Shoulder Injuries Pt. 1

Question 1

If there’s suspected subacromial impingement syndrome, which structures should you try and palpate?

Answer 1

AC joint, shoulder capsule, shoulder joint line, tendons of supraspinatus, infraspinatus, and long head of biceps

Question 2

How do you palpate the supraspinatus tendon? How about the muscle?

Answer 2

Tendon- ask patient to put hand behind lower back (like Gerber’s position) and palpate inferior to acromion
Muscle- Resisted first 15 degrees of abduction while palpating above scapular spine

Question 3

Which muscles are responsible for abduction and upwards rotation of the arm? and at which degrees?

Answer 3

First 15 degrees= supraspinatus
15-90 degrees= deltoid
(Upwards rotation) 90-180 degrees= trapezius and serratus anterior

Question 4

Where do the tendons of the rotator cuff muscles attach? How about teres major?

Answer 4

Supraspinatus, infraspinatus, teres minor attach to greater tubercle of humerus
Subscapularis (anterior aspect of scapula in subscapular fossa) attaches to lesser tubercle of humerus

Teres major (not a rotator cuff) attaches to medial lip of intertubercular sulcus of humerus

Question 5

What are the attachments of the tendons of the biceps brachii?

Answer 5

Long head from supraglenoid tubercle to radial tuberosity (on medial part of radius)
Short head from coracoid process of scapular to radial tuberosity

Question 6

What are the attachments of the tendons of the triceps brachii?

Answer 6

Long head from infraglenoid tubercle of scapula
Lateral head from posterior humerus, superior to radial groove
Medial head from posterior humerus, inferior to radial groove
All heads insert into olecranon of ulna

Question 7

What are the tests for subacromial impingement?

Answer 7

Neer’s, Hawkins’-Kennedy, relocation

Question 8

What are the full can and empty can tests for?

Answer 8

Full can- deltoid strain/rupture

Empty can- supraspinatus strain/rupture

Question 9

Which structures risk being damaged when the shoulder is dislocated?

Answer 9

Shoulder capsule, glenoid labrum, humeral head (Hills-Sachs lesion), biceps tendon, axillary nerve

Question 10

What are the tests for shoulder dislocation?

Answer 10

Apprehension, drawer, sulcus

Question 11

What are the differentials for shoulder pain and deformity?

Answer 11

Shoulder dislocation, AC joint sprain, clavicle fracture, acromion fracture

Question 12

Which structures does a SLAP lesion damage? What are the tests for this?

Answer 12

Biceps tendon

Speed’s or Yergason’s

Question 13

Which rotator cuff muscle is most likely to be torn secondary to impingement?

Answer 13

Supraspinatus