Shoulder Disorders

Question 1

• Herpes Zostera.k.a.- Shingles

Answer 1

1.) Infection with herpes zoster virus (chickenpox related)2.) Severe neuralgic pain3.) Sometimes chills and fevers4.) Malaise and lethargic5.) Erythema of skin6.) Tender regional lymph nodes7.) Clear crops of vesicles along course of cutaneous nerve8.) Always unilateral and does not cross midline of body9.) Vesicles burst & slowly heal

Question 2

• Erb’s Palsya.k.a.- Erb-Duchenne Paralysis

Answer 2

1.) Upper brachial plexus (C5-C6)2.) Forceful depression of the shoulder during birth3.) Trauma to the shoulder later in life4.) Internally rotated and adducted5.) Biceps reflex is lost and there is muscle wasting6.) Some motions of the elbow and hand may be present7.) “Waiter’s tip” position of the arm

Question 3

• Klumpke’s Palsya.k.a.- Klumpke-Dejerine Paralysis

Answer 3

1.) Lower brachial plexus injury (C8 and T1)2.) Forceful pulling of the upper arm during birth3.) Stretching or tearing inferior part of the brachial plexus4.) Impairment of wrist flexion and movements of the intrinsic muscles of the hand

Question 4

• Scheuermann’s Diseasea.k.a.- Juvenile Kyphosis

Answer 4

1.) Kyphosis is evident in the mid and lower thoracic regions in which at least three contiguous involved vertebrae are wedged anteriorly more than 5 degrees2.) A slight male predominance3.) Adolescent (13-17 years old)4.) Etiology is unknown5.) Cosmetic deformity with a predisposition to thoracic disc herniation and premature degenerative changes6.) Characteristic radiological features: a.) Anterior vertebral wedging b.) Irregular vertebral end plates c.) Loss of intervertebral disc heights

Question 5

• Sprengel’s Deformity

Answer 5

1.) Congenital abnormality2.) Partially undescended scapula3.) Condition develops prior to the 3rd month of skeletal development4.) A 2:1 female predominance5.) Examination of patient shows elevation of scapula with reduction of abduction of the arm

Question 6

• Scoliosis

Answer 6

1.) Some 60% - 80% of cases occur in females2.) Initial complaint may be fatigue in the lumbar region after sitting and standing for a long period. This may be followed by muscular backaches in areas of strain, such as the lumbosacral angle. Pain, a late manifestation, may become more persistent as irritation of the ligaments increases3.) Lateral curvature of the thoracic spine is usually accompanied by some rotation of the vertebral bodies4.) Many persons with severe curvatures suffer from cardiovascular and pulmonary disease secondary to reduced thoracic cage volume

Question 7

• Tietze’s Syndromea.k.a.- Costochondritis

Answer 7

1.) Etiology is unknown2.) Pain and swelling of one or more costicartilages may occur gradually or suddenly3.) Overlying skin is reddened4.) Pain may radiate to the shoulder, neck or arm5.) Swelling may persist for months after the pain and tenderness subside6.) X-ray findings are lacking7.) Direct trauma or coughing can irritate these junctions

Question 8

• Frozen Shoulder

Answer 8

1.) An inflammation of the synovial layers causing an outpouring secretion of exudate, which contains protein. The microscopic fibers attach from adjacent synovial layers which, then multiply, thicken and shorten (adhesive process)2.) Pain increases to such an extent that patient is prevented from sleeping on affected side3.) No glenohumeral motion, only scapulothoracic motion4.) Progressive limitation of motion continues until complete anklosis stops the pain5.) Men 50-60, Women 40-506.) Concomitant muscle atrophy

Question 9

• Scapular Winging

Answer 9

1.) Paralysis of the serratus anterior muscle due to trauma to the long thoracic nerve2.) Injury is usually caused by stretching during heavy lifting, severance of the nerve during surgery (mastectomy) or a direct trauma to the side of the neck to the base of the cervical vertebrae