The Shoulder

Question 1

What is impingement?

Answer 1

A syndrome where the tendons of the rotator cuff (predominately supraspinatus) are compressed in the tight subacromial space during movement producing pain

Question 2

What is the typical sign of impingement?

Answer 2

A painful arc between 60-120 degrees of abduction

Question 3

What are the causes of impingement?

Answer 3

Tendonitis
Subacromial bursitis
Acromioclavicular OA with inferior ostephyte
A hooked acromion
Rotator cuff tear

Question 4

Where may the pain of impingement radiate to?

Answer 4

The deltoid and upper arm

Question 5

Where is tenderness felt in the shoulder joint in impingement

Answer 5

Lateral edge of the acromion

Question 6

What is test will recreate the patient pain?

Answer 6

Hawkins test - internally rotating the flexed shoulder

Question 7

What is the treatment of impingement

Answer 7

NSAIDS
analgesia
Physio
Subacromial steroid injection (up to 3) 
May need subacromial decompression surgery - if does not respond to conservative management

Question 8

Which muscle is usually involved in a rotator cuff tear?

Answer 8

Supraspinatous

Question 9

What is a sign of a supraspinatous tear

Answer 9

Weakness in initiaton of abduction

Question 10

What is a sign of a subscapularis tear

Answer 10

weakness of internal rotation

Question 11

What is a sign on infra spinatous

Answer 11

weakness of external rotation

Question 12

What is the usual cause of rotator cuff tears in oldr people

Answer 12

tendon degeneration

Question 13

What is a frozen shoulder

Answer 13

adhesive capsulitis - progressive pain and stiffness in shoulder in patients around ages 40-60, resolving around 18-24 months

Question 14

What is the characteristic picture of a roxen shoulder

Answer 14

pain which subsides followed by stiffness which gradually thaws out over time

Question 15

What is the principle clinical sing of a frozen shoulder

Answer 15

loss in external rotation

Question 16

Who is particularly prone to a frozen shoulder

Answer 16

diabetes
hypercholesterolaemia
dupuytrens disease

Question 17

What happens to the joint in a frozen shoulder

Answer 17

the capsule and glenohumeral ligaments become inflamed then thicken and contract

Question 18

What is shoulder instability

Answer 18

painful adnormal translational movement or subluxation and or recurrent dislocation

Question 19

What are the two types of instability

Answer 19

traumatic

atraumatic

Question 20

What usually results in a traumatic instability

Answer 20

previous anterior dislocation of the shoulder joint can result in an unstable shoulder

Question 21

What determines how likely someone is to get a traumatic instability

Answer 21

age- the younger the first dislocation occurred the more likely the patient is to develop instability - particualry if under 20

Question 22

What surgical procedure can be used to repair a traumatic unstable shoulder

Answer 22

Bankart - labrum and capsule are reattached

Question 23

When does an atraumatic instability usually occur

Answer 23

Ligamentous laxity (idiopathic, Ehlers- Danlos, Marfan’s)

Question 24

What is an acute calcific tendonitis

Answer 24

calcium deposits in the supraspinatous tendon results in acute onset of severe shoulder pain

Question 25

Where on an xray are the calcium depostits in calcific tendonitis seen

Answer 25

just proximal to the greater tuberosity

Question 26

What is the treatment of calcific tendonitis

Answer 26

Subacromial steroid and local anaesthetic

Question 27

What can cause anterior shoulder pain and pain on resister biceps contraction

Answer 27

biceps tendonitis

Question 28

What relieves a biceps tendonitis

Answer 28

surgical division of the tendon

Question 29

What is a popeye deformity

Answer 29

bunched up biceps as a result of a ruptured biceps tendon

Question 30

describe how rotator cuff tears are managed

Answer 30

remains controversial surgery - repair open or arthrocopic with subacrommial decompression - tendon is usually diseased and so failure rate is 1/3 non operative - phsyio to strengthen remaining muslces to compensate, subacromial injections

Question 31

how is frozen shoulder managed

Answer 31

typically resolves over about 18-24 months treatment aims to relieve symptoms in the meantime - analgesia and physio, intra articular joint injections (glenohumeral rather than subacromial) manipulations under anaesthetic or surgical capsular release in severe cases with significant functional losses

Question 32

what is acute calcific tendonitits

Answer 32

acute onset shoulder pain due to calcium deposition in supraspinatour tendon which can be seen on xray

Question 33

treatment of acute caclific tendonitis

Answer 33

subacromial steroid injection and local anaesthetic injections self limiting

Question 34

what are the two types of shoulder instability

Answer 34

traumatic | atraumatic

Question 35

what predicts likelyhood of redislocation of the shoulder

Answer 35

age at first dislocation - younger more likely to redislocate

Question 36

causes of atraumatic shoulder dislocation

Answer 36

idiopathic marfans ehlers danlos

Question 37

treatment of traumatic shoulder instability

Answer 37

generally conservative bankart repair (open or arthroscopic) can stabilise by reattaching labrum and capsule to the anterior glenoid

Question 38

what is a SLAP tear

Answer 38

anterior glenoid labrum tear where the biceps tendon attaches "superior labrum anterior and posterior"

Question 39

diagnosis of a SLAP tear

Answer 39

MRI arthrogram

Question 40

treatment of a slap tear

Answer 40

biceps tenotomy | or labral resection