Shoulder pathologies and upper limb nerve entrapment

Question 1

What is the most likely presentations at 20-30s

Answer 1

instability

Question 2

What is the most likely presentations at 30-40s

Answer 2

impingement

Question 3

What is the most likely presentations at 40-50s

Answer 3

Frozen shoulder

Question 4

What is the most likely presentations at 50-60s

Answer 4

Cuff tear

Question 5

What is the most likely presentation over 60

Answer 5

arthritis

Question 6

What are the intrinsic muscles of the rotator cuff

Answer 6

Supraspinatus
infraspinatus
teres minor
subscapularis

Question 7

What is the shoulder ROM

Answer 7

forward flexion
adbuction
external rotation
internal rotation

Question 8

What is the usual picture of shoulder instability?

Answer 8

Teenage to 30s, young, sporty, mostly traumatic

Question 9

Anterior dislocation

Answer 9

common 95%
traumatic
sports

Question 10

Posterior dislocation

Answer 10

infrequent 5%
epileptic fit
electrocution
(lightbulb sign on X-ray)

Question 11

Instability acute presentation

Answer 11

A and E department reduction
painful
in sling

Question 12

Instability chronic presentation

Answer 12

atraumatic laxity/subluxations
not painful
no support

Question 13

In instability presentation what is it important to ask about

Answer 13

traumatic event
mechanism of injury
ease of dislocation
frequency
general laxity

Question 14

On EXAM OF INSTABILITY WHAT DO YOU Look,feel,move,test for

Answer 14

LOOK-abnoraml shoulder contour, muscle wasting
feel-tenderness,muscle spasm
move-good ROM,scapula winging
Test-RC strength

Question 15

In anterior shoulder dislocation

Answer 15

Reduced by manipulation

analgesia and sedation IV and O2

Question 16

What are the extrinsic muscles of the shoulder

Answer 16

Deltoid
trapez
latissimus dorsi

Question 17

Post-reduction treatment

Answer 17

2-3 weeks sling
analgesia
gradual mobilisation
physiotherapy

Question 18

Instability investigations

Answer 18

MRI arthrogram

Question 19

Instability physiotherapy- what does it hope to improve

Answer 19

RC and core strengthening scapula stabilising

Question 20

What is impingement syndrome

Answer 20

Pain originating from the sub-acromial space
common and most transient
intrinsic and extrinsic causes

Question 21

Intrinsic causes of impingement syndrome

Answer 21

tendon vascularity
watershed area
tendon degeneration
Cuff dysfunction

Question 22

Extrinsic causes of impingement syndrome

Answer 22

External “pressure”

• type of acromium
• coraco-acromial ligament
• clavicular spur/osteophyte

Question 23

Impingement syndrome can look different at different ages

Answer 23

RC tendinitis/subacromial bursitis-20s
Calcific tendonitis-30-40s
Cuff tear-50-60s
Cuff arthropathy-70s

Question 24

What is the classification for Impingement syndrome

Answer 24

Neer’s classification (1-3)

Question 25

Impingement rehab

Answer 25

Painful
Sling 1-2 weeks
Early PT and ROM exercises
RC strengthening

Question 26

Cuff tear presentation

Answer 26

age 50-60
grey hair-cuff tear
acute traumatic or chronic attrition

Question 27

What on examination are you looking for in a cuff tear?

Answer 27

Look-contour,wasting
Feel-tenderness sub deltoid region
Move- ROM active

Question 28

Cuff tear investigations

Answer 28

-

Question 29

Frozen shoulder

Answer 29

40-50s 
more common in female (2;1)
not uncommonly bilateral
gradual severe pain
association with diabetes, lipid and endocrine disease and dupuytren's

Question 30

Pathology of frozen shoulder

Answer 30

contracture and thickening of Glenn-humeral ligament

Question 31

Frozen shoulder operative options

Answer 31

1-manipulation under anaesthesia

2-arthroscopic capsular release

Question 32

Glenhumoral arthritis presentation

Answer 32

over 60
uncommon location
OA,RA, post-traumatic arthritis

Question 33

What is the mnemonic to remember the median nerve innervation

Answer 33

LOAF