Shoulder

Question 1

What is another name for the shoulder, and what does it consist of?

Answer 1

The glenohumeral joint, it consists of a ball and socket joint that is formed by the humeral head and scapular glenoid.

Question 2

What forms the shoulder girdle?

Answer 2

Formed by the scapula, clavicle, proximal humerus and the supporting muscles including the deltoid and muscles of the rotator cuff.

Question 3

What are the 4 muscles of the rotator cuff?

Answer 3

Infraspinatus
Subscapularis
Supraspinatus
Teres minor

Question 4

What is the function of each of the rotator cuff muscles?

Answer 4

Supraspinatus - abduction of the arm.
Infraspinatus and teres minor - external rotation.
Subscapularis - internal rotation

Question 5

Where is the great and lesser tuberosity located?

Answer 5

Greater tuberosity is located lateral to the humeral head.
Lesser tuberosity is located located inferiorly and on the anterior part of the humerus.

Question 6

What shoulder pain problems are usually present in each age group?

Answer 6

Young - shoulder instability
Middle aged - rotator cuff tears and frozen shoulder (adhesive capsulitis)
Elderly - glenohumeral osteoarthritis predominates.

Question 7

What is impingement syndrome?

Answer 7

Where tendons of the rotator cuff (mainly the supraspinatus) are compressed in the tight subacromial space during movement resulting in pain.

Question 8

What test is used to confirm impingement syndrome?

Answer 8

patients will commonly present wiith painful arc at around 60-120 degrees of abduction. This is due to an inflamed area of the supraspinatus tendon passing through the subacromial space.

Question 9

What can impingement occur as a result of?

Answer 9

Subacromial bursitis, acromioclavicular OA with inferior osteophyte formation and hooked acromion rotator cuff tear.

Question 10

What test can be used to replicate impingement syndrome pain?

Answer 10

Pain from impingement usually radiates to the deltoid and upper arm. May be tender at the lateral edge of the acromion. Hawkins - kennedy test can recreate this pain.

Question 11

How are most cases of impingement syndrome managed?

Answer 11

Analgesics, NSAID’s, physiotherapy and subacromial steroid injections.

Question 12

Another name for adhesive capsulitis?

Answer 12

Frozen shoulder

Question 13

What is the main clinical sign of a frozen shoulder?

Answer 13

Loss of external rotation

Question 14

What are the 2 distinct types of shoulder instability?

Answer 14

Traumatic = patients can suffer a traumatic anterior dislocation which, after reduction, can settle and stabilise with rest and physiotherapy. In some individuals there is no stabilisation, leading to recurrent dislocations/subluxations, typically at minimal force.

Atraumatic = those with generalised ligamentous laxity (e.g., Ehlers danlos syndrome or Marfan’s syndrome) can occur from recurrent multidirectional subluxations/dislocations.

Question 15

What is more common, posterior or anterior shoulder dislocations?

Answer 15

Anterior shoulder dislocations are most common.

Question 16

Posterior shoulder dislocations are mostly caused by high energy blows during contact sports i.e. rugby. True/false

Answer 16

False. Anterior shoulder dislocations are usually caused by high impact sporting injuries.

Posterior shoulder dislocations are caused by tonic-clonic seizures or electrical shocks.

Question 17

What sign on x ray is associated with posterior shoulder dislocation?

Answer 17

Lightbulb sign

The humeral head looks like a lightbulb when viewed from anterior aspect of x ray.

Question 18

The supraspinatus muscle initiates shoulder abduction from 0-15 degrees and the deltoid muscle initiates shoulder abduction from 15-90 degrees. True/false?

Answer 18

True

Question 19

What muscle carries out shoulder abduction past 90 degrees?

Answer 19

Upper trapezius

Question 20

Damage to what nerve causes “scapula winging”?

Answer 20

Long thoracic nerve

Question 21

What 4 tests are used for impingement syndrome?

Answer 21

Hawkins kennedy test
Scarf test
Jobe’s test
For rotator cuff tear - test supraspinatus (abduction), subscapularis (internal rotation) and infraspinatus/teres minor (external rotation).

Question 22

What 3 tests are used for shoulder instability?

Answer 22

Sulcus sign (pulling down on shoulder - shows a dimple)
Anterior drawer test
Posterior drawer test