shoulder conditions

Question 1

what is impingement syndrome

Answer 1

• characterised by a painful arc of active abduction of the shoulder between 60-120 degrees of movement
• no pain associated with abduction above or below this range and on passive movement of the shoulder

Question 2

mechanism of impingement syndrome

Answer 2

• caused by compression of the rotator cuff tendons as they pass through the tight sub acromial space
• most likely tendon to be affected is supraspinatus

Question 3

impingement syndrome causes

Answer 3

• supraspinatus tendonitis/partial tear
• calcific tendonitis
• subacromial bursitis
• acromioclavicular osteoarthritis

Question 4

what is supraspinatus tendonitis/partial tear

Answer 4

presents with painful arc or crescendo arc (increasing amount of pain throughout range of abduction)

Question 5

what is calcific tendonitis

Answer 5

• develops due to deposition of calcium within tendon
• typically associated with an acute onset of pain which coincides with the resorption of calcium

Question 6

what is subacromial bursitis

Answer 6

swelling and inflammation of the subacromial bursa

Question 7

what is acromioclavicular osteoarthritis

Answer 7

osteoarthritis typically seen in older patients or slightly younger patients with history of AC joint trauma

Question 8

impingement syndrome presentation

Answer 8

• painful arc of abduction
• positive Jobes and Hawkins Kennedy

Question 9

impingement syndrome diagnosis

Answer 9

x-ray

Question 10

impingement syndrome management

Answer 10

• analgesia
• physiotherapy
• sub acromial steroid injections

Question 11

mechanism of rotator cuff tear

Answer 11

• injury (sudden jolt or dislocation)
• degeneration

Question 12

most likely muscle to be affected in a rotator cuff tear

Answer 12

supraspinatus

Question 13

rotator cuff tear presentation

Answer 13

• weakness and shoulder pain that’s worse at night
• reduced range of active movements of shoulder
• painful arc
• reduced range of movement (especially full abduction)
• reduced power of movements (especially external and internal rotation)
• positive Jobes and Hawkins Kennedy
• wasting of muscles within supraspinatus and infraspinatus

Question 14

rotator cuff tear diagnosis

Answer 14

• ultrasound tendons
• MRI for muscle wasting

Question 15

rotator cuff tear management

Answer 15

• physiotherapy
• analgesia
• surgical repair

Question 16

adhesive capsulitis risk factors

Answer 16

• diabetes
• Dupuytrens
• hypocholesteraemia
• shoulder injury
• shoulder surgery

Question 17

what is adhesive capsulitis

Answer 17

inflammation, thickening and contracture of the shoulder joint capsule and ligaments

Question 18

adhesive capsulitis presentation

Answer 18

• progressive and severe pain that’s worse at night
• progressive stiffness following resolution of pain
• reduced movements, especially external rotation and abduction
• reduced active and passive movements, abduction less than 90 degrees and external rotation les than 30 degrees

Question 19

adhesive capsulitis management

Answer 19

• self limiting with pain typically lasting 2-9 months and stiffness 4-12 months after pain
• analgesia
• physiotherapy
• steroid injections
• capsule release

Question 20

biceps tendonitis presentation

Answer 20

anterior shoulder pain that’s worse on resisted contraction of the muscle

Question 21

biceps tendonitis management

Answer 21

NSAIDs

Question 22

biceps rupture presentation

Answer 22

feeling that something has gone after pulling something and then a bulge on contraction of biceps (pop eye sign)

Question 23

osteoarthritis presentation

Answer 23

pain associated with initial loss of external rotation then abduction and finally a global decline in shoulder movements