Shoulder

Question 1

What does Axillary pouch do

Answer 1

it supports the humeral head above 90 abduction, limiting inferior translation while anterior band tightens on lateral rotation and posterior band tightens on medial rotaion

Question 2

superior glenohumeral ligament

Answer 2

limiting inferior translation in adduction, restrains anterior translation and lateral rotation upto 35 degree abduction

Question 3

middle glenohumeral ligament

Answer 3

absent in 30 % of population, limits lateral rotation between 45-90%

Question 4

Excessive lateral rotation such as throwing may lead…

Answer 4

stretching of anterior portion of the ligament and capsule, increasing glenohumeral laxity

Question 5

coracohumeral ligament primarily limits

Answer 5

inferior translation helps limit lateral rotation below 60 degree abduction

Question 6

Which two tendons coracohumeral ligament unites

Answer 6

Supraspinatus and Subscapularis

Question 7

Rotator interval consists

Answer 7

coracohumeral ligament, superior glenohumeral ligament, glenohumeral joint capsule, part of the tendons of supraspinatus and subscapularis

Question 8

coracoacromio ligament limits

Answer 8

superior translation of glenohumeral joint

Question 9

paratenonitis

Answer 9

outer covering of the tendon whether or not it is lined with synovium.

Question 10

Tendinosis

Answer 10

actual degeneration of the tendon itself

Question 11

Primary ligaments of the Glenohumeral joint and which is important

Answer 11

Superior, middle and inferior Glenohumeral ligament

Inferior glenohumeral ligament is most important, has anterior and posterior band with thin axillary pouch in between.

Question 12

TUBS type instability

Answer 12

Traumatic onset, Unidirectional anterior with Bankart lesion responding to Surgery

Question 13

AMBRI type instability

Answer 13

Atraumatic cause, Multidirectional with Bilateral shoulder findings with Rehabilitation as appropriate treatment and rarely Inferior capsular ship surgery

Question 14

SICK scapula

Answer 14

malposition of Scapula prominence of Inferior medial border of scapula, Coracoid pain and malposition, and scapular dysKinesia

Question 15

step deformity

Answer 15

acromioclavicular dislocation with the distal end of the clavicle lying superior to the acromion process. Indicates acromioclavicular and coracoclavicular ligaments have been torn

Question 16

Fountain sign

Answer 16

welling anterior to acromioclavicular joint. indicating degeneration has caused communication between the acromioclavicular joint and swollen subacromial bursa underneath

Question 17

sulcus deformity

Answer 17

multidirectional instability or loss of muscle control due to nerve injury or a stroke, leading to inferior subluxation of the glenohumeral joint. This deformity is lateral to the acromion and should not be confused with a step deformity

Question 18

scapular dyskinesia

Answer 18

aka scapular dysfunction, excessively protracted scapula during arm motion

Question 19

Primary scapular winging

Answer 19

implies the winging is the result of muscle weakness of one of the scapular mm stabilizers that in turn, disrupts the normal mm force couple balance of the scapulothoracic complex

Question 20

secondary scapular winging

Answer 20

normal movement of the scapula is altered because of pathology in the glenohumeral joint

Question 21

Dynamic scapular winging

Answer 21

winging with movement may be caused by a lesion of the long thoracic nerve affecting serratus anterior, rhomboid weakeness, multidirectional instability, voluntary action or a painful shoulder resulting in splinting of the glenohumeral joint which in turn causes reverse scapulohumeral rhythm

Question 22

Spinal accessory nerve palsy

Answer 22

CN XI AKA trapezius palsy, scapula to depress and move laterally with the inferior angle rotated laterally. If Trapezius is weak or paralyzed,the winging of the scapula occurs before 90 degree abduction and there is little winging on forward flexion

Question 23

Long thoracic nerve palsy

Answer 23

AKA serratus anterior palsy: the scaupla to elevate and move medially with the inferior angle rotating medially. If the serratus anterior is weak or paralyzed, the winging of the scapula occurs on abduction and forward flexion (especially with a punch out forward against resistance)

Question 24

Static winging

Answer 24

winging occuring at rest caused by a structural deformity of the scapula, clavicle, spine or ribs

Question 25

Sprengel's deformity

Answer 25

most common congenital deformity of shoulder complex, poorly developed scapular mm or replaced by fibrous band

Question 26

open chain movement of shoulder

Answer 26

eating, reaching, dressiong

Question 27

close kinetic chain

Answer 27

crutch walking, pushing up from a chair

Question 28

scapulohumeral rhythm

Answer 28

first 30: no movement of scapula 30-90: 2:1 ratio 90-180: 2:1 Clavicle add 10 degrees of elevation after 90 degree, rotating posteriorly

Question 29

Reverse scapulohumeral rhythm

Answer 29

scapula moves more than humerus, for frozen shoulder

Question 30

crepitus is present during 90 degree abduction and rotation it is called

Answer 30

abrasion sign. Abrasion of torn tendon margins against coracoacromial arch

Question 31

GIRD and GERD

Answer 31

Glenohumeral internal/external rotation deficit. if ratio is greater than 1, patient will probably develop shoulder problems

Question 32

swallow tail sign

Answer 32

can't extend arm due to injury to mm or axillary nerve

Question 33

snapping scapula

Answer 33

adducting, abducting scapula clicking or snapping caused by the scapula rubbing over the underlying ribs

Question 34

Spinal accessory nerve lesion

Answer 34

inability to abduct arm beyond 90 degree and pain in shoulder on abduction

Question 35

Long thoracic nerve

Answer 35

pain on flexing fully extended arm, inability to flex fully extended arm, winging starts at 90 forward flexion

Question 36

Suprascapular nerve

Answer 36

increased pain on forward shoulder flexion, shoulder weakness (partial loss of humeral control), pain increases with scapular abduction, pain increases with cervical rotation to opposite side

Question 37

axillary circumflex nerve

Answer 37

inability to abduct arm with neutral rotation

Question 38

musculocutaneous nerve

Answer 38

weak elbow flexion with forearm supinated

Question 39

what may limit full rateral rotation of GH

Answer 39

subcoracoid bursitis

Question 40

what may limit full abduction because of compression or pinching

Answer 40

subacromial bursitis

Question 41

what % consider normally for anterior and posterior translations of GH

Answer 41

anterior 25% (1/4 width of head) | Posterior 1/2 width of head

Question 42

which tests give best probability of impingement

Answer 42

Hawkins-kenedy, painful arc and positive infraspinatus test

Question 43

Which tests give best for full thickness rotator cuff tears

Answer 43

Painful arc, drop arm, and infraspinatus test

Question 44

Neer impingement

Answer 44

fully abduct arm with medial rotation. Positive is oeveruse injury to the supraspinatus mm and sometimes biceps. If lateral rotation is positive, it is called acromioclavicular differentiation test and consider acromioclavicular joint.

Question 45

Primary impingement

Answer 45

impingement is the problem, rotator cuff degeneration or shape of the acromion, etc

Question 46

secondary impingment

Answer 46

result of altered muscle dynamics in the scapula or glenohumeral joint

Question 47

outlet impingement syndrom

Answer 47

anteiror area because in the supraspinatus outlet area

Question 48

internal impingement

Answer 48

or non outlet impingement. Found posteriorly rather than anteriorly, mostly in overhead athletes. it is contact of suprasupinatus and infraspinatus with posterosuperior glenoid labrum when the arm is abducted to 90 degree and laterally rotated fully

Question 49

bankart lesion

Answer 49

the anteroinferior labrum is torn

Question 50

SLAP lesion

Answer 50

superior labrum

Question 51

axillary circumflex nerve

Answer 51

C5-C6 motor loss, inability to abduct arm (deltoid), weak to rotate laterally (may cheat with biceps), because of loss of teres minor, atrophy of the deltoind, sensory loss of deltoid insertion

Question 52

Suprascapular nerve

Answer 52

(C5-C6) injured by a fall on the posterior shoulder, stretching repeated microtrauma, fracture of the scapula. injured as it passess through the suprascapular notch under the transverse scapular ligament or as it winds around spine of the scapula under the spinoglenoid ligament. Sx include persistent rear shoulder pain and paralysis of the supraspinatus and infraspinatus, leading to decreased strength of abduction and lateral rotation of the shoulder. Wasting may also be evident. (volley ball, spiking pitching, people work with their arm over head)

Question 53

musculocutaneous nerve

Answer 53

C5-C6, rare for injury, loss of elbow flexion, shoulder forward flexion, decreased supination strength. Sonsory branch is over antebrachial aspect of the forearm. Can be compressed by distal biceps tendon, resulting in musculocutaneous nerve tunnel syndrome

Question 54

musculocutaneous nerve tunnel syndrome

Answer 54

result by hyperextension or repeated pronation (excessive screwdriving, backhand tennis srokes), may be misdiagnosed as tennis elbow. Sensory loss of forearm, pinched by distal biceps tendon

Question 55

Long thoracic nerve

Answer 55

C5-8 heavy effort above shoulder height, pressure on the nerve from backpacking, vigorous upper limb activities, (shoveling, chopping, stretching) causing winging of scapula, pain and weakness of forward flexion of the extended arm.abduction above 90 is difficult because of scapular winging. recovery can be as long as 2 years

Question 56

Spinal accessory nerve

Answer 56

C3-C4 it passes through posterior triangle but affect trap. Abnormal pressure from poorly fitting backpack. Shoulder drooping (scapula translated laterally and rotated downward) and scapular winging (medial superior portion) with medial rotation of the inferior angle, especially on abduction. Winging with abduction, but not forward flexion differentiating from long thoracic nerve palsy