Shoulder

Question 1

What nerve is most likely to get damaged in shoulder dislocation?

What movements will this now stop from being able to happen?

How can you test sensory function of axillary nerve?

Answer 1

Axillary

Supplies teres minor and deltoid
-> cannot abduct/externally rotate

Badge patch area

Question 2

What nerve is found in a spinal groove on humerus and is damaged in humeral shaft fracture?

What happens as a result of damage to this nerve?

Answer 2

Radial nerve

Can’t extend hand/wrist = wrist drop
Loss of sensation in first dorsal web space

Question 3

What is the most common type of shoulder dislocation?

What can cause a posterior dislocation?

Answer 3

Anterior

Seizures/electric shock

Question 4

In posterior dislocation what sign is present on Xray?

Answer 4

Light bulb sign

Question 5

What is the name of the manoeuvre used to reduce shoulder dislocations?

What is the further management after reduction?

Answer 5

Hippocractic manoeuvre

Sling for a couple of weeks at least

Question 6

What is the most common cause of humeral neck fracture?

What part of the humeral neck does this more commonly occur in?

Answer 6

From FOOSH on osteoporotic bone

Surgical neck as opposed to anatomical neck

Question 7

What nerve is most commonly affected in humeral neck fracture?

Answer 7

Axillary

Question 8

How are the majority of humeral neck fracture managed?

Answer 8

Conservatively with sling

Question 9

If humeral fracture involves the humeral head, what complication is common?

Answer 9

AVN

Question 10

How are humeral shaft fractures most commonly managed?

Answer 10

Functional humeral brace

Question 11

In the humeral shaft all types of fracture can occur. For each of the following patterns of fracture, are they more likely to be caused by fall or RTA?

• Oblique
• Comminated
• Transverse
• Spiral

Answer 11

Oblique - fall
Spiral - fall (with rotation)

Comminated and transverse - RTA

Question 12

Injuries to the acromioclavicular joint (ACJ) occur after what?

How are most treated?

Answer 12

Fall to the point of the shoulder - fairly common sporting injury

Conservative management - very rarely surgery to repair torn ligaments

Question 13

What is the difference between subluxation and dislocation in terms of ligament damage in ACJ injuries?

Answer 13

Subluxation - just acromioclavicular ligament tear

Dislocation - also coracoclavicular ligament tear

Question 14

In what condition would you find Bankart lesion and Hill Sachs lesion?

Describe both.

Answer 14

Anterior shoulder dislocation

Bankart lesion -> detachment of anterior glenoid labrum and capsule

Hill-Sachs lesion -> impaction fracture on posterior head of humerus

Question 15

A patient in their 30-40s presents with a painful arc that radiates to the deltoid and upper arm.

What examinations would you do?

Answer 15

–Impingement syndrome–

Hawkins-Kennedy (interally rotate humerus - watch video again - only quick)

Jobes (arm out straight thumb facing ground and resist pushing down on it) - isolates just supraspinatous - no deltoid

Tenderness on lateral shoulder

Check neurology and neck pain - rule out cervical problem

Question 16

What causes the pain in impingement syndrome?

Answer 16

Supraspinatous muscle passing through tight subacromial space - getting squidged

Question 17

How is impingment syndrome managed?

At what point would you consider surgery?

Answer 17

Conservatively - rest, painkillers, steroid injections

After 6 months conservative care

Usually just self limiting

Question 18

Paitent presents with sudden onset of acute shoulder pain.

They are discovered on Xray to have acute calcific tendonitis of the supraspinatous. How is this managed?

Answer 18

Steroid injection

Question 19

What are you differentials for a patient with loss of passive external rotation of humerus?

Answer 19

• Locked posterior dislocation
• Frozen shoulder
• Glenohumeral arthritis

Question 20

Who typically presents with rotator cuff tears?

Answer 20

Grey hair = cuff tears

Typically degenerative

Question 21

What is a very typical examination finding of rotator cuff tears?

How are they further investigated?

Answer 21

Significantly reduced active movement compared to passive

If patient has good ROM - USS
or MRI

Question 22

Rotator cuff tear management is very controversial.

What is the non-operative option, what is the surgical option?

Answer 22

Strong physio + steroids

Rotator cuff repair - best for young and acute tears

Question 23

What is the typical age of patient presenting with frozen shoulder?

How long can it take to resolve?

Answer 23

40-50s (more women + assoc. with other conditions e.g. diabetes)

3-4yrs

Question 24

What are the 3 stages of frozen shoulder?

Answer 24

1. Freezing (bad pain and increasing stiffness)
2. Frozen (ROM stays same and background pain)
3. Thawing (starts loosening off)

Question 25

What is better management of problematic frozen shoulder MUA (manipulation under anaesthetic) or capsular release?

Answer 25

Both have similar results, MUA is quicker and less invasive

Question 26

Frozen shoulder is adhesion of ligaments. True or false?

Answer 26

False. Despite sometimes being termed adhesive problem.

Thickening of capsule and glenohumeral ligament

Question 27

Patient presents with sudden onset of increasing stiffness and pain at rest and night in shoulder.

On examination there is reduced EXTERNAL ROTATION of humerus.

What should be suspected?

How should patient initially be managed?

Answer 27

Frozen shoulder

Analgesia
Physio
Steroids useful in painful phase