Shoulder

Question 1

what forms the shoulder joint

Answer 1

humeral head

glenoid fossa of the scapula

Question 2

what type of joint is the shoulder joint

Answer 2

ball and socket synovial joint

Question 3

what forms the shoulder girdle

Answer 3

scapula
clavicle
proximal humerus
supporting muscles of rotator cuff and deltoid

Question 4

rotator cuff muscles

Answer 4

1. SUPRASPINATUS
   posterior scapula, above spine of scapula
2. INFRASPINATUS
   posterior scapula, below spine of scapula
3. TERES MINOR
   posterior scapula, below infraspinatus
4. SUBSCAPULARIS
   anterior scapula

Question 5

where do the rotator cuff muscles attach to

Answer 5

supraspinatus
infraspinatus
teres minor
- all attach to greater tuberosity of humerus

subscapularis
- attaches to lesser tuberosity of humerus

Question 6

What shoulder movement is supraspinatus responsible for

Answer 6

initiation of abduction

Question 7

What shoulder movement is infraspinatus responsible for

Answer 7

external rotation

Question 8

What shoulder movement is teres minor responsible for

Answer 8

external rotation

Question 9

what shoulder movement is subscapularis responsible for

Answer 9

internal rotation

Question 10

principle muscle responsible for shoulder abduction

Answer 10

deltoids

Question 11

most common shoulder problem in the young

Answer 11

instability

Question 12

most common shoulder problems in the middle aged

Answer 12

rotator cuff tears

frozen shoulder

Question 13

most common shoulder problem in the elderly

Answer 13

glenohumeral OA

Question 14

what is impingement syndrome also known as

Answer 14

painful arc

Question 15

what is impingement syndrome

Answer 15

a syndrome where the tendons of the rotator cuff are compressed in the tight subacromial space during movement, producing pain.

Question 16

The tendon of which rotator cuff muscle is predominately involved in impingement syndrome

Answer 16

supraspinatus

Question 17

presentation of impingement syndrome

Answer 17

painful arc between 60-120 degrees of abduction

pain ceases when tendon has passed through subacromial space

Question 18

causes of impingement syndrome

Answer 18

tendonitis subacromial bursitis
acromioclavicular OA with inferior osteophyte
a hooked acromion rotator cuff tear

Question 19

characteristic radiation pattern of impingement syndrome pain

Answer 19

deltoid and upper arm radiation

Question 20

Tx of impingement syndrome

Answer 20

1. Conservative Mx -
   NSAIDs, analgesia, physio, subacromial steroid injection
2. subacromial decompression surgery

Question 21

velocity of injury of rotator cuff tear in middle aged person: high or low?

Answer 21

Low velocity - there is already degenerative change in the rotator cuff tendons and injury happens from a sudden jerk type injury

Question 22

Most common muscle involved in rotator cuff tears

Answer 22

supraspinatus

Question 23

symptoms of rotator cuff tear

Answer 23

weakness of initiation of abduction (supraspinatus)
weakness of external rotation (infraspinatus)
weakness of internal rotation (subscapularis)
difficulty sleeping on affected side

Question 24

Ix for suspected rotator cuff tear

Answer 24

USS or MRI

Question 25

Mx rotator cuff tear

Answer 25

Controversial! Long term results of surgery not known Non-operative: physio (strengthens up remaining muscles to compensate) +/- subacromial steroid injection Surgical: repair of tear and subacromial decompression

Question 26

what is frozen shoulder also known as

Answer 26

adhesive capsulitis

Question 27

what is adhesive capsulitis

Answer 27

progressive pain and stiffness of the shoulder which resolves after 18-24 months capsule and glenohumeral ligaments become inflamed, and thickened and contracted

Question 28

causes of adhesive capsulitis

Answer 28

``` often unclear ?triggering injury ?after shoulder injury ?diabetes ? hypercholesterolaemia ?Dupuytren's ```

Question 29

presentation of adhesive capsulitis

Answer 29

initial pain lasting for 2-9months | then stiffness for 4-12 months, which gradually thaws out over time

Question 30

Tx of adhesive capsulitis

Answer 30

physio analgesia intra-articular glenohumeral injections in painful phase stiffness phase - can be manipulated under GA

Question 31

What is acute calcific tendonitis

Answer 31

deposition of calcium in the supraspinatus tendon

Question 32

presentation of acute calcific tendonitis

Answer 32

acute onset severe shoulder pain

Question 33

Ix for acute calcific tendonitis

Answer 33

X-ray - shows calcium deposition in the supraspinatus tendon (just proximal to the greater tuberosity)

Question 34

Tx of acute calcific tendonitis

Answer 34

subacromial steroid and local anesthetic injection | self-limiting - symptoms resolve as calcium is reabsorbed

Question 35

What 3 concepts does instability of the shoulder involve

Answer 35

1. Abnormal tranlational movement 2. Abnormal subluxation movement 3. +/- Recurrent dislocation i. e. you can have the abnormal movements but the shoulder doesn't dislocate

Question 36

2 sub-types of shoulder instability

Answer 36

1. traumatic instability | 2. atraumatic instability

Question 37

What is traumatic shoulder instability

Answer 37

A shoulder that is unstable after a traumatic anterior shoulder dislocation, after all treatment.

Question 38

What predicts the likelihood of a patient developing traumatic shoulder instability

Answer 38

Age at the time of first dislocation 80% re-dislocation rate in under 20s 20% re-dislocation rate in under 30s

Question 39

What is atraumatic shoulder instability

Answer 39

A shoulder that is unstable from conditions that predispose to generalised ligament laxity e.g. Ehlers Danlos syndrome, Marfan's syndrome

Question 40

proximal insertions of the biceps brachii

Answer 40

short head: coracoid process of scapula long head: supraglenoid tubercle of scapula (i.e. superior part of glenoid labrum)

Question 41

Is the long or short head of biceps brachii more commonly affected by biceps tendinopathy?

Answer 41

Long head

Question 42

Presentation of biceps tendonitis

Answer 42

anterior shoulder pain, radiating to elbow | pain on resisted biceps contraction

Question 43

Tx of biceps tendonitis

Answer 43

Conservative - rest and physio

Question 44

"popeye sign"

Answer 44

Sign of ruptured biceps brachii tendon - biceps muscle becomes 'bunched up'

Question 45

what is the glenoid labrum

Answer 45

fibrocartilaginous structure around the rim of the glenoid cavity

Question 46

what is a SLAP tear

Answer 46

Superior Labrum Anterior Posterior tear | i.e. a tear of the glenoid labrum and long head of biceps tendon

Question 47

Ix for a SLAP tear

Answer 47

contrast MRI arthrogram