shoulder pathology

Question 1

what attaches to the greater tubercle of the humerus

Answer 1

the SIT muscles

Question 2

role of supraspinatus

Answer 2

abduct 0-15

Question 3

role of infraspinatus and teres minor

Answer 3

externally rotate

Question 4

role of subscapularis

Answer 4

internally rotate

Question 5

what is subacromial impingement

Answer 5

compression of (normally supraspinatus) under the coracoacromial arch

Question 6

what can cause subacromial impingement

Answer 6

osteophytes, bursitis (may be caused by overuse of the tendon by repetitive overhead action), calcific tendonitis

Question 7

examination findings of subacromial impingement

Answer 7

painful arc and positive hawkins test

Question 8

diagnosis of subacromial impingement

Answer 8

normally clinical but can do an MRI to confirm

Question 9

MX of subacromial impingement

Answer 9

1) conservative - NSAID, ice, rest, physio 2) steroid injections 3) surgery

Question 10

complications of subacromial impingement

Answer 10

adhesive capsulitis and rotator cuff tears

Question 11

will strength be effected in subacromial impingement

Answer 11

no

Question 12

a rotator cuff tear can be what

Answer 12

acute or chronic

Question 13

RF for rotator cuff tear

Answer 13

age, trauma, repetitive overhead use

Question 14

Ex findings of a rotator cuff tear

Answer 14

tenderness over the lateral aspect of the shoulder, muscle wasting, reduced ROM and power

Question 15

IX for rotator cuff tear

Answer 15

Xray to rule out fracture, US to confirm tear and MRI for details of tear

Question 16

Mx of rotator cuff tear

Answer 16

conservative or surgical

Question 17

main complication of any shoulder pathology

Answer 17

adhesive capsulitis

Question 18

RF for adhesive capsulitis

Answer 18

diabetes, thyroid, female, adhesive capsulitis in other shoulder

Question 19

PC in adhesive capsulitis

Answer 19

generalised deep and constant pain, joint stiffness and reduced ROM

Question 20

Ex findings in adhesive capsulitis

Answer 20

reduced ROM in active and passive, tenderness on palpation, movement worse in external rotation and flexion

Question 21

Ix for adhesive capsulitis

Answer 21

clinical diagnosis but can do MRI to confirm and do HbA1c

Question 22

surgical options for adhesive capsulitis

Answer 22

MUA and arthrographic distension (where water is put into the joint to break down the adhesions)

Question 23

how long might adhesive capsulitis last

Answer 23

3 years

Question 24

what kind of shoulder dislocation causes a lightbulb sign

Answer 24

posterior

Question 25

why is shoulder dislocation most common

Answer 25

shallow glenoid fossa

Question 26

MOA of anterior shoulder dislocation

Answer 26

FOOSH

Question 27

MOA of posterior shoulder dislocation

Answer 27

electrocution

Question 28

how does someone with an anterior inferior shoulder dislocation present

Answer 28

pain, unwillingness to move, loss of shoulder contours, anterior bulge and arm in ABDUCT and EXT ROTATION

Question 29

nerves to assess in shoulder dislocation

Answer 29

axillary and supra scapular (if abnormal recheck in one week)

Question 30

IX for shoulder dislocation

Answer 30

AP and scapula Y and axillary

Question 31

complications of shoulder dislocation

Answer 31

Hill sach and bankart lesion

Question 32

MX of a shoulder dislocation

Answer 32

reduction (kocher or double traction) and immobilisation for 6 weeks in a broad arm sling. Early physio is important.

Question 33

what displacement occurs in a clavicular fracture

Answer 33

medial displaces superiorly due to the pull of SCM an the lateral displaces inferiorly due to the weight of the arm

Question 34

how are most clavicle fractures treated (even those with significant deformity)

Answer 34

conservatively due to the prominence of the metal work

Question 35

non union is a big problem for clavicle fractures - where is this most likely to happen

Answer 35

if the fracture occurs in the distal third and if non union occurs there has to be an ORIF