Shoulder

Question 1

shoulder - deformities + causes

Answer 1

steps in clavicle
winging of scapula - long thoracic nerve injury
squaring of shoulders - trapezius wasting

Question 2

shoulder - wasting

Answer 2

trapezius - squaring of shoulders
deltoid - axillary palsy (traumatic, iatrogenic)
triceps
biceps
supraspinatus - nerve injury, chronic rotator cuff tear
infraspinatus - nerve injury, chronic rotator cuff tear

[think 2 of each]

Question 3

shoulder - swelling - causes

Answer 3

inflammation
effusion
bursitis
inflammatory joint disease anterior dislocation

Question 4

shoulder - look - function

Answer 4

hands behind head
hands behind back
touch each hand to shoulder

Question 5

shoulder - feel - sequence

Answer 5

bony - SCJ, clavicle, ACJ, acromion, borders scapula, greater tubercle humerus, coracoid process, biceps tendon
muscles - supraspinatus, infraspinatus, deltoid

Question 6

shoulder - abduction pain

Answer 6

lower arc (80-90) - supraspinatus impingement
high arc (>120) - ACJ pathology/injury

Question 7

shoulder - loss of external rotation

Answer 7

frozen shoulder - when testing for, stabilise scapula to avoid compensatory movement

Question 8

muscles of rotator cuff

Answer 8

supraspinatus
infraspinatus
teres minor
subscapularis

Question 9

empty can test - muscle tested

Answer 9

supraspinatus

[pouring soup]

Question 10

shoulder - external rotation against resistance - muscle tested

Answer 10

teres minor

infraspinatus

Question 11

gerber’s lift off test (hand behind back)

Answer 11

subscapularis

Question 12

tests for rotator cuff

Answer 12

empty can
external rotation against resistance
gerber’s lift off

Question 13

abnormal rotator cuff tests - general findings + causes

Answer 13

weakness - tear

pain only - strain

Question 14

tests for impingement

Answer 14

hawkin’s-kennedy (rotate hand down)

mid arc - pain on abduction 60–120 (not specific)

Question 15

hawkin’s kennedy

Answer 15

pain - supraspinatus impingement

Question 16

scarf test

Answer 16

pain - ACJ pathology/injury

Question 17

shoulder - joint above

Answer 17

C spine FERL

Question 18

shoulder - neurovascular

Answer 18

power - deltoid (axillary)
sensation - regimental badge (axillary)
vascular - radial

Question 19

shoulder - feel for

Answer 19

tenderness, bony abnormality (eg osteophytes, steps)

Question 20

shoulder - radial, median, ulnar sensation

Answer 20

radial - dorsal 1st interosseus space
median - lateral index finger
ulnar - medial little finger

Question 21

shoulder - i would also

Answer 21

above + below (elbow + c spine), then MSK
xrays (modified + axillary views)
MRI
joint aspiration

Question 22

impingement - what is it + tests

Answer 22

supraspinatus tendinitis (painful arc syndrome)

1 - mid arc - pain abducting 60-120 (due to impingement of underside of acromion on inflamed tendon)
2 - hawkin’s kennedy test

[supraspinatus abducts arm]
no restriction of passive movement

Question 23

complications of anterior dislocation of shoulder

Answer 23

nerve damage - axillary, brachial plexus
artery damage - axillary
rotator cuff injury
associated fracture - humeral head, clavicle, acromion
recurrent dislocation

[nerve - artery - muscle - bone - joint]

Question 24

frozen shoulder - what is it, risk factors

Answer 24

adhesive capsulitis of glenohumeral joint

spontaneous, rotator cuff injury, immobility, diabetes, thyroid

Question 25

frozen shoulder - phases

Answer 25

freezing - gradual onset pain + stiffness, 2-9mo
frozen - pain goes, stiffness stays, limited external rotation, 4-12mo
thawing - gradual return of movement, 1-3y

restriction of all movements but external rotation most obv

Question 26

if pain is present on active but not passive movement what does it suggest?

Answer 26

muscular problem

Question 27

rotator cuff muscles - roles

Answer 27

infraspinatus - external rotation, with teres minor
supraspinatus - abduction
subscapularis - internal rotation

Question 28

ACJ pathology/arthritis - features OE

Answer 28

painful high arc
tender ACJ
pain on scarf test

Question 29

movements to test supraspinatus

Answer 29

thumbs up/down

Question 30

movement to test ACJ

Answer 30

touch opposite shoulder

Question 31

movement to test infraspinatus

Answer 31

touch occiput (with teres minor)

Question 32

movements to test subscapularis

Answer 32

touch opposite hip

touch ipsilateral buttock