Shoulder Problems

Question 1

What is the most common cause of shoulder problems?

Answer 1

Rotator cuff injuries

Question 2

What is the spectrum of disease that is recognised in rotator cuff injuries?

Answer 2

Shoulder impingement (when a bony spur presses down on the bursa and rubs rotator cuff tendons during abduction)
Calcific tendonitis
Rotator cuff tears
Rotator cuff arthropathy

Question 3

What are the symptoms & signs of acute rotator cuff problems?

Answer 3

Intense shoulder pain may occur acutely when tendons are violently stretched
Pain on abduction

Signs: painful arc of abduction.
Tenderness over anterior acromium may occur

Question 4

What are the symptoms of chronic rotator cuff problems?

Answer 4

Due to regular wear and tear and often in the elderly
Blood supply reduces over time and it is harder to heal after an injury
May be asymptomatic
May be due to the same repetitive action over and over again

Pain may be absent or only when using affected shoulder

Question 5

What muscle is responsible for the first 15 degrees of shoulder abduction?

Answer 5

Supraspinatus

Question 6

What muscle is responsible for 15-90 degrees of shoulder abduction?

Answer 6

Deltoid

Question 7

What muscle is responsible for 90-180 degrees of shoulder abduction?

Answer 7

Serratus anterior

Question 8

In what degrees of shoulder abduction would subacromial impingement and rotator cuff tears present?

Answer 8

Subacromial impingement: between 60 and 120

Rotator cuff tears: before 60

Question 9

What muscles laterally rotate the humerus?

Answer 9

Infraspinatus and Teres Minor

Question 10

What muscles medially rotate the humerus?

Answer 10

Subscapularis

Question 11

What happens in calcific tendonitis, and what is the management?

Answer 11

Hydroxyapatite deposits in the rotator cuff tendons (often supraspinatus) causing pain and inflammation

May lead to a frozen shoulder

Investigate with X-Ray or ultrasound

Manage using physiotherapy, NSAIDs, corticosteroid injections

Question 12

What occurs in shoulder impingement?

Answer 12

When a bony spur presses down on the bursa and rubs rotator cuff tendons during abduction. Pain especially worse when lifting above head.

Pain or aching at night. Weakness of arm.

Can use ice, NSAIDs, steroid injections or ultimately arthroscopy

Question 13

What happens in adhesive capsulitis and what are the features?

Answer 13

‘Frozen shoulder’
Usually middle aged females
20% of diabetics may get this

External rotation is most affected. Active and passive movement affected.
Lasts between 6m and 2y.

Question 14

What is the commonest type of shoulder dislocation and how does this occur?

Answer 14

Glenohumeral: anterior shoulder dislocation

Abduction, extension then external rotation leads to dislocation
Bankart lesions on the labrum may lead to a high recurrence of dislocations

If the patient can touch their opposite shoulder then dislocation is ruled out

Question 15

What is a Hill-Sachs lesion?

Answer 15

Anterior dislocation: when the head of the humerus impacts on the anterior inferior edge of the glenoid, flattening part of the humeral head

Question 16

What is posterior dislocation of the shoulder associated with and what happens with it?

Answer 16

Seizures or electric shock
Lack of external rotation of the joint
The shoulder will be locked in internal rotation

Rim’s sign and light bulb sign will be seen

Question 17

What is the treatment of shoulder dislocation treatment?

Answer 17

Check neurovascular status pre treatment
Then do reduction
Do a X-Ray post reduction to ensure no fractures have occurred

Question 18

What happens in lateral epicondylitis?

Answer 18

Pain on wrist extension and in elbow

Also called tennis elbow