stability

A

Crank shoulder apprehension test
Patient holds their hand out like they’re giving a high-five
Then pull back elbow and push proximal humerus forward

30
Q

Function for shoulder

A

Combing their hair

Put on jacket

31
Q

Adhesive capsulitis (frozen shoulder) symptoms

A

Reduced active + passive ROM in all directions +/- pain in painful phase

32
Q

Treatment of adhesive capsulitis

A

Analgesia and physio (if tolerated)

Surgery (manipulation under GA or open/arthroscopic release of adhesions)

33
Q

OA of shoulder history

A

Often secondary to chronic shoulder instability or chronic rotator cuff tear

34
Q

Treatment of OA

A

Analgesia and physio +/- steroid injection +/- surgery

35
Q

proximal biceps rupture

A

Rupture of long head tendon

36
Q

Proximal biceps rupture history

A

Discomfort after something has ‘gone’ when lifting or pulling

37
Q

Proximal biceps rupture example

A

‘Ball’ appears in the muscle on elbow flexion like a ‘popeye’ muscle

38
Q

Proximal biceps rupture treatment

A

repair rarely indicated as function remains

However if tendon insertion is ruptured surgical repair will be needed

39
Q

Distal biceps rupture

A

Rupture of biceps muscle

40
Q

Distal biceps rupture history

A

Men involved in heavy lifting

Sometimes ‘tearing’ or ‘popping’ and pain in antecubital fossa with bruising over medial forearm

41
Q

Distal biceps rupture treatment

A

Needs urgent surgical repair

42
Q

Poly myalgia rheumatica

A

Pain in shoulders but no weakness, examination of shoulders normal
May be associated with mild polyarthritis, tenosynovitis and carpal tunnel syndrome

43
Q

Poly myalgia rheumatica treatment

A

Prednisolone 15mg/d PO

44
Q

Anterior (glenohumeral) shoulder dislocation history

A

Usually contact sports with arm forced into abduction, extension, and external rotation

45
Q

Anterior shoulder dislocation exam

A

Loss of shoulder contour

Anterior bulge from head of humerous

46
Q

Anterior shoulder dislocation investigations

47
Q

Anterior shoulder dislocation treatment

A

Simple reduction

48
Q

Acromioclavicular dislocation history

A

Typically direct blow on top of shoulder in young contact-sport athletes or a fall on outstretched hand

49
Q

Acromioclavicular dislocation exam findings

A

Tender prominence over ACJ

Pain on abduction of arm across body

50
Q

Acromioclavicular investigations

51
Q

Acromioclavicular dislocation treatment

A

Broad arm sling if minimal displacement

Open reduction and ligament reconstruction for more severe disruption

52
Q

Clavicle fracture history

A

Direct blow on top of shoulder (common in cyclists) or a fall on outstretched hand

53
Q

Clavicle fracture treatment

A

Broad arm sling with follow-up on XR at 6 weeks

54
Q

Inflammatory arthritis history

A

Pain and stiffness in the morning alleviated by movement

Systemic features

55
Q

Inflammatory arthritis investigations

A

Bloods for inflammatory and autoimmune markers +/- XR

56
Q

Crystal arthropathy history

A

Acute, extremely painful

57
Q

Gout presentation

A 
Elderly
Male or post-menopausal female
HTN
CKD
Diuretics (spironolactione, furosemide, thiazides)
Diet (alcohol, red meat)
Myelo/lymphoproliferative disorders
58
Q

CPPD presentation

A 
Elderly
Haemochromatosis
Wilson’s disease
Acromegaly
Hyper parathyroid is
Hypophosphataemia
Hypomagnesaemia
59
Q

Gout exam

A

Monoarthritis
>50% in 1st MTP
Also ankle, foot, hand, wrist, elbow, knee (rare in shoulder)
May be tophi found

60
Q

CPPD exam

A

Acute monoarthritis
RA-like polyarthritis
or chronic OA with CPPD flares
Knee, wrist and shoulder most commonly affected

61
Q

Crystal arthropathy investigations - bloods

A

Serum urate

62
Q

Crystal arthropathy investigations - Joint aspirate

A

To exclude septic arthritis
In gout- negatively birefringent needle-shaped urate crystals
In CPPD- weakly positively birefringent rhomboid-shaped crystals

63
Q

Crystal arthropathy investigations - XR

A

Gout- soft tissue swelling, then later ‘punched-out’ erosions
CPPD- soft tissue calcium deposition and chondrocalcinosis

64
Q

Management of gout

A

High-dose NSAID/colchicine and rest for acute attack

Allopurinol for prevention

65
Q

Management of CPPD

A

Rest and cool packs for acute attack

NSAIDs + colchicine for prevention

66
Q

Septic arthritis history and exam

A

Extremely painful, hot, swollen joint of acute onset

Systemic upset

67
Q

Septic arthritis investigation

A

Joint aspirate to decompress the joint and send off for Gram stain, MC+s, cytology and polarised light microscopy

68
Q

Septic arthritis treatment

A

6-12 weeks antibiotics depending on sensitivities

Start flucloxacillin empirically if in doubt

69
Q

Referred pain to shoulder

A

Neck pathology
Cardiac ischaemia (L arm)
Pancoast tumour
Intra-abdominal pathology touching diaphragm (C3-5 referral)

OSCE (15 decks)

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