shoulder problems plus carpal and cubital tunnel

Question 1

how many joints in shoulder girdle and what are they

Answer 1

4
acromioclavicular 
glenohumeral 
sternoclavicular 
scapulothoracic

Question 2

muscles of the shoulder

Answer 2

rotator cuff muscles:

• supraspinatus
• infraspinatus
• subscapularis
• teres minor

Question 3

what ligament runs inside the glenoid process

Answer 3

capsular ligament

Question 4

where is the origin of the two heads of the biceps

Answer 4

short head- coracoid process

long head - glenoid tubercle

Question 5

what is a joint bursa

Answer 5

fluid filled sac or sac like cavity countering friction at a joint

Question 6

what is shoulder impingement

Answer 6

a syndrome not a diagnosis
very common
pain on movement
night pain unusual

Question 7

physical signs of shoulder impingement

Answer 7

painful arc 
hawkins sign 
other impingement tests 
no muscle wasting 
loss of range of movement

Question 8

what suggests a painful arc

Answer 8

pain on abduction from 50-120 degrees

crescendo arc - not impingement

Question 9

burial shoulder pain causes

Answer 9

……

Question 10

bigliani acromial grading

Answer 10

….

Question 11

calcific tendonitis

Answer 11

…..

Question 12

OS acromiale

Answer 12

…

Question 13

shoulder arthritis

Answer 13

no space left between ball and cup of joint

Question 14

treatment for shoulder arthritis

Answer 14

conservative (NSAIDS, physio)

operative - high risk

Question 15

causes of shoulder instability

Answer 15

traumatic - 
bankhart
hill Sachs 
rotator cuff tear 
fracture of glenoid 
atraumatic

Question 16

what is a hill Sachs lesion

Answer 16

fracture of the humeral head causing shoulder instability

Question 17

cause of hill sacs lesions

Answer 17

trauma

Question 18

what is a bankart lesion

Answer 18

a labral lesion

most important injury associated with shoulder instability

Question 19

cause of bankart lesion

Answer 19

trauma

Question 20

features of atraumatic shoulder instability

Answer 20

A- atraumatic 
M-multidirectional 
B -bilateral 
R -rehabilitation 
I -inferior capsular shift

Question 21

what is MDSI

Answer 21

abnormal soft tissue
often started by minor trauma
sulcus sign
beightons score

Question 22

what is carpal tunnel syndrome

Answer 22

parathesiae in median nerve distribution
night time disturbance
compression of median nerve at carpal tunnel

Question 23

how to treat carpal tunnel

Answer 23

night splints
surgery
injection??

Question 24

investigation for carpal tunnel

Answer 24

nerve conduction studies

Question 25

what is cubital tunnel syndrome

Answer 25

parasthesiae in ulnar nerve distribution
compression around elbow
three sites:
-cubital tunnel
-FCU tendon heads
-intermuscular fibrous bands just above elbow

Question 26

treatment for cubital tunnel

Answer 26

surgical release

anterior transposition?

Question 27

four main shoulder problems

Answer 27

instability 
cuff decrease 
-impingement 
-cuff tear 
frozen shoulder 
arthritis

Question 28

who gets frozen shoulders

Answer 28

instability - 20-30 (young sporty people, usually traumatic)

Question 29

how many muscles attach to the scapula

Answer 29

17

Question 30

what causes a frozen shoulder

Answer 30

thickening of the coracohumeral ligament

Question 31

4 important extrinsic muscles of the shoulder

Answer 31

deltoid
trapezium
pectorals major
latissimus dorsi

Question 32

what are the intrinsic muscles of the shoulder

Answer 32

rotator cuff muscles

• supraspiatus
• infraspinatus
• teres minor
• subscapularis

Question 33

where does the shoulder most commonly dislocate

Answer 33

anteriorly

Question 34

what indicates whether a dislocation is anterior or posterior

Answer 34

subtle dislocation = posterior

gross dislocation = anterior

Question 35

likely cause of a posterior dislocation

Answer 35

epileptic fit
alcohol
electrocution

Question 36

first step in treating an anterior shoulder dislocation due to trauma

Answer 36

analgesia

reduce joint

Question 37

questions to ask in shoulder dislocation

Answer 37

mechanism of injury
ease of dislocation
has it happened before

Question 38

what is seen on examination of shoulder insability

Answer 38

abnormal shoulder contour 
muscle wasting 
tenderness
spasm 
good range of movement 
scapular winging/dyskinesia

Question 39

2 conditions associated with hyperlaxity

Answer 39

marfans

ehlers dans syndrome

Question 40

how do you reduce a dislocated shoulder

Answer 40

kocher method
can give IV analgesia, O2 or IV sedation

hippocratic method (for large muscle people)

Stimson method (for multiple dislocations)

Question 41

what are some post reduction treatments

Answer 41

3 weeks sling for pain relief
analgesia
gradual early mobilisation
physiotherapy

Question 42

shoulder dislocation investigations

Answer 42

imagine 
MRI angiogram (if multiple dislocation)

Question 43

surgical treatment for dislocations

Answer 43

arthroscopic/open stabilisation

Question 44

what is rehab for shoulder instability

Answer 44

6 weeks sling 
8-10 weeks no driving 
12 weeks no heavy lifting 
no contact sports for 12 weeks 
training and no-contact sports after 6 weeks

Question 45

where does pain originate from in impingement syndrome

Answer 45

pain originating from the sub acromial space

Question 46

what is intrinsic impingement syndrome

Answer 46

tendon vascularity
watershed area
tendon degeneration
cuff dysfunction

Question 47

what is extrinsic impingement syndrome

Answer 47

external pressure due to:

• type of acromion
• coraco acromial ligament
• clavicular spur/osteophyte

Question 48

x ray signs of shoulder impingement

Answer 48

calcification (fluffy dots) in muscles

sclerosis on underside of acromion

Question 49

treatment for shoulder impingement

Answer 49

rest 
pain relief 
physio 
steroid injections in subacromial space 
surgery - last resort

Question 50

what is surgical treatment for shoulder impingement

Answer 50

arthroscopic/subacromial decompression