Shoulder

Question 1

Physical exam signs of bicep tendon tear

Answer 1

• Popeye sign: bulge in lower arm at rest
• Tenderness in bicipital groove
• Luddington test: patient contracts both biceps, provider palpates for lack of contraction

Question 2

Physical exam signs of rotator cuff tendinopathy

Answer 2

• Subacromial tenderness
• Decreased active ROM (passive ROM ok)

Question 3

What condition is associated with gradual onset superior/lateral shoulder pain, especially while laying on the affected side as well as pain with overhead/arm-length activities with no history of a traumatic event

Answer 3

Rotator cuff tendinopathy

Question 4

SLAP lesion treatment

Answer 4

Surgical debridement
- injury more common in younger athletes, do need surgery to get back

(Non-surgical usually unsuccessful)

Question 5

Most common risk factor for frozen shoulder (adhesive capsulitis)

Answer 5

Diabetes

Question 6

Nerve most likely to be compromised in a humeral shaft fracture and how to assess for it

Answer 6

Radial nerve
- check ability to extend wrist or fingers
- check sensation over dorsum of hand

Question 7

Two primary groups who get proximal humerus fractures

Answer 7

Young and the elderly

Question 8

Joints to assess for injury after diagnosing a humeral fracture

Answer 8

Shoulder and elbow

Question 9

Name of fracture of posterior humeral head, associated with shoulder instability

Answer 9

Hill-Sachs

Question 10

Rotator cuff muscle most commonly affected by tendinopathy

Answer 10

Supraspinatus

Question 11

Humeral shaft fracture treatment

Answer 11

Most are non-surgical

Question 12

Two tests for bicep tendinopathy and SLAP lesion

Answer 12

• Speed’s test
• Yergason’s test

Question 13

Bicep tendon ruptures are more common in this gender and age

Answer 13

Men aged 40-60

Question 14

Describe thoracic outlet syndrome

Answer 14

• Nerves and vessels impinged by scalenes against first rib
• Brachial plexus, axillary artery, and subclavian vein pass through there
• Can be from whiplash injury or extra muscles

Question 15

Thoracic outlet syndrome treatment

Answer 15

• PT
• Weight loss
• Decompression

Question 16

Most common types of shoulder instability

Answer 16

• Anterior (injury)
• MDI (condition)

Question 17

Name of lesion seen on shoulder x-rays as a bony defect at edge of glenoid rim, associated with shoulder instability

Answer 17

Bankart lesion

Question 18

A patient with a history of shoulder trauma/throwing presents with a feeling of the shoulder “slipping out” when arm is abducted and externally rotated (apprehension test). What do they likely have?

Answer 18

Anterior shoulder instability

(MDI not associated with trauma)

Question 19

Symptoms of SLAP lesions

Answer 19

• Pain with overhead activities (most common)
• Popping, clicking, catching in shoulder

Question 20

What is a SLAP lesion?

Answer 20

Labral tear

SLAP = Superior Labrum Anterior to Posterior

Biceps long head originates from the glenoid labrum

Question 21

Diagnosis of thoracic outlet syndrome

Answer 21

Diagnosis of exclusion

Question 22

Best imaging method for rotator cuff tendinopathy after x-ray has excluded osteoarthritis

Answer 22

MRI

Question 23

Most common ages for frozen shoulder (adhesive capsulitis)

Answer 23

40 to 60

Question 24

Treatment of shoulder instability

Answer 24

Acute dislocation
- Reduction asap
Repeat dislocations
- Surgery
MDI
- PT
- Avoid positions of known instability

Question 25

How to differentiate between rotator cuff tendinopathy and frozen shoulder (adhesive capsulitis)

Answer 25

Range of motion Rotator cuff: decreased AROM Frozen shoulder: decreased AROM *and PROM*

Question 26

How to differentiate anterior shoulder instability from frozen shoulder (adhesive capsulitis)

Answer 26

Onset - Anterior shoulder instability: acute - Frozen shoulder: gradual

Question 27

Treatment of frozen shoulder (adhesive capsulitis)

Answer 27

Conservative treatments best - NSAIDs only work early on - PT - Injections (no surgery)

Question 28

Which condition is associated with intense scarring, thickening, and contraction of shoulder ligaments leading to loss of active and passive ROM

Answer 28

Frozen shoulder (adhesive capsulitis)

Question 29

Symptoms of a bicep tendon rupture

Answer 29

- Sudden pain in anterior shoulder - May hear/feel a snap - Ball of muscle down by elbow (popeye sign)

Question 30

Treatment of choice for most patients with a bicep tendon rupture

Answer 30

Non-surgical best for *most* patients - PT for strength and ROM - Steroid injections Surgical repair for younger athletes, or laborers who needs strength (old people can live with it and more common in older men)

Question 31

SLAP lesion best imaging method

Answer 31

MRI

Question 32

How to differentiate between rotator cuff/shoulder osteoarthritis and SLAP lesions

Answer 32

Age - SLAP lesions <35 - Rotator cuff/osteoarthritis >35

Question 33

Three phases of frozen shoulder (adhesive capsulitis)

Answer 33

Freezing phase - 4 to 20 months - pain at deltoid insertion, night pain - decreased ROM, especially external rotation Frozen phase - 4 to 12 months - more stiffness, less pain Thawing phase - 5 to 24 months - gets better on its own, can recur

Question 34

Most common symptoms in thoracic outlet syndrome

Answer 34

Neurogenic symptoms in arm - Pain, dysesthesia, weakness, numbness (nerves easily irritated, take a long time to calm down)

Question 35

Which area of the clavicle is most commonly fractured?

Answer 35

Middle third (diaphysis)

Question 36

Are bicep tendon ruptures more commonly in the long or short head?

Answer 36

97% in the long head (rubs in bicipital groove of humerus over time)

Question 37

Four muscles of the rotator cuff

Answer 37

- Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

Question 38

How to differentiate clavicular fracture from AC joint separation?

Answer 38

- X-ray - Maybe crepitus in fracture

Question 39

A patient has superior shoulder pain after falling on their lateral shoulder. There is pain to palpation over the AC joint and they have decreased ROM. What condition might they have?

Answer 39

AC Joint separation (separated shoulder) (may need x-ray to differ from clavicular fracture)

Question 40

Imaging methods for bicep tendon ruptures

Answer 40

- MRI - Ultrasound good if complete tear

Question 41

Clavicle fracture treatment

Answer 41

Non-surgical - Figure of 8 brace - PT for ROM - Will heal but look deformed Surgical - for more active patients - or open fractures/n/v damage

Question 42

Are rotator cuff injuries more common in patients under or over the age of 40?

Answer 42

Over 40

Question 43

Are rotator cuff tears more commonly due to acute injury or degeneration?

Answer 43

More commonly degeneration from chronic impingement

Question 44

Best treatments for rotator cuff tendinopathy

Answer 44

- Avoidance of aggravating activities - PT

Question 45

Why can we only give a limited total number of glucocorticoid injections to any patient with joint pain?

Answer 45

Cortisone destroys collagen in the body and will degrade the joint