Shoulder conditions

Question 1

What is impingement syndrome?

Answer 1

When the tendons of the rotator cuff are compressed in the subacromial space - the rotator cuff tendons insert on the greater tuberosity of the humerus

Question 2

What can cause impingement syndrome?

Answer 2

Anything that reduces the subacromial space:

• rotator cuff tear that has hooked
• tendonitis (tendon will swell)
• osteoarthritis (osteophytes etc)

Question 3

How does impingement syndrome present?

Answer 3

Painful arc on abduction (60-120 degrees)
pain radiating to deltoid and upper arm
Positive Hawkins-Kennedy test

Question 4

How is impingement syndrome managed?

Answer 4

Rest & physio
NSAIDs
Up to 3 subacromial steroid injections
If still not improving - decompression surgery

Question 5

What is another name for adhesive capsulitis?

Answer 5

Frozen shoulder

Question 6

What is adhesive capsulitis?

Answer 6

disorder characterised by progressive stiffness and pain in the shoulder which slowly resolves over 18-24 months

Question 7

Which conditions are people more likely to get adhesive capsulitis in?

Answer 7

Diabetes
Hypercholestereamia
Dupytrens contracture

Question 8

What is the typical presentation of adhesive capsulitis?

Answer 8

Loss of external rotation

Pain will subside after a few months as stiffness increases, then stiffness begins to thaw after about a year

Question 9

Management of adhesive capsulitis?

Answer 9

Physio and steroid injections

Question 10

What is the classic history of a rotator cuff tear?

Answer 10

> 40 year old with pain and weakness following a sudden jerk e.g. holding the rail on the bus and it suddenly stopping

Question 11

if supraspinatus, infraspinatus or Subscapularis was affected by a rotator cuff injury which movement would be lost?

Answer 11

Supraspinatus = initiation of abduction
Infraspinatus = external rotation 
Subscapularis = internal rotation

Question 12

What can confirm a rotator cuff tear?

Answer 12

MRI/ultrasound

Question 13

Management options for rotator cuff tears?

Answer 13

Conservative = physio + steroid injections
Surgical = rotator cuff repair +/- subacromial decompression

Question 14

Which type of shoulder dislocation is most common and which age group is most commonly affected?

Answer 14

Anterior dislocation

Teens-30 yrs

Question 15

What is the relation between age of first shoulder dislocation and chances of recurrent dislocations?

Answer 15

The younger you are the more likely you are to dislocate it again - 80% if under 20 and 20% if under 30

Question 16

What is the management of shoulder dislocations acutely?

Answer 16

Reduction in A&E and a sling for a few weeks

Physio to get it moving

Question 17

What is a Bankart repair?

Answer 17

Surgical reattachment of the labrum and capsule to the anterior glenoid to prevent recurrent anterior shoulder dislocations

Question 18

What is acute calcific tendonitis?

Answer 18

Acute onset severe shoulder pain due to calcium deposits on the supraspinatus tendon

Question 19

How can a diagnosis of acute calcific tendonitis be confirmed?

Answer 19

X-Ray - will show the calcium deposits

Question 20

Management of acute calcific tendonitis?

Answer 20

Pain relief from subacromial steroid & analgesic injection
Self limiting condition

Question 21

What is a key sign of frozen shoulder on examination?

Answer 21

Loss of external rotation/pain on external rotation