Shoulder

Question 1

4 Tendons of Rotator Cuff (+ innervation/function of ea)

Answer 1

(SITS)

• S- supraspinatous (forward elevation)
  - Suprascapular nerve
• I- infraspinatous (external rotation)
  - Suprascapular nerve
• T- teres minor (external rotation)
  - Axillary nerve
• S - subscapularis (internal rotation)
  - Upper and lower sub scapular nerves

Question 2

How does a torn rotator cuff present?

Answer 2

• Common - older patient after fall w/ shoulder dislocation
• Night pain, inability to sleep on affected shoulder, difficulty reaching up
• Limited active ROM but fine passive ROM
• May see posterior shoulder atrophy (scapula more visible on affected side)
• Acute trauma or chronic degeneration

Question 3

2 PE Signs of Rotator Cuff Injury

Answer 3

• Hawkin - pain w/ adduction and internal rotation of shoulder
• Neer - pain w/ passive full forward flexion of shoulder

**Also pos in bursitis

Question 4

Dx and Tx of Torn Rotator Cuff

Answer 4

• MRI - can see rotator cuff itself (partial or full thickness tear); see soft tissue (tendons and muscles)
• Surgical repair unless very poor candidate; arthroscopically or small incision

Question 5

What is the most common shoulder dislocation?

Answer 5

ANTERIOR

Question 6

Pathophysiology of anterior v posterior dislocation

Answer 6

• Anterior - usually from direct trauma to shoulder or upper extremity
• Posterior - w/ seizure or lightening strike

Question 7

4 Injuries Associated w/ Dislocation

Answer 7

1- Axillary nerve damage (runs inferior to humeral head)

2- Greater tuberosity fracture

3- Bankhart Lesion - small impression fracture of lip of glenoid

4- Hill-Sach’s Deformity - compression causing defect of humeral head

Question 8

How do anterior, posterior and inferior dislocations present?

Answer 8

• Anterior - direct blow to shoulder while arm abducted and externally rotated
  
  • Present w/ shoulder held in abducted, externally rotates position; “squared off” shoulder
• Posterior - seizure, lightening strike, or direct blow anterior to shoulder pushing humerus posteriorly
  
  • Easy to miss; held into body in adductor/internal rotation
• Inferior - forceful hyperabduction of arm going above head
  
  • Easy to ID; hold arm above head like raising hand to ask a question (“luxatio erecta”)

Question 9

Dislocation Imaging

Answer 9

• Xray series - A/P and axillary (posterior hard to see on A/P- get axillary view)
• Do pre and post reduction

Question 10

Dislocation Tx

Answer 10

REDUCTION

• Hennepin - externally rotate then hold arm above head until back in place
• Traction - Countertraction; use towel or sheet to stabilize body while another person pulls arm away from body until enough distance that humeral head can slip back into glenoid fossa

** Surgery if not-reducible OR if multiple dislocations/chronic laxity