Shoulder Pathologies

Question 1

Rotator cuff muscles

(4) + action and site of insertion

Answer 1

Supraspinatus

• Initiation of abduction
• insert into greater tuberosity of humerus

Infraspinatus

• External rotation of shoulder joint
• Insert into greater tuberosity off humerus

Teres Minor

• External rotation of shoulder joint
• Insert into greater tuberosity of humerus

Subscapularis

• Internally rotates shoulder
• Inserts into lesser tuberosity of humerus

All function together to pull humeral head into glenoid fossa and provide stability

Question 2

Rotator cuff tear aetiology

Answer 2

Sudden jerk in patients >40 which produces subsequent pain and weakness

Question 3

Rotator Cuff Tear Site

Answer 3

Usually Supraspinatus

Can include infraspinatus and subscapularis

Question 4

Rotator Cuff tear examination signs

Answer 4

Weakness of initiation of abduction (Supraspinatus)

Internal rotation weakness (subscapularis)

External rotation weakness (infraspinatus)

Wasting of Supraspinatus

Question 5

Rotator Cuff tear investigations

Answer 5

MR

Ultrasound scan

Question 6

Rotator Cuff Tear Treatment

Answer 6

Physiotherapy
Subacromial Injections
Surgery is controversial

Question 7

Impingement Syndrome

Answer 7

Pain due to the tendons of the rotator cuff muscles caused by compression in the subacromial space during movement

Question 8

Impingement syndrome aetiology

Answer 8

Tendonitis 
Subacromial Bursitis 
OA with inferior osteophyte
Hooked acromion
ROtator Cuff tear

Question 9

Painful arc

Answer 9

Pain between 60 to 120 degrees on abduction

Question 10

Painful arc radiation

Answer 10

Radiates to

• Deltoid
• Upper arm

Question 11

painful arm investigations

Answer 11

Hawkings-kennedy test

Question 12

Painful arc treatment

Answer 12

NSAIDs
Analgesia
Physio
Subacromial Injections 
Subacromial decompression surgery

Question 13

Adhesive Capsulitis

Answer 13

Progressive pain and stiffness of the shoulder in patients 40-60 years old

Question 14

Adhesive capsulitis symptoms

Answer 14

Adhesive Capsulitis pain (subsides after 2-9 months)

Increasing stiffness (for 4- 12 months. Gradually thaws over time)

Loss of external rotation

Question 15

Adhesive Capsulitis Risk Factors

Answer 15

Diabetes
hypercholesterolaemia
Dupuytren’s Contracture

Question 16

Adhesive Capsulitis Treatment

Answer 16

Takes 18-24 months to fully resolve
Physio
Analgesia
Intra-articular injections 
After pain settles: manipulation under analgesia. Surgical capsular release

Question 17

Acute Calcific Tendonitis

Answer 17

Acute onset of sever shoulder pain characterised by deposition of calcium in the Supraspinatus tendon

Question 18

Acute Calcific Tendonitis Site

Answer 18

Calcium deposits proximal to the greater tuberosity of the humerus

Question 19

Acute calcific tendonitis treatment

Answer 19

Self-limiting

Subacromial steroids and local anaesthesia can control pain

Question 20

Shoulder Instability Types

Answer 20

Traumatic
- usually anterior dislocation

Atraumatic

Question 21

Traumatic Shoulder Instability Treatment

Answer 21

Rest
Physio
Strengthening

Recurrent dislocation requires bankcard repair which involves stabilising the shoulder by reattaching the labrum and capsule to the anterior glenoid.

Question 22

Epidemiology of multidirectional subluxations/ dislocations

Answer 22

Occurs in patients with generalised ligamentous laxity

• Idiopathic
• Marfans
• Ehlers-Danlos

Question 23

Bicep tendonitis symptoms

Answer 23

Anterior shoulder pain
- on resisted biceps contraction

Popeye deformity
- Spontaneous tendon rupture

Question 24

Bicep tendonitis treatment

Answer 24

Surgical division of the tendon

Question 25

Glenoid Labrum tear investigations

Answer 25

MRI arthrogram

Labral resection or repair

Question 26

Other causes of shoulder pain

Answer 26

Neck Problems
Angina
Diaphragmatic Irritation