T&O: Shoulder and rotator cuff

Question 2

What does Neer’s test assess?

Answer 2

Shoulder impingement

Question 3

A patient comes in with tendonitis of the rotator cuff muscles. You are worried about shoulder impingement. What test could you do?

Answer 3

Neer’s test

Question 4

Describe a positive Neer’s test

Answer 4

Hand is positioned in the empty can position. Arm is passively raised into full flexion. When arm is raised = subacromial space narrows = impinge tendon and cause pain.

Question 5

Name the rotator cuff muscles and identify their function

Answer 5

Suprspinatus- abduction
Infraspinatus- external rotation
Teres minor- external rotation
Subscapularis- internal rotation

Question 6

Where is the attachment of rotator cuff muscles?

Answer 6

Greater tuberosityof the humerus- Suprspinatus, Infraspinatus and Teres minor
Lesser tuberosity of the humerus- Subscapularis

Question 7

What is the mechanism of injury for anterior shoulder dislocation

Answer 7

FOOSH, playing sport, trauma, ?recurrent trauma

Question 8

How would the patient look on examination with an anteriorly dislocated shoulder?

Answer 8

Shoulder is tender, loss of roundness of the deltoid, held externally rotated , swelling

Question 9

What are you worried about in an anterior shoulder dislocation?

Answer 9

Rotator cuff injuries, associated fractures, potential nerve injuries

Question 10

What views of an X-ray would you request for an anterior shoulder dislocation and what would you see?

Answer 10

AP and Y Lateral, you would see the head towards the corocoid process in a Y lateral view

Question 11

What is a Bankart lesion?

Answer 11

• When the labrum is pulled from the glenoid (injury to anterior part of the glenoid labrum).
• This needs urgent repair as it makes the shoulder unstable

Question 12

How do you manage an anterior shoulder dislocation?

Answer 12

• If NO ASSOCIATED FRACTURE- reduce it in ED- traction and counter traction.
• Immobilise in sling- 2 weeks in elderly as stiffness is an issue, longer in young people.
• Physio
• Follow up and assess for any rotator cuff injuries

Question 13

What is the mechanism of injury for a posterior shoulder dislocation?

Answer 13

Electrocution or epileptic seizure

Question 14

Why and what do we need to be aware of with posterior shoulder dislocations?

Answer 14

EASILY MISSED! The arm will be held in an internally rotated position, therefore we need to ask them to externally rotate

Question 15

How would you investigate a posterior shoulder dislocation? What would you find?

Answer 15

XRAY- AP- light bulb sign
Y lateral- head of humerus towards the acromion

Question 16

How do you manage posterior shoulder dislocation?

Answer 16

Surgical reduction, potentially a humeral head replacement or partial replacement

Question 17

How would a patient with an inferior shoulder dislocation present?

Answer 17

Arm abducted with hand running down

Question 18

What is frozen shoulder?

Answer 18

Stiff painful shoulder due to adhesive capsulitis

QM: Frozen shoulder, clinically known as adhesive capsulitis, is a condition characterized by a painful and stiff shoulder, which results in a limited range of motion.

Question 19

How does the pain from frozen shoulder present?

Answer 19

• Gradual onset pain and stiffness of the shoulder with reduced movement, most notably external rotation.
• Pain worsens initially and persists for weeks- months

Question 20

How is frozen shoulder managed?

Answer 20

Analgesia(NSAIDS), Physiotherapy and exercise and local intraarticular steroid injection

Question 21

What does an xray of a frozen shoulder look like?

Answer 21

Normal

Question 22

What muscle is tested by the empty can test?

Answer 22

Supraspinatus

Question 23

How do you test for subscapularis function?

Answer 23

Gebers lift off test

Question 24

Pt had a FOOSH or fell laterally on an adducted arm gets a mid humeral shaft fracture where might she get reduced sensation and weakness and why?

Answer 24

If the radial nerve is involved, complain of reduced sensation over the dorsal 1st webspace and weakness in wrist extension.