Shoulder

Question 1

Two bursae associated with the shoulder

Answer 1

Subacromial bursa

Subascapular bursa

Question 2

Name for the shoulder joint

Answer 2

Glenohumeral joint

Question 3

Ligament round the shoulder joint

Answer 3

Capsular ligament

Question 4

What forms the rotator cuff?

Answer 4

The tendons of the SITS muscles

Question 5

Night pain and shoulder impingement?

Answer 5

Night pain not common

Question 6

When will shoulder impingement hurt?

Answer 6

Pain on movement
Painful arc
Hawkins test
PAINFUL CRECENDO NOT ASSOCIATED WITH SHOULDER IMPINGEMENT

Question 7

Differential diagnosis for shoulder impingement?

Answer 7

Shoulder impingement
Frozen shoulder
Shoulder instability

Question 8

Bigliani acromial grading

Answer 8

flat inferiorly
curved
​​parallel to the humeral head with concave undersurface
considered most common type 3
hooked
​​most anterior portion of the acromion has a hooked shape
associated with increased incidence of shoulder impingement
convex (upturned)
most recent classification of acromion process shape
the undersurface of the acromion is convex near the distal end 4
no convincing correlation between a type 4 acromion and impingement syndrome exists 4, 5

Question 9

OS acromiale

Answer 9

Unfused acceossory ossification centre

Question 10

Rotator cuff tear signs & symptoms

Answer 10

Night pain
Weakness
Muscle wasting

Question 11

Surgical ways of fixing shoulder problems

Answer 11

Cuff repair (feeding tendon through hole drilled in bone)
Suture anchor
Shoulder arthroplasty

Question 12

Injection you could give into the shoulder

-From GPPC lecture

Answer 12

Steroid

Medrone with lignocaine (medrone is a steroid)

Question 13

Which shoulder problem is more common in diabetics?

Answer 13

Frozen shoulder

Question 14

Which bones form the shoulder girldle?

Answer 14

The scapula, the acromopn and the humerus and the supporting muscles including the deltoid and the muscles of the rotator cuff

Question 15

Where do the supraspinatous, infraspinatous and teres minor attach to?

Answer 15

The greater tuberosity
Supraspinatous is responsible for initiating abduction
Infraspinatous and teres minor are external rotators

Question 16

What does the subscapularis do?

Answer 16

Internal rotation

Subscapularis attaches to the lesser tuberosity

Question 17

Shoulder condition with painful arc?

Answer 17

Shoulder impingement

Question 18

Which tendons of the rotator cuff are usually compressed in shoulder impingement?

Answer 18

Supraspinatous

Question 19

Where does pain of shoulder impingement typically radiate to?

Answer 19

The upper arm and deltoid

Pain may be felt under the lateral edge of the acromion

Question 20

Which test can be used to re-create the pain of shoulder impingment?

Answer 20

Hawkins-kennedy test

Question 21

Treatment for shoulder impingement

Answer 21

Treatment is conservative in the first instance with the majority of cases settling with NSAIDs, analgesics, physiotherapy and subacromial injection of steroid. Up to 3 subacromial injections may be required. Cases which do not improve with these interventions may benefit from subacromial decompression surgery to create more space for the tendon to pass through. This procedure can be done as an open procedure (through an incision large enough to visualise the subacromial space) or with minimally invasive arthroscopic techniques (when small instruments and a keyhole camera are inserted into the subacromial space to perform the surgery) .

Question 22

The tendons of which muscle are usually involved in a rotator cuff tear?

Answer 22

Supraspinatous

Large tears can extend into the infrapinatous and subscapularis

Question 23

How do you confirm a rotator cuff tear?

Answer 23

Ultrasound or MRI

Question 24

What does supraspinatous do?

Answer 24

Initiation of abduction

Question 25

What does subscapularis do?

Answer 25

Internal rotation

Question 26

What does infraspinatous do?

Answer 26

External rotation

Question 27

Treatment for rotator cuff tear

Answer 27

Surgery: Rotator cuff repair (open or arthroscopic) with subacromial decompression can be performed in an attempt to improve/maintain strength and to prevent subsequent arthritis from chronic cuff deficiency. However, the tendon is usually diseased and failure of repair occurs in around a third of cases. Very large tears may be irrepairable and the tendon may be retracted too far. Non-operative: Many patients do well with physiotherapy to strengthen up the remaining cuff muscles which can compensate for the loss of supraspinatus. Subacromial injection may help symptoms.

Question 28

Frozen shoulder

Answer 28

Progressive pain and stiffness of the shoulder in patients aged 40-60, resolving in 18-24 months

Question 29

Principal clinical sign of frozen shoulder

Answer 29

Loss of external rotation

Question 30

Which conditions are associated with frozen shoulder?

Answer 30

Diabetes Hypercholesterolemia Dupuytrens disease (similar thickened tissue is found histologically) The capsule and the glenohumeral ligaments become inflamed and then thicken and contract

Question 31

Which type of injection could you give in frozen shoulder?

Answer 31

Glenohumeral (glenohumeral rather than subacromial)

Question 32

The 2 worst shoulder pains (says internet)

Answer 32

Calcific tendonitis | Frozen shoulder

Question 33

Bankart operation

Answer 33

Can be used if recurrent shoulder dislocations | Re-attaches labrum and capsule to the anterior glenoid, which is where they were torn during the first dislocation

Question 34

Conditions which cause ligamentous laxity?

Answer 34

Idiopathic Marfans Ehlers-Danlos Treatment is difficult as soft tissue procedures may not work

Question 35

What is the principal clinical sign of frozen shoulder?

Answer 35

Loss of external rotation | -Loss of external rotation also occurs in OA but patients affect tend to be elderly/older

Question 36

What can cause a mucous cyst in your fingers?

Answer 36

Osteoarthritis

Question 37

What injection may help to ease pain quickly in OA?

Answer 37

Steroid injection

Question 38

Mucous cyst

Answer 38

``` outpouching of synovial fluid from DIPjt OA typical appearance may be painful may fluctuate/discharge may deform nail, cause ridge ``` Management: you can leave them alone excision

Question 39

What type of joint is the thumb joint?

Answer 39

Saddle joint = moves in two planes

Question 40

Which are the most common joints affected in OA?

Answer 40

1st most common: PIP/DIP 2nd most common: thumb CMP SCAPHO-TRAPEZIAL-TRAPEZOID JOINT (STT)

Question 41

Base of thumb OA

Answer 41

2nd most common joint for OA thumb CMCjt is at 90˚ to hand saddle joint, so moves in 2 planes remember scapho-trapezial-trapezoid joint (STT) often asymptomatic pain at base of thumb prevents pinch, grasp, sleep ``` Mx rest, splint, NSAIDs steroid injection surgery trapeziectomy (+/- tendon interposition) ```

Question 42

How will base of thumb OA present?

Answer 42

Often asymptomatic Pain at base of thumb Prevents pinch, grasp, sleep

Question 43

Treatment for base of thumb OA

Answer 43

Rest, splint NSAIDs, Steroid injection Surgery: trapeziectomy (+/- tendon interposition)

Question 44

What is a ganglion?

Answer 44

Outpouching of synovial cavity | -usually painless but may feel tight

Question 45

Rheumatoid arthritis

Answer 45

Auto-immune inflammatory joint disease Results in ligament thinning + weakness -capsules become lax, joints unstable MCP joints dislocate, ulnar deviation Swan-neck + Boutonniere deformity at PIP/DIP joints

Question 46

Ligaments and joints in rheumatoid arthritis

Answer 46

Ligaments become thin and weak | Capsules become lax and joints unstable

Question 47

Which hand deformities are found in rheumatoid arthritis?

Answer 47

Boutonniere and swan neck | heberdens and bouchards are found in OA