Shoulder

Question 1

The shoulder region possesses less mechanical _____ and less bony _____ than any other large joint in body

Answer 1

protection

stability

Question 2

What 2 radiographic views are recommended as an initial study for all trauma cases to the shoulder?

Answer 2

• AP

- Axillary or scapular Y

Question 3

When is an MRI of the shoulder recommended?

Answer 3

For acute and subacute shoulder pain if the initial radiograph is normal, or RC pathology, instability, or labral tears are suspected

Question 4

When is a CT of the shoulder recommended?

Answer 4

When the MRI is unavailable or contraindicated

Question 5

The 4 tendons of the RC muscles fuse to form what?

Answer 5

The fibrous capsule of the GH joint

Question 6

RC tears may result for what 3 MOIs?

Answer 6

• GH dislocation
• Fall on outstretched hand
• Forceful abduction of arm

Question 7

What is a non-traumatic MOI for a RC tear?

Answer 7

Progressive tendon irritation caused by repetitive overhead movements or impingement

Question 8

Where does the most common RC tear occur?

Answer 8

In the hypovascular critical zone of the supraspinatus tendon 1 cm above its insertion on greater tuberosity

Question 9

How are complete RC tears diagnosed via radiographs (arthrography)?

Answer 9

A complete RC tear will allow the contrast medium to travel up through the tear and fill the subacromial-subdeltoid bursa, this causes the bursa to be radiopaque

Question 10

How are incomplete RC tears diagnosed via radiographs (arthrography)?

Answer 10

There is a collection of contrast medium at the tear site

Question 11

When is an arthrography recommened in the diagnosis of a RC tear?

Answer 11

Only when the patient cannot have MRI and ultrasound expertise is not available

Question 12

What are the 3 secondary changes in chronic RC tears that are evident on radiographs?

Answer 12

1) Irregularity of the greater tuberosity
2) Narrowing of the distance between the acromion and humeral head
3) Erosion of the inferior aspect of the acromion

Question 13

How may the greater tuberosity appear in chronic RC tears? Why?

Answer 13

Flattened, atrophied, or sclerotic because of the rupture of the supraspinatus tendon and lack of traction stress at insertion site.

Question 14

What are the 2 reasons why there is a narrowing of the distance between the acromion and humeral head in chronic RC tears?

Answer 14

• There is atrophy of the cuff muscles

- The weak RC muscles do not oppose the pull of the deltoid muscle

Question 15

In chronic RC tears the humeral head migrates ____.

Answer 15

superiorly

Question 16

The upward migration of the humeral head may cause changes to what bony structure?

Answer 16

The acromion

Question 17

What are most complications following a RC tear due to?

Answer 17

Degenerative changes at the GH and AC joints

Question 18

Failure to regain full ROM and strength following RC repair surgery can lead to what?

Answer 18

• Impaired scapulohumeral rhythm
• Chronic tendon irritation and inflammation
• Poor function

Question 19

A “SICK” scapula may develop following RC tear, what does this stand for?

Answer 19

S = Scapular malposition
I = Inferior medial border prominence
C = Coracoid pain and malposition
K = DysKinesis of the scapula

Question 20

Describe the positioning of a “SICK” shoulder

Answer 20

It sits inferior, lateral, and is upwardly rotated

Question 21

A “SICK” scapula represents with pain in what 4 distributions?

Answer 21

• Postero-superior scapular pain
• Anterior shoulder pain
• Proximal lateral arm pain
• C-spine pain

Question 22

What are the 3 types of scapular dyskinesis?

Answer 22

• Type I: Inferior medial scapular prominence
• Type II: Medial scapular border prominence
• Type III: Superomedial border prominence

Question 23

Type I and type II scapular dyskinesias are associated with what?

Answer 23

SLAP lesions

Question 24

Type III scapular dyskinesia is associated with what?

Answer 24

impingement and rotator cuff lesions

Question 25

What are the 2 basic functions of the labrum?

Answer 25

- deepen the glenoid fossa so the humeral head stays in place - serve as attachment site for capsular ligaments and the biceps tendon

Question 26

What are the symptoms of a labral tear?

Answer 26

- pain that is worse with overhead movements - clicking or catching - sense of instability

Question 27

What are the 3 acute MOIs for a labral tear?

Answer 27

- dislocation - forceful lifting manuever - fall on an outstretched hand

Question 28

What can also injure the labrum?

Answer 28

Repetitive movements of the arm, especially in overhead athletes

Question 29

What aspects of the labrum are susceptible to injury in overhead athletes?

Answer 29

Biceps tendon stress at the superior labral attachement as well as repetitive impingement of the posterior humeral head against the rotator cuff and labrum

Question 30

The action of throwing overhand includes high velocity abduction and ER rotation during the cocking phase, which ligaments are twisted and elongated?

Answer 30

The middle GH ligament and anterior band of the inferior GH ligament

Question 31

The active motion produce during the cocking phase of throwing tends to translate the humeral head _____, toward what structures?

Answer 31

anteriorly, toward the anterior glenoid labrum and the subscapularis muscle

Question 32

Other than overhead throwing, what may be cause abnormal shear forces at labrum?

Answer 32

Muscle imbalances that decentralize the position of the humeral head within the glenoid fossa which can trigger a cascade of abnormal shoulder biomechanics

Question 33

What is the most appropriate procedure to assess suspected instability and labral tears?

Answer 33

An MR anthrography

Question 34

What is an advantage of MR anthrology in detecting labral pathologies?

Answer 34

The contrast medium distends the joint permitting better visualization

Question 35

What is the second procedure of choice when assessing suspected instability and labral tears?

Answer 35

CT arthrography

Question 36

How are labral tears treated?

Answer 36

Conservatively, due to the rich blood supply to the labrum

Question 37

What are 3 surgical interventions for labral tears?

Answer 37

- Avulsions are reattached to glenoid rim with sutures and anchors - Torn edges of minor tears debrided, whereas.large tears require suture repair - Biceps tenodesis surgery

Question 38

When are biceps tenodesis performed

Answer 38

In patients with labral tears over the age of 40

Question 39

Describe the procedure behind a biceps tenodesis

Answer 39

The biceps is cut from where it attaches to labrum and reinserted into another area on the labrum

Question 40

How long can overhead athletes with SLAP repairs expect to be out?

Answer 40

6 months