Shoulder pain

Question 1

name the 5 special tests in the shoulder examination

Answer 1

• empty can test
• lift off test
• test for external rotation w/ resistance
• scarf test
• hawkins kennedy

Question 2

what does pain on abduction of the arm between 60 and 120 degrees suggest?

Answer 2

subacromial pain or rotator cuff disorder

Question 3

how is the scarf test carried out and what does pain suggest?

Answer 3

cross arm adduction and reinforce by applying pressure to the elbow

Suggests subacromion impingement or acromioclavicular joint pathology

Question 4

how is the Hawkin’s Kennedy test performed and what can pain suggest?

Answer 4

with the shoulder abducted and elbow fixed at 90 degrees; rotate the shoulder with force so that the palm goes downwards

suggests subacromion impingement/supreaspinatus impingement

Question 5

movement of supraspinatus muscle

Answer 5

abduction

Question 6

nerve supply to supraspinatus

Answer 6

suprascapular nerve

Question 7

movement by infraspinatus muscle

Answer 7

external rotation

Question 8

nerve supply to infraspinatus

Answer 8

suprascapular nerve

Question 9

movement by teres minor?

Answer 9

external rotation

Question 10

nerve supply to teres minor?

Answer 10

axillary nerve

Question 11

what movement does the lift off test assess?

Answer 11

internal rotation against resistance

testing subscapularis muscle

Question 12

what is the nervous supply to subscapularis muscle?

Answer 12

upper and lower subscapular nerve

Question 13

name 2 causes of subacromial impingement

Answer 13

• calcification

- bursitis

Question 14

what is another name for Frozen shoudler

Answer 14

adhesive capsulitis

Question 15

which movements are affected in adhesive capsulitis?

Answer 15

external rotation 
(active and passive movement)

Question 16

what are the 3 stages of presentation of adhesive capsulitis?

Answer 16

Pain (2-9 moths)

stiffness + pain (4-12 months)

stiffness with pain settling and gradual return of range of motion (5-24 months)

Question 17

how is adhesive capsulitis managed?

Answer 17

• physiotherapy
• NSAIDs
• injected corticosteroids

Question 18

How can OA of the shoulder and adhesive capsulitis be differentiated?

Answer 18

Plain x-ray

OA will show LOSS changes

Question 19

what is Cuff Arthropathy?

Answer 19

Combination of
- supraspinatus impingement (USS confirmed)
and
- secondary impingement causing superior migration of the humeral head

Question 20

how would you explain cuff arthropathy to a patient

Answer 20

You have torn one of the tendons in your shoulder that helps you move your arm out to the side AND half the ball of your shoulder in the correct position in the socket

As the tendon is torn and the tissues are being rubbed against the bone above, this is causing you pain

Question 21

conservative management of Cuff arthropathy?

Answer 21

• analgesia

- physiotherapy to recruit the deltoid muscle to achieve abduction

Question 22

what injections can be given in cuff arthropathy

Answer 22

Steroid and local analgesia

steroid for anti inflammatory and anaesthetic to increase the volume of the injection

Question 23

surgeries that can be done for cuff arthropathy (3)

Answer 23

• Supraspinatus repair using sutures and bone anchors to re attach the torn cuff to the greater tuberosity
• Subacromial decompression - to remove inflamed tissue to create a space for normal cuff gliding and remove any bony spurs from under acromion
• Arthroplasty: shoulder replacement. mainly to alleviate pain

Question 24

what is the relationship between steroid injections and surgery?

Answer 24

having a steroid injection excludes being able to have surgery over the following 3 months, due to the infection risk